Meniscal surgery

Meniscal (cartilage) tears in the knee may be the result of injury or part of the degenerate process of ageing  in the knee. The purpose of the meniscus is to distribute load evenly in the knee as well as contributing to stability. The meniscus has a poor blood supply, and so does not heal well. Repair is however possible, particularly in athletes and the under 50’s where loss of the meniscus can accelerate degenerate change. The rehabilitation period is longer if the meniscus is repaired rather than resected (trimmed).

Cruciate ligament surgery

The anterior and posterior cruciate ligaments provide stability in the knee and are commonly injured in twisting sports. If identified early they can be repaired, or can be reconstructed using tendons from around the knee to replace the injured structures.  Artificial ligaments such as the internal brace can be used in conjunction with repairs to provide support whilst healing takes place.

The rehabilitation period following surgery is prolonged, as the balance centre in the brain that communicated with the knee takes at least 18 months to recover fully, and physiotherapy aims to regain range of motion, strength and proprioception. Return to sport is guided by functional goals which assess these parameters rather than time from surgery alone

Surgery for knee arthritis

Arthroscopy has very little use in the management of knee arthritis, with many studies showing it to be ineffective.  When arthritis is present in only one part of the knee it is possible to perform joint preserving surgery to offload the affected part of the knee. This is termed osteotomy surgery, and alters the mechanical axis of the leg by precisely moving the femur/ tibia at the knee to a new position and holding it there with a plate and screws. Should this not be feasible then partial joint replacements such as the Oxford knee replacement can be performed, preserving the rest of the joint. Total knee replacement involves removing the worn out joint surfaces and replacing them with metal and plastic. This gives good pain relief, reducing pain by around 80%, but it often takes a year until the knee feels like it is truly a part of you.

For small areas of arthritis in young, active patients articular cartilage regeneration techniques can be used. This involves regenerating the lost area of articular cartilage using an artificial membrane , Chondrogide, to encourage cell growth.

If you have arthritis and you are keen to avoid surgery but are struggling with conventional non- operative treatments then biologic treatment may be appropriate. This involves injection of the joint with platelet rich plasma, a concentrate of your own blood, which acts to naturally reduce the level of inflammation in the joint and can control symptoms for a year. Stem cells can also be used, although this is still an experimental procedure. Fat is removed from the abdomen or limb, the tissue is broken down to release the mesenchymal stem cells within it, and the stem cells are injected into the joint.

Arthroscopy

  • Meniscal repair
  • Meniscectomy
  • Removal of loose bodies
  • Patella stabilisation
  • Anterior cruciate ligament repair/ reconstruction
  • Revision ACL surgery
  • Posterior cruciate ligament repair/ reconstruction
  • Posterolateral corner repair
  • Collateral ligament repair / reconstruction
  • Plica/ fat pad debridement
  • Microfracture

Osteotomy

  • Tibial osteotomy
  • Femoral osteotomy

Arthroplasty

  • Unicompartmental knee replacement
  • Total knee replacement
  • Revision knee replacement

The following forms outline the procedures, alternatives and risks associated. If you have any additional questions please do not hesitate to contact Jon to discuss them.

Total Knee Replacement – A guide for patients

ACL/PCL Protocol

Oxford

Arthroscopy