Please see Paediatric Orthopaedics
Pain or instability originating from the kneecap can be a significant cause of disability in both the child and adult patient. The symptoms can range from anterior knee pain through to recurrent dislocations of the kneecap. The assessment and management of patellofemoral problems requires a careful history and examination along with specific imaging of the bones and ligaments of the affected knee.
Management of the painful or dislocating kneecap will always start with a regimented physiotherapy program to ensure that every possible measure has been taken to avoid surgery. There are many different surgical options all which can have associated complications and it is very important to ensure that the appropriate surgical procedure is performed.
The meniscus are very specialised cartilages that act as shock absorbers and bearing surfaces between the thigh bone (femur) and the shin bone (tibia) in the knee joint. Knee injury often results in tears of these cartilages which can cause pain and mechanical symptoms of clicking and catching in the knee.
It is possible to repair certain tears that are not the result of chronic injury and degeneration in the knee. If the tear is old or the result of repetitive trauma, then the only treatment possible may be to “debride” or remove the area of affected tissue to prevent the symptoms from affecting your function.
Knee arthroscopy is used to perform both repair and debridement procedures. A small camera is used to see inside the knee joint through a small 1cm incision at the front of the knee. A second incision can be used to insert small instruments that enable the procedures to be performed while using the camera to see what is being done. Arthroscopy is usually performed as a day case, with rehabilitation tailored to the surgery performed.
ACL stands for Anterior Cruciate Ligament of the knee. The ACL connects the front part of the shin bone (tibia) to the back part of the thigh bone (femur) and helps to stabilize the knee in activities that require twisting or turning movement.
One of the most common ways for the ACL to be injured is by twisting the knee, which commonly happens in football, netball or a fall when skiing. In many cases, when the ACL is torn, the knee give way with an audible "pop." The injury is usually associated with a moderate amount of pain and continued activity is usually not possible. Over the next several hours, the knee becomes very swollen and walking becomes difficult.
ACL tears usually cause enough discomfort to cause the injured person to seek medical attention. It is not uncommon for an ACL injury to occur with an associated meniscal tear. There may also be injuries to the joint surface that are more difficult to diagnose. An MRI will assist in fully defining the extent of the injury.
Many people wonder if an ACL injury always requires surgery? The answer varies from person to person depending on their age, functional demands and expectations. Surgery usually involves taking one of the hamstring tendons and passing it through tunnels in the femur and tibia, so that the tendon graft recreates the position of the original ligament in the knee. Over a period of nine to twelve months the graft will develop a blood supply and recover the strength it requires to enable return to activities, without the sensation that the knee is going to give way.
When the cartilage in the knee joint wears away, the underlying bone is exposed and can cause severe pain and stiffness. Usually this results in a patient being significantly limited in their ability to walk. They may also notice that the shape of their leg changes, either becoming bow legged or knock kneed. When pain and function stops being amenable to non operative management, the option of a knee replacement may be offered in order to restore quality of life.
A total knee replacement is a major surgical procedure that involves removing the bone around the knee joint and replacing it with metal components that are separated by a plastic (polyethylene) insert. The aim of the surgery is to relieve pain caused by a degenerate knee joint. The operation carries significant risks that should be carefully considered by every patient who is offered the procedure.