Knee

The knee is a joint which essentially consists of three parts. These are the thigh bone (femur), the shin bone (tibia) and the kneecap (patella).

The knee is a joint which essentially has three parts. These include the thigh bone (femur), the shin bone (tibia) and the kneecap (patella). The femur meets the tibia forming the main joint. This joint has an inner (medial) and outer (lateral) compartment. The patella joins the femur to create the third joint.

The knee joint is surrounded by a joint capsule with ligaments strapping the inside and outside of the joint, as well as crossing within the joints. These ligaments provide stability and strength for the joint.

There is also a meniscus between the femur and tibia, which gives cushioning, so the bones can move with minimum friction. There are also air sacs, called bursae, surrounding the joint which act as gliding surfaces.

Below the patella, there is a large tendon (patellar tendon) which joins onto the front of the tibia in addition to large blood vessels passing through the area behind the knee. The knee also rotates slightly under the guidance of specific muscles in the thigh.

The knee is a complex joint which consists of bone, cartilage, ligaments and tendons that make joint movements easy and at the same time more susceptible to various kinds of injuries. Knee problems may arise if any of these structures are injured by overuse or sports activities. Pain, swelling, and stiffness are common symptoms of any damage or injury to the knee.

Bursitis

Anterior knee pain commonly affects teenagers. Girls are affected more often than boys. It is usually the result of maltracking of the patella in the femoral trochlea. There is usually an underlying anatomical abnormality, such as a shallow femoral trochlea and/or horizontal lateral facet of the patella with or without a very vertical or no medial facet.

Meniscus Tear

Meniscus tear is the most common knee injury in athletes, especially those involved in contact sports. A sudden bend or twist in your knee can cause the meniscus to tear. This is a traumatic meniscus tear. Elderly people are more prone to degenerative meniscal tears as the cartilage wears out and weakens with age. The two wedge-shape cartilage pieces present between the thighbone and the shinbone are called meniscus. They stabilise the knee joint and act as “shock absorbers”.

A torn meniscus causes pain, swelling, stiffness and a catching or locking sensation in your knee making you unable to move your knee through its complete range of motion. Your orthopaedic surgeon will examine your knee, evaluate your symptoms, and survey your medical history before suggesting a treatment plan. The treatment will depend on the type, size and location of the tear as well your age and activity level. If the tear is small with damage in only the outer edge of the meniscus, nonsurgical treatment may be sufficient. However, if the symptoms do not resolve with nonsurgical treatment, surgical treatment may be recommended.

Surgical Treatment

Knee arthroscopy is the commonly recommended surgical procedure for meniscal tears. The surgical treatment options include meniscus removal (meniscectomy), meniscus repair, and meniscus replacement. Surgery can be performed using arthroscopy where a tiny camera will be inserted through a tiny incision which enables the surgeon to view inside of your knee on a large screen and through other tiny incisions, surgery will be performed. During a meniscectomy, small instruments called shavers or scissors may be used to remove the torn meniscus. In arthroscopic meniscus repair the torn meniscus will be pinned or sutured depending on the extent of tear.

Meniscus replacement or transplantation involves replacement of a torn cartilage with the cartilage obtained from a donor or a cultured patch obtained from a laboratory. It is considered as a treatment option to relieve knee pain in patients who have undergone a meniscectomy.

Patellofemoral Instability

Patellofemoral Instability results from one or more dislocations or partial dislocations, also called subluxations. This misalignment can damage underlying soft structures such as muscles and ligaments that hold the knee in place. Once damaged, these soft structures are unable to keep the patella (knee cap) in position.

Signs and symptoms of Patellofemoral Instability can include the following:

  • Pain, especially when standing up from a sitting position
  • A feeling of unsteadiness or tendency of the knee to “give way” or “buckle”
  • Recurrent Subluxation: When the kneecap slips partially out of place repeatedly
  • Recurrent Dislocation: When the kneecap slips all the way out of position repeatedly
  • Severe pain, swelling and bruising of the knee immediately following subluxation or dislocation
  • Visible deformity and loss of function of the knee. This often occurs after subluxation or dislocation
  • Sensation changes such as numbness or even partial paralysis. This can occur below the dislocation as a result of pressure on nerves and blood vessels

Causes

Patellofemoral Instability can be caused by a number of factors that affect the way the patella moves along the groove of the femur (trochlear groove) when the leg is bent or straightened. The patella normally moves up and down with a slight tilt without touching the other knee bones. In Patellofemoral Instability the patella does not maintain its normal path of movement and can slip out of the trochlear groove either partially (subluxation) or completely (dislocation).

Diagnosis

Evaluating the source of Patellofemoral Instability is critical in determining your treatment options for relief of the instability. Your physician will perform the following:

  • Medical History
  • Physical Examination
  • Diagnostic studies such as X-rays, CT scan, or MRI

The goal of conservative treatment for Patellofemoral Instability is to restore full range of motion by restoring the normal tracking pathway of the patella during flexion and extension of the knee. Treatment options may include closed reduction, pain medications, rest, ice, physical therapy, orthotics, and bracing. Surgical treatment of Patellofemoral Instability is sometimes necessary to help return the patella to a normal tracking path when conservative treatment options are unsuccessful.



 

Total Knee Replacement (TKR)

A total knee replacement (TKR) or total knee arthroplasty is a surgery that resurfaces the arthritic knee joint with an artificial metal or plastic replacement parts called a ‘prostheses’.

Partial Knee Replacement

Unicondylar knee replacement (or partial knee replacement) simply means that only a part of the knee joint is replaced through a smaller incision than would normally be used for a total knee replacement.

Knee Arthroscopy

Arthroscopy is a surgical procedure in which an arthroscope is inserted into a joint. Arthroscopy is a term that comes from two Greek words, arthro, meaning joint, and skopein, meaning to examine. The benefits of arthroscopy involve smaller incisions, faster healing, a more rapid recovery, and less scarring. Arthroscopic surgical procedures are often performed on an outpatient basis and the patient is able to return home on the same day.

Anterior Cruciate Ligament (ACL) Reconstruction

The anterior cruciate ligament is one of the major stabilizing ligaments in the knee. It is a strong rope like structure located in the centre of the knee running from the femur to the tibia. When this ligament tears unfortunately it doesn’t heal and often leads to the feeling of instability in the knee.

ACL reconstruction of the hamstring tendon and patellar tendon is a commonly performed surgical procedure and with recent advances in arthroscopic surgery can now be performed with minimal incision and low complication rates.

Computer-assisted Knee Replacement

A total knee replacement surgery is the last resort to relieve pain and restore function in a knee damaged by arthritis or an injury. This surgery is recommended when non-surgical treatments do not relieve the condition.