University Hospital Southampton NHS Foundation Trust
Nicole Austin

Meet the patients: Nicole Austin

Horse-mad Nicole Austin is back in the saddle after specialist surgery to correct her dislocating kneecaps.

Since the age of four, keen horsewoman Nicole had struggled with agonising pain in both knees, often leaving her unable to walk – let alone go for a gallop.

Now, after a gruelling 14 years, delighted Nicole is back where she belongs – riding her favourite horse Dylan, an 18-year-old dun.

“I hadn’t shown signs of any problems until one day, at the age of four, when I ran up the stairs, got to the top and just collapsed in a heap,” said Nicole, who is studying biology, psychology and English language at A level.

“My family and I had no idea what was going on and, as I got older, things worsened – I would be walking along and the next minute I’d be on the floor.”

Despite her determination to get on with life and regular trips to GPs and physiotherapists, who tried to treat the problem by strengthening her thigh muscles, Nicole faced many setbacks.

After giving up her beloved hobby at just eight-years-old, she bravely returned to horse riding at 13 to help coach younger children with the hope she may find a magic cure somewhere along the way if she persisted.

Nicole, 18, from Chichester, West Sussex, explained: “I tried to keep things going as much as I could by trying to ride and cycle, but my knees would just give way when I was least expecting it, which made things difficult.”

Following a variety of unsuccessful treatments and procedures, Nicole was referred for specialist treatment at the children’s orthopaedic department in Southampton.

Her case was picked up by consultant orthopaedic surgeon Vel Sakthivel, a specialist in sports injuries and knee cap problems, who wanted to perform a complex operation called trochleoplasty, which involves taking a piece of bone from the hip to deepen the groove on the end of the thigh bone where the kneecaps glide.

“The knee has to move over the end of the thigh bone when a person bends and straightens the knee, like trains having to run on tracks. But, in Nicole’s case, one of the many problems she had was a very flat groove on the end of the thigh bone,” said Mr Sakthivel.

“With Nicole, her kneecaps had no groove to glide over with any control. To simplify, if thinking in terms of a railway, the track was the same level as the ground and not elevated as it should be. This would make it easy for the train to derail and that’s what happened to Nicole’s kneecaps.”

The surgery was completed by taking a strip of Nicole’s hamstring muscle to create additional support under the kneecap.

“When we heard about the procedure, I remember my dad and I looking at each other and thinking ‘wow, this is kind of big’, but I was also excited at the thought this might be it; I would be able to walk down the road without worry,” said Nicole, who hopes to study speech and language therapy at university.

Nicole had to complete seven months of rehabilitation following the first operation and the same again following the second – but she has not looked back since.

“Although it will take further time before I’m completely comfortable, I have an increased confidence in the way my legs work,” she said.

“After such a long time, I began to wonder if I’d ever get to do the things I enjoy again, so I am so happy and excited to be back riding and cycling – I can’t imagine my life without the stables."

First published in Connect issue 29.