The knee is one of the most essential joints in the body, responsible for allowing us to perform basic movements such as walking, running, and climbing. However, due to its critical role in mobility and its exposure to frequent use, the knee joint is prone to a variety of injuries and diseases. From traumatic injuries like meniscus tears to degenerative conditions like osteoarthritis, knee problems can significantly impair function and cause debilitating pain. In many cases, conservative treatments such as rest, physical therapy, and medications are effective; however, some conditions require surgical intervention for long-term relief and recovery.
This blog post delves deep into the most common knee surgeries performed today, offering a comprehensive explanation of the procedures and the knee conditions they treat. Whether you are dealing with a meniscus tear, ACL injury, or knee arthritis, understanding the surgical options available can help you make informed decisions about treatment and recovery.
Common Knee Conditions and Surgical Interventions
1. Meniscus Tears
Overview:
The meniscus is a C-shaped piece of cartilage that serves as a cushion between the femur (thigh bone) and tibia (shin bone). Meniscal tears are one of the most common knee injuries, often resulting from a sudden twist, direct trauma, or degenerative changes in the cartilage.
Symptoms:
- Pain and swelling, especially after activity
- A feeling of “locking” or “catching” in the knee
- Limited range of motion
Surgical Treatment:
Meniscus Repair vs. Meniscectomy
- Meniscus Repair: The surgeon stitches the torn meniscus back together, which is often the preferred option, especially in younger patients or those with tears located in areas with a good blood supply.
- Meniscectomy: In cases where the tear is too severe to repair, a meniscectomy may be performed. This involves the removal of the damaged portion of the meniscus. Though effective for pain relief, removing part of the meniscus increases the risk of arthritis over time due to the loss of cushioning in the joint.
Procedure:
- Arthroscopic Surgery: Meniscus surgery is typically performed arthroscopically, meaning the surgeon uses small incisions and a camera (arthroscope) to visualize the inside of the knee joint. This technique minimizes damage to surrounding tissues and speeds up recovery time.
Best For:
- Patients with acute meniscus tears
- Athletes or active individuals aiming to preserve knee function
2. Anterior Cruciate Ligament (ACL) Injury
Overview:
The ACL is a key ligament in the knee that helps stabilize the joint. ACL injuries are particularly common in athletes who participate in sports involving sudden changes in direction, such as soccer, basketball, and skiing. A torn ACL can lead to knee instability and difficulty performing physical activities.
Symptoms:
- Severe pain and swelling immediately after injury
- A “popping” sensation at the time of injury
- Difficulty walking or bearing weight on the knee
- Knee instability, especially when pivoting or twisting
Surgical Treatment:
ACL Reconstruction
- ACL reconstruction involves replacing the torn ligament with a graft, often taken from the patient’s own hamstring tendon, patellar tendon, or from a donor. The graft is secured with screws or other fixation methods to restore knee stability.
Procedure:
- The surgery is usually performed arthroscopically, where the surgeon makes small incisions around the knee and uses specialized instruments to remove the damaged ACL and replace it with the graft.
Recovery:
- ACL reconstruction requires a lengthy recovery period, including physical therapy to restore strength and mobility. The full return to sports activities typically takes about 6-9 months.
Best For:
- Active individuals, particularly athletes who require knee stability
- Individuals with complete ACL tears that affect their mobility
3. Osteoarthritis (OA)
Overview:
Osteoarthritis is a degenerative joint disease that occurs when the cartilage in the knee joint wears away, leading to pain, stiffness, and swelling. OA is more common in older adults, but it can also be caused by injury, obesity, or overuse. When the cartilage is gone, the bones in the joint may start to rub against each other, causing significant pain.
Symptoms:
- Pain that worsens with activity or after prolonged periods of rest
- Stiffness and reduced flexibility in the knee
- Swelling and tenderness around the knee joint
Surgical Treatment:
Total Knee Replacement (TKR) and Partial Knee Replacement (PKR)
- Total Knee Replacement (TKR): In TKR, the damaged knee joint surfaces are removed and replaced with artificial components made of metal, plastic, or ceramic. This is considered the gold standard for treating severe knee OA.
- Partial Knee Replacement (PKR): For patients with OA confined to one part of the knee, a partial knee replacement may be an option. Only the damaged portion of the knee is replaced, and the healthy parts are preserved.
Procedure:
- Both TKR and PKR are major surgeries that involve the removal of damaged cartilage and bone, followed by the placement of a prosthetic joint. The surgery is typically performed under general or spinal anesthesia.
Recovery:
- Recovery from TKR or PKR generally involves several weeks of rehabilitation to restore movement, strength, and flexibility in the knee. Patients may need crutches or a walker during the first few weeks and are usually able to return to light activities within 3-6 months.
Best For:
- Individuals with severe knee osteoarthritis that affects daily activities
- Older adults or individuals who have not found relief through conservative treatments
4. Patellofemoral Pain Syndrome and Patellar Tendonitis
Overview:
Patellofemoral pain syndrome (PFPS) refers to pain around the kneecap, often caused by overuse, improper alignment, or injury. Patellar tendonitis (also known as “jumper’s knee”) involves inflammation of the tendon connecting the kneecap to the shinbone, typically caused by repetitive motion or overuse, especially in athletes.
Symptoms:
- Pain at the front of the knee, especially after climbing stairs or kneeling
- Swelling and tenderness around the kneecap
- Weakness or tightness in the quadriceps
Surgical Treatment:
Patellar Tendon Repair or Realignment Surgery
- Patellar Tendon Repair: In cases of chronic tendonitis or a torn tendon, surgery may be required to repair the tendon or replace it with a graft.
- Realignment Surgery: For PFPS, if the kneecap is misaligned and causing abnormal movement, a realignment procedure may be performed to reposition the patella.
Procedure:
- Patellar tendon repair is typically performed with an incision over the tendon, while realignment surgery may involve making adjustments to the alignment of the patella or surrounding tissues.
Best For:
- Patients with chronic patellar tendonitis that does not respond to rest and rehabilitation
- Individuals with patellofemoral pain syndrome caused by misalignment of the kneecap
5. Bursitis
Overview:
Bursitis occurs when the bursae (small fluid-filled sacs that cushion the knee joint) become inflamed, typically as a result of repetitive motion or trauma. This condition often affects the prepatellar bursa (in front of the kneecap) or the infrapatellar bursa (below the kneecap).
Symptoms:
- Swelling and warmth around the knee
- Tenderness when touching the affected area
- Pain that worsens with kneeling or squatting
Surgical Treatment:
Bursectomy
- If conservative treatments such as rest, ice, and medications do not relieve symptoms, a bursectomy (removal of the inflamed bursa) may be performed.
Procedure:
- A bursectomy is typically performed using minimally invasive techniques, where small incisions are made to remove the bursa.
Best For:
- Patients with chronic or severe bursitis that does not respond to conservative treatments
Conclusion
Knee surgeries have advanced significantly over the years, offering effective solutions for a variety of knee conditions ranging from meniscus tears to severe arthritis. Whether you’re dealing with a torn ACL, a meniscus injury, or the debilitating effects of osteoarthritis, there are several surgical options available that can restore knee function, alleviate pain, and improve your quality of life.
While each surgery carries its own set of risks and recovery times, advancements in minimally invasive techniques and prosthetic materials have greatly improved outcomes and reduced recovery times for most procedures. If you’re considering knee surgery, consult with an experienced orthopedic surgeon to determine the best course of action for your specific condition and lifestyle.