Partial Knee Replacement
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Meniscal Cartilage Tears
Following a twisting type of injury the medial (or Lateral) meniscus can tear. This results either from a sporting injury or may occur from a simple twisting injury when getting out of a chair or standing from a squatting position. Our cartilages become a little brittle as we get older and therefore can tear a little easier.
The symptoms of a torn cartilage include
- Pain over the torn area i.e. inner or outer side of the knee
- Knee swelling
- Reduced motion
- Locking if the cartilage gets caught between the femur and tibia
The following drawing demonstrates the types of tears that occur
Articular Cartilage (Surface) injury
If the surface cartilage is torn, this is most significant as a major shock-absorbing function is compromised. Large pieces of articular cartilage can float in the knee (sometimes with bone attached) and this causes locking of the joint and can cause further deterioration due to the loose body floating around the knee causing further wear and tear. Most surface cartilage wear will ultimately lead to osteoarthritis. Mechanical symptoms of pain and swelling due to cartilage peeling off can be helped with arthroscopic surgery. The surgery smoothes the edges of the surface cartilage and removes loose bodies.
Cruciate Ligament Injuries
Rupture of the Anterior (rarely the posterior) Cruciate Ligament (ACL) is a common sporting injury. Once ruptured the ACL does not heal and usually causes knee instability and the inability to return to normal sporting activities. An ACL reconstruction is required and a new ligament is fashioned to replace the ruptured ligament. This procedure is performed using the arthroscope.
Patella (knee-cap) disorders
Arthroscopy is sometimes useful in the treatment of patello-femoral problems of the knee. Looking directly at the articular cartilage surfaces of the patella and the patello-femoral groove is the most accurate way of determining how much wear and tear there is in these areas. Your physician can also watch as the patella moves through the groove, and may be able to decide whether or not the patella is tracking normally. If there are areas of articular cartilage damage behind the patella that are creating a rough surface, special tools can be used by the surgeon to smooth the surface and reduce your pain. This procedure is sometimes referred to as shaving the patella.
The arthroscope can be used to treat problems relating to kneecap disorders, particularly mal-tracking and significant surface cartilage tears. Patients may need to stay overnight if a lateral release has been performed as knee swelling is quite common. The majority of common knee -cap problems can be treated with physiotherapy and rehabilitation
Occasionally arthroscopy is used in inflammatory conditions (e.g. Rheumatoid Arthritis) to help reduce the amount of inflamed synovium (joint lining) that is producing excess joint fluid. This procedure is called a synovectomy. After the surgery a drain is inserted into the knee and patients generally require one or two nights in the hospital.
Bakers cysts or popliteal cysts are often found on clinical examination and ultrasound / MRI scans. The cyst is a fluid filled cavity behind the knee and in adults arises from a torn meniscus or worn articular cartilage in the knee. These cysts usually do not require removal as treating the cause (torn knee cartilage) will in most cases reduce the size of the cyst. Occasionally the cysts rupture and can cause calf pain. The cysts are not dangerous and do not require treatment if the knee is asymptomatic.
NEW TECHNOLOGY: Autologous Chondrocyte Grafting
Isolated areas of articular cartilage loss can be repaired using cartilage transplant technology. This is a new and exciting field that is developing in the treatment of specific isolated cartilage defects in younger patients.
The process is called Autologous Chondrocyte Grafting. It involves harvesting cartilage cells from the affected knee, sending these cells to a laboratory and then culturing the cells to multiply into many cells. The large amounts of cells produced are then placed back into the affected knee into the defect requiring resurfacing. Results are still short-term but are looking encouraging.
After a major cartilage or ligament injury has been treated the knee can return to normal function. There is however a small increase in the risk of developing long-term wear and tear (Osteoarthritis) and depending on the degree of injury activity modification may be required. Activities that help prevent knees deteriorating quickly include:
- Low impact sports like swimming, cycling and walking
- Reducing weight and maintaining a healthy diet