Fat-zapping wand that vaporizes the pain of dodgy knees
It was recently reported that six out of ten women over 50 have knee pain — either with exercise or just climbing stairs. But it also affects younger people of both sexes.
Simon Evans, 21, a biology student, from Epping in Essex, had a new procedure to relieve the pain.
Tennis has always been my passion. A few years ago, I was playing full-time and hoping to go professional, but I started getting pain in my knees.
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Keyhole surgery: Simon Evans, who almost became a professional tennis player, after an operation for his knee pain
In my case, it was caused by exercise, but he said anyone can get it if they use their knees a lot — even climbing up many stairs or walking uphill.
He recommended putting ice on my knees, which helped, and I also did lots of stretches and took pain-killers, but nothing stopped the pain completely.
In fact, it was getting worse. The physiotherapist suggested I stop playing tennis completely for a while, which I found incredibly frustrating.
When I started playing again more gently, the pain came back. After just ten minutes, my knees would swell and turn red.
In June 2009, my mother did some research on the internet and came across John Hardy, a knee specialist and surgeon. I went to see him, and when he found the tender spot under each kneecap, the pain was so bad I nearly jumped out of my chair.
An MRI scan confirmed I had patellar
tendinopathy. Mr Hardy said this is when the pad of fat under the knee
swells and damages the tendon below the kneecap.
Since I’ve had operations for sporting injuries before and wanted to avoid surgery, I had lithotripsy — shockwaves are applied to stimulate the tendon to heal.
It helped, but it still hurt whenever I bent my knees, climbed stairs or drove.
Then Mr Hardy told me he could operate to remove the swollen area of the fat pad, so it wouldn’t press on the tendon and damage it. Even better, he said he could do it as keyhole surgery, which would mean less scarring and a faster recovery time.
I had the operation in October 2009. Immediately afterwards, I noticed that all the stiffness was gone.
When I saw Mr Hardy an hour later, he asked if I could bend my leg right up so my heel touched my bottom. Amazingly, I could — something that had been too painful before.
I went home the following day with painkillers and lots of physiotherapy exercises.
Within six to eight weeks I was back on the tennis court without any pain — it’s great.
John Hardy is an orthopaedic surgeon at the Bupa Cromwell Hospital in London. He says:
Back in action: Simon had the operation in October 2009. Immediately afterwards he noticed that all the stiffness was gone
Around 65 per cent of people who do regular exercise have patellar tendinopathy, so the condition is common.
This front-of-knee pain can also affect people who live in houses with lots of stairs, or even people who regularly walk up steep hills.
We think the problem starts because over-use of the knee can cause swelling in the Hoffa’s fat pad, which lies directly below the kneecap.
When this swells, it can press on and disrupt the fibres of the patellar tendon, which links the kneecap to the shinbone.
This tendon is part of the mechanism of straightening the knee or pushing off when we run, jump or climb stairs.
The swelling in the fat pad and the disruption of the tendon fibres cause pain.
Abnormal blood vessels also start to grow into the nerve tissue, which cause the area to become hypersensitive.
It usually starts gradually, with pain after exercise that can rapidly become pain during exercise or even while climbing the stairs.
There are simple methods for treating the condition, including losing weight to take pressure off the tendon. We can also offer physiotherapy exercises, and taping or a brace for the knee to reduce pressure on the tendon and alleviate symptoms, allowing the swelling to go down.
Or we can try lithotripsy, which sends shockwaves directly to the affected tissue. This reduces the nerve sensations in the knee and also seems to stimulate healing.
But in 10 per cent of patients none of these works and they require surgery.
Conventionally, this has involved diathermy — using an electrical current to burn away the damaged section of tendon and the swollen parts of the Hoffa’s pad.
The problem is you can’t control the current very well, meaning huge collateral damage to surrounding healthy tissue.
As a result, only 63 per cent of patients are cured. There is also a risk of bleeding and swelling in the knee, meaning even successful patients had to use crutches.
I use the latest radio- frequency technology to treat just the Hoffa’s pad. If you can treat this, there’s no need to touch the tendon because it will heal on its own.
The ArthroCare ambient wand, which is the size of a thin pen, was developed and launched in Texas last year, and is available at a few centres on the NHS as well as privately.
It works at much lower temperatures to vaporise the swollen upper section of the Hoffa’s fat pad, which is causing the tendon damage.
The lower temperatures and the fact the wand penetrates much less deeply into the tissues means it’s more controlled and accurate, and therefore there is less risk of causing damage to the patellar tendon.
'Within six to eight weeks I was back on the tennis court without any pain — it’s great'
It also seals off the abnormal blood vessels so they shrink, meaning there is little or no bleeding and swelling in the knee and the patient does not need to use crutches.
This new method has an 86 per cent chance of getting rid of symptoms within three months.
Performing the operation takes around 20 minutes, using a local anaesthetic and a mild sedative anaesthetic, so the patient sleeps through the procedure and wakes refreshed and without pain.
I make two incisions of less than 1cm on either side of the patellar tendon, using MRI scans to guide me to the damaged tissue in the fat pad.
I then put an arthroscope, or small telescope with a video camera, into one incision, and use the other for the fine surgical instruments.
The video camera sends back images to wide screens in the theatre, so I can identify the abnormal tissue.
I have to remove a reasonable amount of tissue, so to start with I take some away with a very small shaver.
Then I use the wand to send intense radiowaves to remove the final bits without damaging the tendon, and then seal off the abnormal blood vessels.
I close the small incisions with a paper butterfly dressing, and the knee is bandaged. After the patient is woken, they start rehabilitation exercises immediately to keep the knee mobile while the wound is healing.
The operation carries the usual small risks of infection (0.06 per cent) and thrombosis — I tell my patients to remove their bandages fairly soon after surgery to reduce the risk.
The patient rarely needs anything more than paracetamol for the first few days.
This new wand has made such a vast difference to patient outcomes, and could help many more.
The operation costs 3,500 for each knee privately, and 2,500 to the NHS.