Knee

The anterior cruciate ligament is one of the major stabilizing ligaments in the knee. It is a strong rope like structure located in the centre of the knee running from the femur to the tibia. When this ligament tears unfortunately it doesn’t heal and often leads to the feeling of instability in the knee.

ACL reconstruction is a commonly performed surgical procedure and with recent advances in arthroscopic surgery can now be performed with minimal incisions and low complication rates.  ACL surgery can be performed using either hamstring tendons, patella tendons, or even tissues from the donor tissue bank (allograft). Artificial ligaments are also available, but are used less commonly for ACL reconstruction as the results of patients own tissue are generally the best.

This simply means that only a part of the knee joint is replaced through a smaller incision than would normally be used for a total knee replacement. The knee joint is made up of 3 compartments, the patellofemoral and medial and lateral compartments between the femur and tibia (i.e. the long bones of the leg). Often only one of these compartments wears out, usually the medial one. If you have symptoms and X-ray findings suggestive of this then you may be suitable for this procedure.A unicondylar knee replacement is less painful to undergo and has a more rapid rehabilitation.

Prepatellar bursitis is inflammation of the bursa or lubricating sac over the front of the knee. The one directly over the patella was known as housemaids knee, and the one over the tibial tubercle where the patella tendon attaches was known as clergyman's knee because kneeling on each area was different depending on your occupation, and led to irritation. The majority of bursitis is treated non-operatively but occasionally a bursa can become painful or infected and in that situation operative surgery with resection may be required.

A meniscal tear refers to a tear of one of the two mobile shock absorbers within the knee joint. These can occur either after a twisting injury, and can be at any age. In later life is common for people to have tears of the meniscus which may be painful. Meniscal tears can be treated with arthroscopic surgery if they do not settle down and re-heal on their own. When someone has a meniscal tear, and also has significant arthritis in the knee, oftentimes the meniscal tear will not represent the major cause of their overall pain, and other surgery which is more involved may be necessary.

Meniscal transplants refer to taking the meniscus from another person, generally an organ donor, and implanting those into the knee. This surgery is complex and is not commonly performed in Australia, but on the horizon is the possibility of collagen scaffolds which may be used instead of a donor meniscus. Those treatments are experimental at the moment, and will require significant further testing and evidence before they become mainstream.

Minimally invasive knee surgery refers to smaller incisions to reduce post-operative pain. The majority of studies do not support any significant improvement in the longer term performance of knees with minimally invasive surgery, and is important not to compromise the positioning of components for the sake of a small incision on the front of the knee. The place of minimally invasive surgery has reduced with new techniques in anaesthetics and other medications around the time of the surgery which make post-operative pain improved.

The posterior cruciate ligament (PCL) stops the shin bone moving backwards on the thigh bone at the knee. It can be torn by twisting injuries, or direct force pushing the knee backwards. Oftentimes this can be treated non-operatively for the lower severity injuries, but reconstruction surgery can be performed arthroscopically, generally using the hamstrings to reconstruct the ligament. PCL rupture is less common than anterior cruciate ligament (ACL) injury. 

Surgical treatment of osteoarthritis of the knee depends on the page and activity levels of the patient, and the particular anatomy that person may have. Younger people may be treated with joint realignment surgery (known as high tibial osteotomy or HTO) with the aim of moving the weight from the worn compartment of the knee to that which has more normal cartilage shock absorber. Some patients can delay a knee replacement surgery for ten to fifteen years with an HTO.

The unstable kneecap or patellar instability, is common in adolescents and patients who have generalised ligamentous laxity (sometimes referred to as being double jointed). In a complete dislocation of the kneecap joint, the patella slips all the way out of the groove on the thigh bone and falls down onto the outer side of the knee, and this is very painful. The kneecap can spontaneously reduce itself back into position but often people need to go to the hospital and have some sedation to have the kneecap push back in again. Subluxation (partial dislocation) is where the kneecap slips out and back again recurrently without complete dislocation. This can cause significant apprehension and pain for patients. The treatment is generally physiotherapy to strengthen the quadriceps to hold the kneecap in position, stretching exercises to loosen the tight band on the outer side, and knee guards or braces when playing sport. For resistant cases surgical intervention to rebalance the ligaments around the knee can be performed. This can be a soft tissue procedure or bony procedure, or a combination of both depending on the individual circumstances and anatomy.