Archives: Testimonials

Sharon Nicholson

I had a meniscal transplant operation last May by Mr Ian McDermott and I cannot thank Mr McDermott enough.

Many years ago I had my cartilage removed in my left knee and over the years with bone on bone rubbing against each other it left me in pain with restrictive movement so I had had micro fracturing which had been successful for four years. However with the life expectancy of this operation up I endured many months of not being able to sleep due to the constant pain in my knee which was not relieved by pain killers. My cycling had to stop and I had even got to the stage of only being able to walk very short distances (less than half a mile) before I would have to sit down in agony.

Sharon’s medial compartment of her knee, with a completely missing (previously excised elsewhere) medial meniscus, and with progressive articular cartilage damage developing (early degeneration / arthritis)

After a consultation with Mr McDermott I was offered a meniscal transplant operation. I had the operation at London Bridge hospital where everything went to plan, the only issue being I live in the Isle of Man and with not being able to fly for three months it meant a car journey up to Liverpool followed by a boat journey. The initial recovery was to protect the transplant for 6 weeks and give it chance to take so I was in a knee brace to keep the leg in a straight position with non to minimal weight bearing. After two weeks I had to go back to London for a check-up and have the stitches removed and everything was looking good.

Once the six weeks were up I was able to discard the knee brace and start physio. The initial targets were to get the bend back in my knee and start to put my weight through my leg. As well as regular physio to help get the bend back I also used a static exercise bike, initially only being able to complete a partial revolution to help with this. Gradually over the following six months I was able to increase the intensity of the exercise and I noticed a significant improvement after Christmas. I was able to start to get back out on both my mountain and road bikes and walking both great passions of mine. These activities are something that I had not been able to do for over 18 months and I must admit it has made me really appreciate the simple things in life.

The excruciating pain in my knee has now gone and the only pain I get is a stinging sensation from time to time which does not cause me any issues.

Sharon’s medial compartment at the end of the meniscal transplantation procedure, with a new medial meniscus inserted in the knee.

I would thoroughly recommend this operation to anyone and the best advice I could give is be patient. I was told the recovery was a good nine months and this was the case but I have gone from not being able to sleep due to constant pain to being virtually pain free and able to walk on a daily basis along with cycling three times a week, something I would never have been able to do 18 months ago.

Louise Ayling

Having had an ACL reconstruction on my left knee 9 years ago, I encountered further problems when my knee began to give way, causing damage to my meniscus. My ACL graft had stretched and was no longer functioning. Consequently, during a physio session, my knee gave way causing a bucket handle tear in my meniscus, resulting in surgery to remove it.

I understood I had three options:

  1. Do nothing and risk early onset arthritis, further wear to my joints as a result of the lack of meniscus, and continuous instability due to my lack of functioning ACL;
  2. ACL reconstruction using a donor tendon;
  3. ACL reconstruction and meniscus allograft from a donor.

The latter option with the meniscus allograft was a daunting prospect. Ian McDermott was recommended to me by another orthopaedic surgeon.

I visited Ian to discuss my options, the different procedures and likely future outcomes. Ian is incredibly knowledgeable, and his understanding of emerging medical practices was evident. What struck me the most was how far medicine has evolved since my first ACL reconstruction in 2006.

Ian’s explanation of the procedure involved with the meniscal allograft and the subsequent restrictions on my sporting lifestyle were detailed yet straight-talking. I was left under no illusion that the meniscal allograft would be a painful process, with a long recovery period and I would need to be absolutely serious about my physio following the operation. Most concerning for me was the ban on sport, particularly as I sail competitively most weekends. Another major concern was the length of the immediate recovery period, with no or very little weight bearing, and a requirement to have my leg elevated most of the time.

Ian was happy to answer any of my questions, and he took the time to explain every aspect of the procedure, using language I could understand. His diagrams were especially useful, to help me to ecognize the process.

After some serious deliberation, debates, indecision (and some differences of opinion!) with family, I chose to proceed with the ACL reconstruction and meniscal allograft, undertaken in a single operation. My decision was based largely on the likelihood of further damage to my joints if I did not proceed.

The operation went well and the procedure and recovery were far better than I had expected. Ian had prepared me for the worst, but the pain levels were manageable throughout; the nerve block and morphine masked a lot of the initial pain. I felt very nauseous following the operation, but this soon subsided and I stayed in hospital for two nights, which felt reassuring given the extent of the surgery. Once out of hospital, I was on tramadol for a while, which made me feel pretty awful, so I ditched that as quickly as possible.

The recovery, although tedious and restrictive, was bearable, and was easier than I had anticipated. The range of motion in my knee brace was adjusted by Ian every time I saw him, to ensure that my new meniscus had time to heal. Netflix certainly helped the boredom during the initial couple of months, and I had a Game Ready ice machine which assisted in the reduction of any swelling.

Ian recommended a fantastic physio, who I trust implicitly, and with both of their continued support, I have made significant progress. My physio even watched the surgery, so that she fully understood the procedure. This was important to me, given the small number of meniscal allografts undertaken in this country to date.

Now, one year on, I am swimming front crawl, going to the gym 2-3 times a week and I’ve even just been walking in the mountains in Scotland. I hope to get back into pilates within the next month, too. I miss the sailing, skiing, surfing and other adventurous sports, but I had come to the ecognize n that I wouldn’t be able to participate in them anyway, given the state of my knee.

I ecognize there’s still a long way to go to build up my strength, and my knee will never be ‘better’ but I am very glad I’ve had the surgery and can carry out my day-to-day life without the constant instability in my knee that I had before.

I would highly recommend Ian to anybody contemplating knee surgery. His professionalism, attention to detail and knowledge (and experience) of current medical research gave me the confidence to go ahead.

Louise Ayling August 2015

Sarah Conway

While I was living in London to pursue a Master’s degree at the London School of Economics & Political Science, I found Ian at the 31 Old Broad Street practice. My knee had been bothering me quite a bit in the weeks prior and I was feeling increasingly concerned about its state. Over the two and a half year period before moving to London I had undergone five knee operations in Singapore: two medial meniscus repairs, two partial meniscectomies, and one ACL reconstruction. The initial injury was caused during a minor motorbike accident in Bali where I resided at the time. The subsequent injuries were all somewhat random, minor, unlucky incidents. I was fairly convinced that I had a strange affinity for medial meniscus problems, especially since I’d had three medial meniscus operations on my other knee when I was younger (due to football injuries).

Upon arrival at 31 Old Broad Street I felt at ease: the receptionists were friendly and warm, and I was immediately brought back to Ian’s office. During our initial visit I explained my somewhat long and complicated history while Ian listened and took copious notes. After examining the knee he decided that the next step would be to have an MRI to gain further clarity on the state of my knee. I scheduled the MRI for a few days later and returned to see Ian later that same day. The MRI confirmed Ian’s suspicion that I no longer had any functional medial meniscus left. Upon hearing this I assumed he would immediately recommend a meniscal allograft transplantation. His approach, however, was much more grounded in educating me on meniscal allograft transplantations than on convincing me as to why I needed one. While I exhibited the characteristics of a “good candidate,” he was very clear that the decision to pursue the path had to come from me: due to the long recovery time and physiotherapy commitment required it is not a decision to take lightly. He was also very balanced in his review of the advantages and limitations of the operation: certainly having a meniscus is better than not having one at all, but the cadaver meniscus would never be as strong as my original had been, and I would have to accept and acknowledge this as I engaged in physical activity moving forward. I found his approach, driven by thoughtful and clear education, refreshing. Ultimately I decided that I could commit to the lengthy recovery process in hopes that my knee pain would decline and that I would avoid future arthritis.

Ian and his team worked diligently to coordinate with the tissue bank in the U.S., my insurance company, and the London Bridge Hospital. It was impossible to predict with certainty as to when a tissue match would be secured, but Ian and his team kept me informed and as soon as a tissue was found they confirmed the operation day and time.

When I arrived at the hospital and checked in, Ian visited my room to go over the specifics of the procedure one more time. Again I sincerely appreciated that he took the time to thoughtfully explain everything and answer questions. The anesthesiologist also came by to review the procedure and post-op pain management regimen. Before I knew it the operation was over and I was back in my hospital room with a knee brace on. Everything had gone well and I was now able to relax, watch movies, and surf the internet while recovering at the hospital overnight.

Once back at my flat I spent the first week resting and recuperating. The swelling and pain levels were helped by my frequent use of the Game Ready machine, yet another one of Ian’s fabulous recommendations.

Walking with crutches (non-weight-bearing) for six weeks was certainly not easy, but I managed to get around London just fine. I saw Ian two weeks post-op and he was very pleased with my low level of swelling (thanks, Game Ready!) and minimal muscle atrophy. At the six week follow-up he adjusted my knee brace to allow for further range-of-motion and recommended a timeline for increasing weight- bearing and reducing my use of crutches. He also put me in touch with a nearby physiotherapist. The physiotherapist, Robert Kavanagh, was absolutely superb and I worked with him 2-3 times per week for several months. The combination of Rob’s encouragement and advice, coupled with Ian’s ongoing support via email were great and exactly what I needed to ensure a slow but steady and successful recovery. It wasn’t always easy: getting the range of motion back and beginning to build up muscle mass in my leg was difficult and at times quite

painful. But I listed to Rob and Ian and wholeheartedly trusted them to provide sound advice and care. I also did my best to be patient and to accept that seeing results takes time. At Ian’s suggestion, I rented a Kneehab XP to assist in my quadriceps strengthening, and I found it to be a good complement to my ongoing physiotherapy exercises. At my three-month post-op appointment, Ian was complementary of my impressive progress. I continued with physiotherapy though completed most of it on my own. By the five-month point I was walking and hiking with minimal to no pain.

Hiking in Greece 5 months after the operation.

The months that followed were reasonably smooth and now, exactly one-year post-op, my knee feels really solid. It still flares up now and again but generally feels much better than it did before the operation. I cannot thank Ian and Rob enough for their thoughtful support and care.

I highly recommend Ian if you are considering a meniscal allograft transplantation. He was extremely measured during our discussions about my options before the operation, did a fantastic job during the operation, and has remained available and responsive via email since then. If you decide to pursue this path, I encourage you to rent a Game Ready for the first month post-op, to find a physiotherapist that will be supportive but that you trust to push you slightly out of your comfort zone, and to just be patient. It may be frustrating at times, but with a good attitude and diligent commitment to physiotherapy, it is well worth the effort!

Sarah Conway April 2013

Leo Camish

I am a 15-year-old student at Hurstpierpoint College, Sussex, where I play a term of Rugby, a term of Hockey and a term of Cricket. I also represent Sussex at Cricket, where I have played for the last 3 years as a wicket keeper / batsman.

I developed a pain in my right knee early in January 2012 as our Hockey term started, and this became progressively worse each game I played. In early February, I stopped playing Hockey and sought advice from Mr McDermott and his colleagues, in London Sports Orthopaedics. I had an MRI scan at a local facility a few miles from my home near Sevenoaks followed by consultations in Northwood.

I ended up having arthoscopic surgery on 4th April 2012, to remove a medial plica and to tidy up some articular cartilage damage on the back of my kneecap. Having had a general anaesthetic, I was able to see the full procedure on the DVD that Mr McDermott recorded for me, and could see the cause of my original pain: rough areas of damaged cartilage that was beginning to come away from the joint surface. These were trimmed and made smooth again with a tiny probe.

Leo had a medial plica in his knee, which was trimmed, but his main problem was quite nasty partial thickness damage to the articular cartilage on the back of his kneecap. This was smoothed off and stabilised by radiofrequency chondroplasty. This relies on a tiny probe made by Arthrocare, where an electric current at the tip of the probe creates a sodium plasma field from the sodium ions in the salt water that is pumped through the knee during the arthroscopy. This plasma melts the rough, unstable, damaged surface of the articular cartilage, smoothing it off and stabilising it but without causing any thermal damage to the underlying tissue layers and the cells in the cartilage beneath. Radiofrequency chondroplasty using low-temperature ‘coblation’ probes from Arthrocare has been shown to stabilise damaged articular cartilage – reducing pain, increasing function and protecting the joint surface. It has been shown to be significantly superior to other arthroscopic techniques for treating partial thickness cartilage damage, such as ‘abrasion chondroplasty’ with shavers. Sadly (perhaps criminally!), only a minority of knee surgeons actually seem to be using this new technology on any kind of regular basis – some of those not using it have given excuses such as ‘it slows me down’! and some simply don’t know of or don’t understand the relevant research. For me, if a radiofrequency probe were not available in theatre, then I would simply cancel the case and reschedule it rather than going ahead and knowingly do a second-class job! (Thankfully, I only work in excellent hospitals, where this has never had to be the case!)

I was worried that the injury would badly disrupt the most important part of the year for me as a cricketer… the summer season, which starts at the end of April.  I ended up missing just 1 game and was back playing for Sussex U15 by mid-May, only 44 days after my surgery.  After a very wet June, I have played a lot of cricket and have not felt any pain at all. I will also be representing Sussex Academy on their three-week tour to Cape Town this December … a trip that would not have been possible six months ago. I am really happy to have had the surgery and recovered quickly.  I must thank Mr McDermott for his care and skill to get me back on my feet playing the sport that I love!

Leo Cammish

Nicholas Dodds

Knees are funny things – most people know a little bit about cartilage, some a bit more about ligaments but what about a plica?

When I first developed pain along the inside of my left knee, there was no obvious cause – other than cycling quite a bit. A succession of GPs and physiotherapists suggested a variety of diagnoses. The only way to stop the pain from recurring was not to exercise – not a satisfactory solution! Given the persistent nature of the pain and having followed the usual advice, I feared my painful knee was here for good.

One day on my commute I was knocked off my bicycle, hurting both knees. The accident presented me with an opportunity and I was referred to Mr McDermott. The results of an MRI scan showed there was nothing structurally wrong with my knees, which was good news. However, I was told that MRI scans don’t show everything, and after carefully discussing my options I chose surgery to find out once and for all if there was something that could be done with my left knee.

Surgery confirmed that the knee was in a good state, but with one rather notable exception; I had a large (medial) plica inside the joint. It was explained that this is basically a remnant of foetal tissue, like a shelf sticking out from the lining of the knee. The plica had been rubbing inside my knee, becoming inflamed and painful – I had been suffering from ‘plica syndrome’.

The plica was removed through keyhole surgery (a knee arthroscopy), as a simple small day case procedure. Thankfully, the surgery resolved the source of my pain.

Nick cycling the Etape du Tour 2010 after his knee surgery -- 110 miles with some truly epic climbs in the Pyrenees, in 10 hours.

Nick cycling the Etape du Tour 2010 after his knee surgery — 110 miles with some truly epic climbs in the Pyrenees, in 10 hours.

I think of a plica as an ‘appendix of the knee’ – it has no use, it shouldn’t really be there and if persistent pain develops then it can be removed surgically. For me at least, this proved to be the best option. It’s unfortunate that sometimes it takes an operation to confirm the presence of a plica – few GPs or physiotherapists would suggest it; you are more likely to be told (not necessarily incorrectly I might add) that your knee pain is a result of some other cause.

Surgery completely resolved my knee pain, and once I had recovered from the operation I was able to enjoy pain-free cycling again, even riding stages of the Tour de France!

Laura Procter

Late May 2008 I managed to damage my knee whilst climbing. It was felt odd at the time. It felt like I had only twisted it but it was very painful to walk on and I could not straighten my leg. The swelling came up the next day when I went to visit the Doctor who said I had just pulled something and it would go down. Sure enough it went down but it was never really recovered, always slightly swollen and I couldn’t straighten it so I had a slight limp. Being a very active person this was very frustrating not to mention the fact that all my jobs require being physically fit. I kept going back to the doctors who said it was nothing to worry about. Eventually I went to see a physio who said she thought it was something more serious. My dad recommended a doctor he knew through work who specializes in knees which is when I first went to see Mr Ian McDermott.

I went in sat down and explained what happened, he examined my right leg and declared it was a medial meniscal tear, could be a bucket handle tear. For me this was fantastic; having spent the last two months hobbling around with people telling me it would be fine and get better to have someone look at it and quickly diagnose the problem felt such a relief. He explained what this meant and the options which were fairly simple and what to do next. Ian must have spent 20 mins drawing diagrams (which I still have) and going though possible outcomes, which meant I really understood what had happened and how it could be treated. He sent me off for an MRI and once the results were back I was straight into surgery a couple of days later. So from meeting Ian to operation was under two weeks!

Laura Procter

The operation was more successful than I could have imagined. It turned out Ian didn’t need to cut anything out, and instead he was able to repair the meniscal tear, to try and get it to heal back together – a far better long term outcome for me with a much less chance of developing arthritis early. But that was the first step. I had 6 weeks non weight bearing on that leg before I could start using it in gentle exercise and then a further six weeks of intensive physiotherapy to regain all strength, movement and reflexes. At the end of the six weeks I was cycling, walking, climbing and ready for a winter of snowboarding in the French alps. My meniscal tear has healed up and my knee recovered so well that I was able to follow out my plan and dream to do a ski season. I skied almost every day as well as leading groups of guests out on the mountain.

Laura Procter

Laura happily back snowboarding after her meniscal repair