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Knee

The knee is a complex joint made up of bones, tendons, ligaments, and muscles that work together for stability and movement. A healthy knee is essential for mobility and staying active.

Knee Conditions

  • Knee Injury
  • Unstable Knee
  • Knee Sprain
  • ACL Tears
  • Meniscal Tears
  • Knee Ligament Injuries
  • Knee Arthritis
  • Knee Pain
  • Knee Dislocation
  • Knee Fracture
  • Knee Stress Fractures
  • Runner’s Knee

Knee Procedures

  • Total Knee Replacement
  • ACL Reconstruction
  • Knee Arthroscopy
  • Knee Fracture Surgery
  • Viscosupplementation
  • Meniscal Surgery

Total Knee Replacement

Total Knee Replacement (TKA) is a surgery where damaged knee joint surfaces are replaced with artificial components. It is commonly used to treat severe knee arthritis, which causes pain, limited mobility, and joint damage.

Knee Arthritis affects the femur, tibia, and patella, and can lead to cartilage loss, bone spurs, and pain. In severe cases, osteoarthritis causes significant damage, affecting daily activities.

Indications for Surgery

  • Severe knee pain limiting daily activities
  • Pain at rest or during sleep
  • Chronic swelling unrelieved by medications
  • Failure of other treatments (medications, therapy, injections)

Procedure

  • Removing damaged bone and cartilage from the femur and tibia.
  • Replacing them with metal and plastic components.
  • Ensuring smooth movement with a plastic insert between the components and adjusting the patella. The procedure is done under anesthesia, and the joint is tested for function before closing the incision.

Postoperative Care

Rehabilitation starts immediately with physical therapy to restore movement and strength. Crutches or a walker are used, and sometimes a continuous passive motion machine is applied to aid recovery.

Risks and Complications

Possible risks include knee stiffness, infection, blood clots, nerve or blood vessel damage, and implant loosening.

ACL Reconstruction

ACL Reconstruction is a surgery to replace a torn anterior cruciate ligament (ACL) in the knee with a tissue graft, often from the patient’s own body (autograft), typically the patellar or hamstring tendon.

The ACL is a key ligament that stabilizes the knee, preventing excessive forward movement of the tibia and limiting knee rotation. A torn ACL causes instability and typically requires reconstruction, as it does not heal on its own.

Indications for Surgery

ACL reconstruction is necessary after an ACL tear, often caused by sudden twisting or hyperextension during sports like football, soccer, and basketball.

Procedure

The surgery is done arthroscopically under general anesthesia. Small incisions are made around the knee, and a camera (arthroscope) is inserted for guidance. The torn ACL is removed, and a tendon graft is prepared, then fixed into place with screws or anchors. The incisions are sutured afterward.

Postoperative Care

Recovery includes pain management, elevation of the leg, and use of crutches. Physical therapy is essential to regain strength and mobility. Full recovery and return to sports can take 9-12 months, while work may be resumed in about 6 weeks for less physically demanding jobs.

Risks and Complications

Possible risks include infection, bleeding, pain, blood clots, stiffness, or re-rupture of the graft.

Knee Arthroscopy

Knee Arthroscopy is a minimally invasive surgery using an arthroscope to diagnose or treat knee issues. It is generally safe, and patients are often discharged the same day.

The knee joint involves the femur (thighbone), tibia (shinbone), fibula (lower leg bone), and patella (kneecap). It contains cartilage, menisci (shock absorbers), ligaments, and tendons that stabilize and provide movement.

Indications for Surgery

  • Torn meniscus or cruciate ligaments
  • Damaged articular cartilage
  • Inflammation or cysts
  • Misaligned patella or knee fractures

Procedure

Under anesthesia, small incisions are made, and saline is used to expand the knee for better visibility. An arthroscope is inserted to view the joint, and surgical tools are used for repair (e.g., meniscus removal, ligament repair, or cartilage cleaning). The incisions are closed after the procedure.

Postoperative Care

Patients are usually discharged the same day with pain medications, crutches, or a knee brace. Physical therapy may be prescribed to regain motion and strength.

Risks and Complications

Though rare, risks include bleeding, infection, knee stiffness, blood clots, or persistent knee issues.

Knee Fracture Surgery

Knee Fracture Surgery is a procedure to repair broken bones in or around the knee joint, which may involve the tibia, patella, or femur. The goal is to restore knee function and stability.

Most knee fractures result from direct trauma, falls, car accidents, sports injuries, or rare muscle contractions.

Indications for Surgery

Common signs include extreme pain, swelling, bruising, difficulty bending or straightening the knee, muscle spasms, and an inability to walk.

Symptoms

Common signs include extreme pain, swelling, bruising, difficulty bending or straightening the knee, muscle spasms, and an inability to walk.

Diagnosis

Diagnosis involves reviewing symptoms and medical history, a physical exam, and imaging tests like X-rays, CT scans, or MRIs.

Surgical Treatments

  • Open Reduction and Internal Fixation: Used for patellar fractures, where bone pieces are reassembled and fixed with screws or wires.
  • Osteotomy: Reshapes bones to relieve pressure on damaged knee areas.
  • Total Knee Replacement: Replaces both sides of the knee joint with a prosthesis when there’s severe damage.
  • Partial Knee Replacement: Replaces only the damaged part of the knee.
  • Arthroscopy: Minimally invasive surgery to repair or remove damaged tissue, fragments, or cartilage.
  • ACL Reconstruction: Replaces a torn ACL with a tendon graft to stabilize the knee.

Postoperative Care

Post-surgery care includes pain management, elevation, crutches, physical therapy, and wound care. Follow-up appointments are necessary to monitor healing.

Risks and Complications

Potential risks include infection, bleeding, blood clots, nerve damage, joint stiffness, or improper healing, which may require additional surgery.

Viscosupplementation

Viscosupplementation involves injecting hyaluronan, a natural substance in joint fluid, into the joint to improve lubrication and support smooth cartilage movement.

Indications for Surgery

It is used for managing osteoarthritis in the shoulder, knee, hip, and ankle when other treatments like pain meds, physical therapy, and corticosteroids have not worked. It helps relieve symptoms and delays surgery.

Procedure

Hyaluronan is injected into the joint, either as a single dose or multiple doses over a few weeks, to enhance lubrication.

The injection replenishes hyaluronan and encourages the production of more, providing gradual symptom relief that can last for months.

Postoperative Care

Ice and pain relief may help with discomfort. Avoid strenuous activities like jogging or sports for 48 hours to a week, depending on your doctor’s advice.

Risks and Complications

Mild pain, swelling, warmth, or redness at the injection site may occur for up to 48 hours. Headache and joint stiffness are also possible. Contact your doctor if symptoms worsen or don’t resolve within 48 hours.

Meniscal Surgery

Meniscal Surgery is a procedure to treat torn or damaged meniscal tissue in the knee, typically performed minimally invasively using keyhole surgery.

The menisci are two wedge-shaped cartilage pieces between the thighbone and shinbone, providing stability and shock absorption.

Meniscal tears are common in athletes, especially in contact sports, caused by sudden twisting or bending. Older individuals may experience degenerative tears as the cartilage weakens with age.

Symptoms

Torn menisci cause pain, swelling, stiffness, and a catching or locking sensation in the knee.

Diagnosis

Your orthopedic surgeon will evaluate your knee and symptoms before recommending treatment.

Treatment

For small tears, non-surgical treatment may suffice. If symptoms persist, surgery may be necessary.

Surgical Options

The most common procedure is knee arthroscopy, which uses a small camera to view the knee. Surgical options include:

  • Meniscectomy: Removal of the torn meniscus
  • Meniscus Repair: Suturing or pinning the torn meniscus
  • Meniscus Replacement: Replacing the meniscus with donor cartilage or a cultured patch, typically after meniscectomy to reduce pain

Resources

  • Knee Replacement / HHS.edu

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KVH Orthopedics

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Anthony Longo, MD

Board Certified Orthopedic Surgeon

Dr. Longo provides comprehensive care for various bone and joint problems using advanced techniques and technology. Check out the Reviews

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