A meniscal injury usually occurs when the knee is twisted or over-flexed, or when it suffers a relatively strong direct impact. Another possible cause for a knee injury is degenerative arthritis (Osteoarthritis).

 

The diagnosis is made through clinical examination and an MRI scan, which allows the identification of the specific type of lesion.

 

The most common form of treatment is arthroscopy surgery with the segmental resection of the injured part of the meniscus (partial meniscectomy) or, whenever possible, with a suture repair of the tear. 

 
 

Unlike open surgery, where usually most of the meniscus is removed, this minimally invasive procedure allows the removal of only the torn meniscus cartilage, requiring only 2 small incisions of 5 mm each. 

 

With this procedure patients have less postoperative pain and a more rapid recovery.

 

Meniscal repair is a technique that preserves the meniscus, which has long term benefits since it prevents possible degenerative changes of the knee.

 

This procedure is limited to tears that occur in the outer vascular region of the meniscus (red zone), since this is the only region with healing potential.

 

Nonetheless, a meniscal repair will require a longer recovery period that a meniscectomy.

 

This used to be a complicated technique; however it recently became simpler with the appearance of several new meniscal suture devices. The videos bellow show examples of some of these techniques.


KNEE ARTHROSCOPY

 

Cruciate ligament injuries are common in sports where the knees are more exposed to trauma, especially due to torsional stress, which occurs when an athlete attempts to change direction. However, smaller impacts may also cause tears in ligaments weakened by age factors, disease, immobilisation, steroids or vascular insufficiency. For this reason, not only does a good proprioceptive and muscle strengthening promote a safer sports practice but it may also, in many cases, eliminate instability symptoms associated with these lesions.

 

Patients in this condition usually state that the "knee gives away" when performing certain movements. The diagnosis is made through clinical examination, through the manual translation test (Lackman test) and magnetic resonance imaging (MRI). For young symptomatic patients surgical treatment, using a tendon graft (autograft) to replace the torn ligament, is used.

 

Our ligamentoplasty techniques are totally arthroscopic, taking the maximum advantage of mini-invasive surgery: small incisions (which are aesthetically advantageous), less surgical aggression, less pain, a better postoperative recovery and a very small chance of associated complications occurring. 

 

We normally use hamstring tendons so as to spare the patellar tendon and preserve the integrity of the extensor apparatus. 

 

Below there are some examples of how these small incisions will look like. 

    

The double-bundle graft we obtain is then folded and prepared to have a high tensile strength in order to respond to the mechanical requirements of the joint. 

 

The bone tunnels, through which the tendon graft will be inserted, should be as near to the original ligament position as possible, so that its primary function is preserved as much as possible. 

 

  
 

 

Posterior cruciate ligament tears are rare. These injuries are often complex, since they might be associated with injuries in other structures, such as the capsule and other posterior or external structures.

 

In this case, surgery is only recommended when rehabilitation programs fail to make the symptoms subside. 

 

LCL tears usually result from trauma in the lateral or medial area of the knee joint or in the tibia, which forces the varus-valgus angulation beyond the limit of the collateral ligament fibers resistance. 

 

These injuries can be treated either conservatively or surgically, depending on the degree of the tear and associated lesions. 

 

Currently there are orthoses that help stabilise the knee allowing, at the same time, for flexion-extension movements, that maintain the activity of the quadriceps.

 

 

The cartilage that coats the knee articulation facilitates low friction and painless mobility between the various articular surfaces. However, its wear can be the cause of knee pathologies. 

 

 

Chondromalacia patellae (CMP) is a degenerative joint disease that is frequent in female teenagers. It is characterised by the softening (malacia) and fissuring of the cartilage surface. The most common symptom is pain while running and going up or downstairs. Physiotherapy and hydrotherapy in particular are essential in CMP treatment.

 

Localised chondral lesions (such as osteochondritis dissecans or osteochondral fractures, etc.) usually affect the subchondral. Bone and arthroscopic interventions are thus required to regularise these injuries (shavings and curettages), to revascularise them (pridie drilling, retrograde drilling, micro fractures) or to replace the injured cartilage with healthy one (grafts) from other parts of the knee (mosaicplasty). 

 

Recently, there have been attempts to use platelet-derived growth factor (PDGF) and chondrocytes culture (MACI) to treat these pathologies, techniques that we have been testing along with the use of stem cells. 

 

The Patello-Femoral Syndrome's aetiology usually lies in the deficient alignment of the knee's extensor apparatus, which causes the side tilting of the patella when the quadriceps is contracted, leading to hyperpressure in the external side of the patella and eventually to instability and recurrent dislocations. Imaging exams (in this particular case, X-Ray, CAT and MRI Scanning) are required to study the patellofemoral interactions, to measure the patellar height, the trochlear inclination angle, the patellar tilt angle, TT-TG, etc. 

 

The symptoms and the results of the exams will help determine the course of treatment. 

 

In general, for patients with Patello-Femoral Syndromes where the alignment between the tuberosity of the tibia and the trochlear groove is relatively well preserved, physiotherapy to strengthen the medial vastus is indicated. This goal can be achieved with isometric or isotonic exercises performed with the knee in external rotation or even with electro-stimulation, which helps to develop the target muscle group.

 

If imaging test results show angle alterations exceeding standard values, then a proximal (medial patellofemoral ligament reconstruction) or distal realignment surgery (with medialisation of the tibial tuberosity) is required. 

KNEE ARTHROSIS 

 

A chronic degenerative injury of the cartilage is caused by its fissuring and/or erosion, which is associated with a reduction of the synovial fluid. Despite there being injured collagen fibres and chondrocyte necrosis, there are no early pain symptoms, which can lead to delayed diagnosis and treatment. Only later on do patients experience mechanical pain (which can be relieved with rest), bone crepitus and the loss of range of motion. 

 

The medical treatment of osteoarthritis has greatly benefited from the development of new anti-inflammatory treatments with better gastrointestinal tolerance. We have also been incrementing the use of viscosupplementation with different hyaluronic acids, after numerous publications have attested its beneficial effects. 

 

KNEE ARTHROPLASTY (PROTHESIS)

When treating a knee with osteoarthritis or pre-osteoarthritis with associated axial deviations, our preferred approach is corrective osteotomy, which nowadays can be performed with a more precise correctional angle and with fixation systems that permit a fast recovery.  

 

If this treatment does not suffice, it is possible to perform an athroplasty with metal resurfacing implants (retained with special cement) with a plastic component (polyethylene liner) placed between them, allowing for painless and low wear mobilisation. 

 

 

Nowadays, there are unicompartmental, patellofemoral ant total arthroplasties available. And mini-invasive and computer-assisted surgery (navigation) may be used to improve the accuracy and precision of bone cutting.