Leading treatment for knee pain and injury

Although minor damage to the cartilage may heal by itself, more severe injuries usually need surgical treatment. Such treatments include; Knee chondroplasty, basically a tidy up involving the removal of loose flaps of cartilage or fragments of tissue; Microfracture, which involves the forming of new tissue; AMIC nanofracture, which combines microfracture surgery with the use of collagen; Knee cartilage transplantation or MACI, a similar but more advanced two stage procedure where cartilage is taken from the knee and grown in a laboratory before re-implantation. In addition, OATS surgery, which stands for osteochondral autograft transplant system, can be performed. This requires a small incision to remove damaged tissue and replace it with healthy cartilage from another area of the joint. In more serious cases, healthy tissue from a donor may be required in a procedure known as osteochondral allograft transplantation.

This is a very safe and straightforward procedure that is usually carried out under a general anesthetic as a day case. It can discover any abnormalities that are restricting movement or find tears that may be difficult to diagnose when you are awake and in pain. The knee can also be manipulated by gentle bending and straightening while you are asleep to further improve strength and flexibility. This can be particularly beneficial following an injury which may have led to a build-up of scar tissue inside the knee.

Anterior cruciate ligament (ACL) surgery:
This surgery can involve either reconstruction or repair. ACL reconstruction involves removing existing tissue and then replacing the torn tissue with a new graft. This uses either the patient’s own tissue (autograft), usually from the hamstrings or patella tendon, or donated human tissue (allograft) to make a new ACL. In ACL repair, the torn ends of the ligaments are stitched together to create an ‘internal brace’ of fibre tape that holds the joint in the correct position. The fibre tape is passed through tiny tunnels drilled into the bones to fix the ligament securely. Patients are generally able to walk normally and carry out their daily activities only a few days after surgery.

Posterior cruciate ligament (PCL) surgery:
With this procedure, a graft is made either from your own tendons or those from a donor and passed through pre-drilled holes in the thigh and shin bones, using X-ray guidance. The graft is then fixed with screws. In most cases, PCL reconstruction is carried out alongside repair to other ligaments.

Posterolateral corner (PLC) repair and reconstruction:
Injury to the PLC occurs as part of a multi ligament injury along with one or both of the cruciate ligaments. To avoid complications, it is recommended that the PLC be repaired within 2-3 weeks of the injury. If this isn’t possible, the ligaments can be reconstructed using tendon grafts.

Medial patellofemoral ligament (MPFL) reconstruction:
The MPFL ligament is located on the inside of the knee joint, connecting the kneecap (patella) to the thigh bone (femur). Its primary purpose is to provide stability to the kneecap. MPFL reconstruction surgery involves the creation of a new ligament and offers an excellent treatment option for people who have experienced more than one dislocation. Post-operative recovery time is typically about three months.

Knee osteotomy surgery is carried out on patients experiencing a range of knee conditions, including arthritis and sports-related pain and injury. You might also need this treatment if you are bow legged or knock-kneed. The main advantages of osteotomy over replacement surgery include reduced pain, wider range of movement, faster recovery time and improved stability, as well as offering the opportunity of a return to your normal activities including competitive sport. In addition, it affords the peace of mind of knowing you are not having any bone or tissue replaced. In short, you keep your own knee.

This procedure is often carried out to treat a torn patella tendon or quadriceps tendon. It involves reattaching the damaged tendon to the kneecap and the sooner this is done, the higher the success rate for the operation. A full recovery can take 6-12 months, but most people can ultimately return to their previous activities.

Surgery to stabilise the kneecap is usually only offered when physiotherapy hasn’t been successful. Options include medial patella-femoral ligament (MPFL) reconstruction (see above for more information), bony realignment surgery and trochleoplasty. Realignment is offered if the instability is caused by an anatomical abnormality, such as a kneecap that is in a higher position than normal (patella alta). Trochleoplasty is designed to improve mobility and is recommended if you have been diagnosed with trochlear dysplasia i.e an abnormally in the shape of the groove (trochlear) where the kneecap sits. The procedure reshapes the trochlea to allow the kneecap to move smoothly, preventing knee instability and pain.

The meniscus is a piece of cartilage that provides a cushion between your femur (thighbone) and tibia (shinbone). There are two menisci in each knee joint. Most meniscal tears can be repaired using keyhole surgery for which there are 3 options, meniscal debridement (resection), meniscal scaffold and meniscal transplantation. Debridement is carried out if the meniscus is not able to be repaired. Simply put, the torn area is removed while preserving healthy tissue, allowing a return to normal activities within 48 hours. With the second option, a scaffold is used to replace part of the meniscus with a material that has an open honeycomb-like structure. Finally, in cases where too much tissue has been lost, resulting in damage to the lining of the knee joint and the potential for arthritis, a meniscal transplantation using your own or donor tissue would be recommended. This type of surgery is more common in patients in their mid-50s.