Knee is one of the major joints in the body. Knee is of particular interest in general as it is a weight bearing joint and its movements are involved in almost all activities of daily life. In Indian sub-continent, knee joint and its function is significant as activities like sitting cross legged, squatting and kneeling are part and parcel of social life.
The lower part of the thigh bone (femur), upper part of the leg bone (tibia) and the knee cap (patella) in front forms the knee joint.
The ends of these three bones are covered by cartilage which is an extremely smooth designed to decrease the friction forces. Outside the cartilage there are two C shaped structures called menisci between the femur and tibia.
The joint capsule has thick and fibrous layer superficially and thinner layers deeper. This along side the ligaments enhances the stability of the knee. The ligaments of the knees are
- ACL
- PCL
- MCL
- LCL
- OA ( Osteo Arthritis )
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Definition: Degenerative condition of the articular cartilage due to wear and tear
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Evaluation: based on x rays
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Treatment options:
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Conservative trial with muscle strengthening exercises
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Knee preservation ( HTO)
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Knee replacement
- MCOA ( Medial compartment Osteo Arthtritis)
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Definition: Degenerative condition of the articular cartilage due to wear and tear only on the on the inner side
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Evaluation : X rays
- Knee stiffness– stiffness of the knee is a common pathology which occurs after complex trauma, surgery, infections etc.
- ACL injury -
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Definition : rupture of the anterior cruciate ligament due to injury resulting in instability and pain
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Diagnosis: diagnosed by clinical examination and MRI
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Treatment options:
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Conservative trial with muscle strengthening exercises
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Key hole surgery (Arthroscopic reconstruction of the ligament)
- PCL Injury -
- Rupture of the posterior cruciate ligament due to injury resulting in instability and pain
- Diagnosed by clinical examination and MRI
- LCL Injury -
- Rupture of the lateral collateral ligament due to injury resulting in instability and pain
- Diagnosed by clinical examination and MRI
- MCL injury -
- Post traumatic rupture of the medial collateral ligament due to injury resulting in instability and pain
- Diagnosed by clinical examination and MRI
- HTO with external fixator (Orthofix)
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HTO – High Tibial Osteotomy is a type of knee preservation surgery
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High Tibial Osteotomy is a surgery done to shift the mechanical axis of the lower limb from inner side of the knee to the outer side.
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This surgery is useful in those patients with knee arthritis who has varus of the knees, which can be diagnosed in a standing x ray.
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This would slow down the rate of progression of arthritis and in most cases a future knee replacement can be avoided
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Any age group of patients suffering from arthritis of the knee can opt for this surgery depending on the severity of the surgery
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Doing the surgery with external fixator is advantageous as it would present with possibility of fine tuning the correction of the axis to a scale of 1 mm
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The advantages of this surgery are
- Avoiding knee replacement
- No implants left in side the body
- Long term pain relief
- No restriction of activities after the correction
- HTO with internal plate (Tomofix)
- HTO – High Tibial Osteotomy is a type of knee preservation surgery
- High tibial osteotomy can be done with internal fixation using a plate
- Advantages -
- DFO with internal plate
- DFO – Distal Femoral Osteotomy
- OA knee can be predisposed by the subtle deformity at the lower end of femur
- DFO is the surgery to correct that deformity to shift the mechanical axis of the limb to the outer side resulting in deformity correction and long term pain relief
- Total knee replacement (TKR)
- Treatment for end stage knee arthritis
- TKR is the only option if the arthritic changes are severe in all the 3 compartments of the knee
- In TKR the articular cartilage of the lower part of femur and upper part of tibia are replaced with metal
- Partial knee replacement (UKA)
- Treatment for MCOA in patients with no significant deformity
- Advantages – Early rehabilitation
- Disadvantages – Chance of conversion to TKR in future
- Knee arthrolysis
- Treatment for knee stiffness
- Knee joint is opened and the bony + soft tissue adhesions are released
- Advantages:
- ACL reconstruction
- PCL reconstruction
- LCL reconstruction
- MCL reconstruction
- Meniscal repair
- Meniscal debridement
