Transplant law enables ligament surgery

 

Most people who suffer an athletic injury might think twice before returning to their favourite sport. But the first thing Phillip Mitchell wanted to know after he tore his posterior cruciate ligament playing football was when he could get back on the field. 

“I was just nervous about the time that I’d have to wait to start back playing sports because I love sports,” he said. 

The 17 year old was among the first people in the Cayman Islands to receive a human tissue transplant made possible by the passage of the Human Tissue and Transplant Law when he underwent posterior cruciate ligament reconstruction surgery on 15 August. 

This is the first PCL reconstruction surgery using donated tissue performed in the Cayman Islands.  

He suffered the injury when he prevented a shot on goal by the opposing offense. 

“I stepped across and kicked the ball but [the winger] was going to take a shot, kicked late and ended up kicking my leg,” he said. 

Dr. Franklin Tran, a surgeon at Scarborough Hospital in Canada and consultant with Cayman Orthopaedic Group, performed the surgery. 

“It’s a complex surgery but it went very well,” Dr. Tran said, explaining that PCL injuries are less common and more difficult to repair than anterior cruciate ligament injuries. 

“It [the PCL] runs in the back of the knee right in front of where the major nerve and artery in the leg runs,” Dr. Tran explained. “You have to be very, very careful when you’re dissecting out this area … because if you don’t know what you’re doing, you can run into some very big complications.” 

While ACL injuries are typically repaired using tissue harvested from the patient, the complexity and intensity of PCL repairs often necessitate the use of donated tissue, known as an allograft. 

“When you take a patient’s own graft, you have harvest site morbidity and you add to the surgery time,” Dr. Tran said. “So, because PCL surgeries usually take longer, we try to minimize the amount of time we operate so we usually use a donated graft.” 

Fay Frederick, nurse manager with Cayman Orthopaedic Group, said that specialized equipment was imported from Canada to perform the surgery on island. 

“It’s quite complicated to organize a case like this,” she said. The PCL reconstruction was performed using a specialized endoscope known as an arthroscope. 

“We do the procedure arthroscopically, which means we use very small incisions, cameras, and we don’t have to make any major incisions,” Dr. Tran said. 

As opposed to open surgery, arthroscopic surgery is a less invasive procedure that results in minimal scarring. 

Mr. Mitchell now faces six to nine months of physical therapy in order to strengthen his repaired ligament before he can return to sports. 

Dr. Tran said that one of the benefits of performing the surgery locally, however, was that the patient could focus solely on his recovery from the outset, rather than the logistical issues associated with travelling after surgery. 

The first tissue transplant surgery performed under the Human Tissue and Transplant Law occurred in April when Department of Environment Marine Enforcement Officer Erbin Tibbetts underwent knee surgery to repair a ligament.  

The law was passed unanimously in the Legislative Assembly in May. 

This is the first PCL reconstruction surgery using donated tissue performed in the Cayman Islands.  

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Dr. Franklin Tran of Scarborough Hospital in Canada and Nurse Manager Fay Frederick of Cayman Orthopaedic Group worked on the surgery. – PHOTO: HANNAH REID

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