Do you need need knee surgery? Whether you're an athlete with knee pain or just someone wishing to return to gardening or walking without constant knee problems, we can help. Our Knee Surgeons will provide a fast diagnosis and the very best treatment and care available.
The anterior cruciate ligament, or ACL, is one of the major ligaments of the knee that is located in the middle of the knee and runs from the femur (thigh bone) to the tibia (shin bone). It prevents the tibia from sliding out in front of the femur. Together with posterior cruciate ligament (PCL) it provides rotational stability to the knee.
An ACL injury is a sports related injury that occur when the knee is forcefully twisted or hyperextended. An ACL tear usually occurs with an abrupt directional change with the foot fixed on the ground or when the deceleration force crosses the knee. Changing direction rapidly, stopping suddenly, slowing down while running, landing from a jump incorrectly, and direct contact or collision, such as a football tackle can also cause injury to the ACL.
When you injure your ACL, you might hear a "popping" sound and you may feel as though the knee has given out. Within the first two hours after injury, your knee will swell and you may have a buckling sensation in the knee during twisting movements.
Diagnosis of an ACL tear is made by knowing your symptoms, medical history, performing a physical examination of the knee, and performing other diagnostic tests such as X-rays, MRI scans, stress tests of the ligament, and arthroscopy.
Treatment options include both non-surgical and surgical methods. If the overall stability of the knee is intact, your doctor may recommend nonsurgical methods. Non-surgical treatment consists of rest, ice, compression, and elevation (RICE protocol); all assist in controlling pain and swelling. Physical therapy may be recommended to improve knee motion and strength. A knee brace may be needed to help immobilize your knee.
Young athletes involved in pivoting sports will most likely require surgery to safely return to sports. The usual surgery for an ACL tear is an ACL reconstruction which tightens your knee and restores its stability. Surgery to reconstruct an ACL is done with an arthroscope using small incisions. Your doctor will replace the torn ligament with a tissue graft that can be obtained from your knee (patellar tendon) or hamstring muscle. Following ACL reconstruction, a rehabilitation program is started to help you to resume a wider range of activities.
Meniscus tear is the commonest knee injury in athletes, especially those involved in contact sports. A suddenly bend or twist in your knee 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 stabilize the knee joint and act as “shock absorbers”.
Torn meniscus causes pain, swelling, stiffness, 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 medical history before suggesting a treatment plan. The treatment depends on the type, size and location of 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.
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 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 laboratory. It is considered as a treatment option to relieve knee pain in patients who have undergone meniscectomy.
Total Knee Replacement (TKR)
Total knee replacement, also called total knee arthroplasty, is a surgical procedure in which the worn out or damaged surfaces of the knee joint are removed and replaced with artificial parts. The knee is made up of the femur (thigh bone), the tibia (shin bone), and patella (kneecap). The meniscus, the soft cartilage between the femur and tibia, serves as a cushion and helps absorb shock during motion. Arthritis (inflammation of the joints), injury, or other diseases of the joint can damage this protective layer of cartilage, causing extreme pain and difficulty in performing daily activities. Your doctor may recommend surgery if non-surgical treatment options have failed to relieve the symptoms.
Total knee replacement surgery is commonly indicated for severe osteoarthritis of the knee. Osteoarthritis is the most common form of knee arthritis in which the joint cartilage gradually wears away. It often affects older people.
In a normal joint, articular cartilage allows for smooth movement within the joint, whereas in an arthritic knee the cartilage itself becomes thinner or completely absent. In addition, the bones become thicker around the edges of the joint and may form bony “spurs”. All of these factors can cause pain and restricted range of motion in the joint.
Your doctor may advise total knee replacement if you have:
- Severe knee pain which limits your daily activities (such as walking, getting up from a chair or climbing stairs).
- Moderate to severe pain that occurs during rest or awakens you at night.
- Chronic knee inflammation and swelling that is not relieved with rest or medications
- Failure to obtain pain relief from medications, injections, physical therapy, or other conservative treatments.
- A bow- legged knee deformity
The exact cause of osteoarthritis is not known, however there are a number of factors that are commonly associated with the onset of arthritis and may include:
- Injury or trauma to the joint
- Fractures at the knee joint
- Increased body weight
- Repetitive overuse
- Joint infection
- Inflammation of the joint
- Connective tissue disorders
Your doctor will diagnose osteoarthritis based on the medical history, physical examination, and X-rays.
X-rays typically show a narrowing of the joint space in the arthritic knee.
The goal of total knee replacement surgery is to relieve pain and restore the alignment and function of your knee.
The surgery is performed under spinal or general anesthesia. Your surgeon will make an incision in the skin over the affected knee to expose the knee joint. Then the damaged portions of the femur bone are cut at appropriate angles using specialized jigs. The femoral component is attached to the end of the femur with or without bone cement. The surgeon then cuts or shaves the damaged area of the tibia (shinbone) and the cartilage. This removes the deformed part of the bone and any bony growths, as well as creates a smooth surface on which the implants can be attached. Next, the tibial component is secured to the end of the bone with bone cement or screws. Your surgeon will place a plastic piece called an articular surface between the implants to provide a smooth gliding surface for movement. This plastic insert will support the body’s weight and allow the femur to move over the tibia, similar to the original meniscus cartilage. The femur and the tibia with the new components are then put together to form the new knee joint. To make sure the patella (knee cap) glides smoothly over the new artificial knee, its rear surface is also prepared to receive a plastic component. With all the new components in place, the knee joint is tested through its range of motion. The entire joint is then irrigated and cleaned with a sterile solution. The incision is carefully closed, drains are inserted and a sterile dressing is placed over the incision.
Rehabilitation begins immediately following the surgery. A physical therapist will teach you specific exercises to strengthen your leg and restore knee movement. Knee immobilizers are used to stabilize the knee. You will be able to walk with crutches or a walker. A continuous passive motion (CPM) machine can be used to move the knee joint . Continuous passive motion is a device attached to the treated leg which constantly moves the joint through a controlled range of motion, while the patient relaxes. Your physical therapist will also provide you with a home exercise program to strengthen thigh and calf muscles.
Risks & Complications
As with any major surgery, possible risks and complications associated with total knee replacement surgery include:
- Knee stiffness
- Blood clots (deep vein thrombosis)
- Nerve and blood vessel damage
- Ligament injuries
- Patella (kneecap) dislocation
- Plastic liner wears out
- Loosening of the implant
If you find difficulty in performing simple activities such as walking or climbing stairs because of your severe arthritic knee pain, then total knee replacement may be an option for you. It is a safe and effective procedure to relieve pain, correct leg deformity, and help you resume your normal activities of daily living.
Dr. Amjad Jody M Moreden
Specialties: Orthopaedic Surgery and Sports Medicine
Dr. Pierdanilo Sanna
Specialties: Orthopedic Surgeon, Sport and Trauma