Knee

 

Knee Anatomy

The knee is a complex joint made up of different structures including bones, tendons, ligaments and muscles. They all work together to maintain normal function and provide stability to the knee during movement.

Having a well-functioning healthy knee is essential for our mobility and ability to participate in various activities. Understanding the anatomy of the knee enhances your ability to discuss and choose the right treatment procedure for knee problems with your doctor.

To learn more about the anatomy of the knee, click on the links below:

 

Conditions

Knee Pain

The knee is one of the largest joints in the body, formed by the lower end of the femur, upper end of the tibia, and the patella or knee cap. Several ligaments and muscles attach to the bones of the knee joint to maintain normal motion of the joint. Special cartilaginous tissues known as menisci are placed between the two ends of the joint. These act as a cushion between the surfaces and absorb the shock during movement.

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Anterior Knee Pain

Anterior knee pain is characterized by chronic pain over the front and center of the knee joint. It is common in athletes, active adolescents (especially girls), and overweight individuals. Anterior knee pain refers to a variety of conditions which include runner's knee or patellar tendinitis and chondromalacia of the patella.

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Runner’s Knee

Runner's knee, also called patellofemoral pain syndrome refers to pain under and around your kneecap. Runner’s knee includes several medical conditions such as anterior knee pain syndrome, patellofemoral malalignment, and chondromalacia patella that cause pain around the front of the knee. As the name suggests, runner’s knee is a common complaint among runners, jumpers, and other athletes such as skiers, cyclists, and soccer players.

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Osgood Schlatter Disease

Osgood-Schlatter disease refers to a condition of an overuse injury that occurs in the knee region of growing children and adolescents. This is caused by inflammation of the tendon located below the knee cap (patellar tendon). Children and adolescents who participate in sports such as soccer, gymnastics, basketball and distance running are at higher risk of this disease.

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Chondromalacia Patella

The patella, also called the kneecap is a small bone present on the front of your knee joint. The underside of the patella is covered by cartilage that allows smooth gliding of the knee with movement. Overuse or misalignment of the patella can cause wear and tear of the cartilage.

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Jumper’s Knee

Jumper’s knee, also known as “patellar tendinitis" is an inflammation of the patellar tendon that connects your kneecap (patella) to your shinbone. This tendon helps in extension of the lower leg.

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Bursitis

A bursa is a small fluid-filled sac found between soft tissues and bones. It lubricates and acts as a cushion to decrease friction between bones when they move. Bursitis refers to the inflammation and swelling of the bursa. Inflammation of the bursa in front of the kneecap (patella) is known as kneecap bursitis or prepatellar bursitis.

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Baker’s Cyst

The knee consists of a fluid called synovial fluid, which reduces friction between the bones of the knee joint while you move your leg. Sometimes this fluid is produced in excess, resulting in its accumulation in the back of your knee. A Baker’s cyst or popliteal cyst is a fluid-filled swelling that develops into a lump behind the knee. This causes stiffness, tightness and pain behind your knee. It is commonly seen in women and people aged over 40 (although it can develop at any age).

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Iliotibial Band Syndrome

Iliotibial band syndrome is an overuse injury resulting from the inflammation of iliotibial band. Iliotibial band is a tough group of fibers that begins at the iliac crest of hip and runs along the outside of the thigh, to get attached to the outer side of the shin bone just below the knee joint. Its function is to coordinate with the thigh muscles and provide stability the knee joint. Iliotibial band syndrome occurs when the iliotibial band and the lower outside portion of the thigh bone at the knee joint rub against each other. It commonly occurs in athletes, cyclists, and runners.

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Lateral Patellar Compression Syndrome

Lateral patellar compression syndrome refers to pain under and around your kneecap.  It is a common complaint among runners, jumpers, and other athletes such as skiers, cyclists, and soccer players.

The patella, also called kneecap, is a small flat triangular bone located at the front of the knee joint. It is a sesamoid bone embedded in a tendon that connects the muscles of the thigh to the shin bone (tibia). The function of the patella is to protect the front part of the knee.

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Osteochondritis Dissecans

Osteochondritis dissecans is a joint condition in which a piece of cartilage, along with a thin layer of the bone separates from the end of the bone because of inadequate blood supply. The separated fragments are sometimes called “joint mice”. These fragments may be localized, or may detach and fall into the joint space causing pain and joint instability.

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Shin Splints

“Shin splints” is used to describe the pain and inflammation of the tendons, muscles and bone tissue around the tibia or shine bone (a large bone in the lower leg). It occurs because of vigorous physical activity such as exercise or sports. The condition is also referred to as medial tibial stress syndrome (MTSS).

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Knee Injury

Pain, swelling and stiffness are the common symptoms of any damage or injury to the knee. If care is not taken during the initial phases of injury, it may lead to joint damage that may end up destroying your knee.

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Unstable Knee

The knee joint is one of the largest joints in the body. This highly complex joint has several tissues supporting and stabilizing its movement:

  • Condyles and menisci: Bony protrusions of the thigh bone called condyles fit snugly into the depressions of the lateral and medial menisci (spongy cartilage) of the shin bone
  • Ligaments: bands of tissue crisscross across the joint bones, connecting and holding them in place
  • Capsules: tissue that connects the bones of the knee, by forming a sleeve over the joint
  • Muscles: provide secondary stability

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Goosefoot Bursitis of the Knee

A bursa is a small fluid-filled sac found between soft tissues and bones. It lubricates and acts as a cushion to decrease friction between bones when they move. Bursitis refers to the inflammation and swelling of the bursa. Goosefoot bursitis or pes anserine bursitis is the inflammation of the bursa present between the tendons of the hamstring muscle and the tibia (shinbone) on the inner side of the knee.

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Knee Sprain

Knee sprain is a common injury that occurs from overstretching of the ligaments that support the knee joint. A knee sprain occurs when the knee ligaments are twisted or turned beyond its normal range causing the ligaments to tear.

Some of the common causes of a knee sprain include forceful twisting of the knee, sudden stop while running, direct blow to the knee, and fall that results in landing on your knees. The factors that increase the risk of knee sprain include participation in sports activities such as skiing, poor coordination, poor balance, and inadequate flexibility and strength in muscles and ligaments.

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ACL Tears

The anterior cruciate ligament, or ACL, is one of the major ligaments of the knee that is in the middle of the knee and runs from the femur (thigh bone) to the tibia (shin bone). It prevents the tibia from sliding out in front of the femur. Together with posterior cruciate ligament (PCL) it provides rotational stability to the knee.

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MCL Tears

The medial collateral ligament (MCL) is the ligament that is located on the inner part of the knee joint. It runs from the femur (thighbone) to the top of the tibia (shinbone) and helps in stabilizing the knee. Medial collateral ligament (MCL) injury can result in a stretch, partial tear, or complete tear of the ligament. Injuries to the MCL commonly occur because of a pressure or stress on the outside part of the knee. Anterior cruciate ligament (ACL) may be torn along with a MCL injury.

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MCL Sprain

The medial collateral ligament (MCL), a band of tissue present on the inside of your knee joint, connects your thigh bone and shin bone (bone of your lower leg). The MCL maintains the integrity of the knee joint and prevents it from bending inward.

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Meniscal Injuries

The knee is one of the most complex and largest joint in the body, and is more susceptible to injury. Meniscal tears are one among the common injuries to the knee joint. It can occur at any age, but are more common in athletes playing contact sports.

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Meniscal Tears

Meniscus tear is the commonest knee injury in athletes, especially those involved in contact sports. A suddenly bend or twist in your knee cause the meniscus to tear. This is a traumatic meniscus tear. Elderly people are more prone to degenerative meniscal tears as the cartilage wears out and weakens with age. The two wedge-shape cartilage pieces’ present between the thighbone and the shinbone are called meniscus. They stabilize the knee joint and act as “shock absorbers”.

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Ligament Injuries

The knee is a complex joint which consists of bone, cartilage, ligaments and tendons that make joint movements easy and at the same time more susceptible to various kinds of injuries.

Knee problems may arise if any of these structures get injured by overuse or suddenly during sports activities. Pain, swelling, and stiffness are the common symptoms of any damage or injury to the knee.

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Multiligament Instability

The knee is a complex joint of the body which is vital for movement. The four major ligaments of the knee are anterior cruciate ligament, posterior cruciate ligament, medial collateral ligament and lateral collateral ligament. They play an important role in maintaining the stability of the knee. An injury resulting in tear of one or more ligaments of the knee thus affects knee stability. Such injuries occur because of direct blow to the knee, or a fall from a height, or motor vehicle trauma.

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Knee Arthritis

Arthritis is a general term covering numerous conditions where the joint surface or cartilage wears out. The joint surface is covered by a smooth articular surface that allows pain free movement in the joint. This surface can wear out for several reasons; often the definite cause is not known.

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Patellar Dislocation/Patellofemoral Dislocation

Patella (knee cap) is a protective bone attached to the quadriceps muscles of the thigh by quadriceps tendon. Patella attaches with the femur bone and forms a patellofemoral joint. Patella is protected by a ligament which secures the kneecap from gliding out and is called as medial patellofemoral ligament (MPFL).

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PCL Injuries

Posterior cruciate ligament (PCL), one of four major ligaments of the knee are situated at the back of the knee. It connects the thighbone (femur) to the shinbone (tibia). The PCL limits the backward motion of the shinbone.

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Chondral (Articular Cartilage Defects)

Articular or hyaline cartilage is the tissue lining the surface of the two bones in the knee joint. Cartilage helps the bones move smoothly against each other and can withstand the weight of the body during activities such as running and jumping. Articular cartilage does not have a direct blood supply to it so has less capacity to repair itself. Once the cartilage is torn it will not heal easily and can lead to degeneration of the articular surface, leading to development of osteoarthritis.

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Patellar Instability

Patellar (knee cap) instability results from one or more dislocations or partial dislocations (subluxations). Patella is the small piece of bone in front of the knee that slides up and down the femoral groove (groove in the femur bone) during bending and stretching movements. The ligaments on the inner and outer sides of patella hold it in the femoral groove and avoid dislocation of patella from the groove.

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Patellofemoral Instability

The knee can be divided into three compartments: patellofemoral, medial and lateral compartment. The patellofemoral compartment is the compartment in the front of the knee between the knee cap and thigh bone. The medial compartment is the area on the inside portion of the knee, and the lateral compartment is the area on the outside portion of the knee joint. Patellofemoral instability means that the patella (kneecap) moves out of its normal pattern of alignment. This malalignment can damage the underlying soft structures such as muscles and ligaments that hold the knee in place.

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Patella Fracture

The knee cap or patella is the largest sesamoid bone in the body and one of the components of the knee joint, present at the front of the knee. The undersurface of the kneecap and the lower end of the femur are coated with articular cartilage, which helps in smooth movement of the knee joint. The knee cap protects the knee and provides attachment to various muscle groups of the thigh and leg. Fracture of knee cap is rare and is more common in adult males.

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Recurrent Patella Dislocation

The patella (knee cap) is a small bone that shields your knee joint. It is found in front of your knee, in a groove called the trochlear groove that sits at the junction of the femur (thighbone) and tibia (shinbone). Articular cartilage present below the patella and end of the femur cushion and help the bones glide smoothly over each other when the legs move. This joint is stabilized and supported by a network of soft tissues. The medial patellofemoral ligament (MPFL) connects to the inner side of the patella and helps to keep it from slipping away from the knee. Damage to this ligament leads to patellar dislocation.

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Quadriceps Tendon Rupture

Quadriceps tendon is a thick tissue located at the top of the kneecap. The quadriceps tendon works together with the quadriceps muscles to allow us to straighten our leg. The quadriceps muscles are the muscles located in front of the thigh.

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Patella Tendon Rupture

Patella tendon rupture is the rupture of the tendon that connects the patella (knee cap) to the top portion of the tibia (shin bone). The patellar tendon works together with the quadriceps muscle and the quadriceps tendon to allow your knee to straighten out.

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Lateral Meniscus Syndrome

The knee joint is formed by the union of two bones, namely the femur (thigh bone) and the tibia (lower leg bone). At the junction of these two bones is a cartilage called the meniscus, which acts as a shock absorber. There are two menisci – the lateral and medial menisci. The lateral meniscus is the outer meniscus of the knee joint and gives a cushioning effect during weight bearing activities. Lateral meniscus syndrome is characterized by an injury caused by the tearing of the cartilage tissue or a rare case of a congenital abnormality called a discoid meniscus, which results in knee pain.

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Medial Meniscus Syndrome

Of the menisci within the knee, it is the medial that is more easily injured. Differences in the anatomical attachments of the medial meniscus compared to the lateral mean that the medial meniscus becomes distorted during combined flexion and rotation movements in a manner not experienced on the lateral side.

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Tibial Eminence Spine Avulsions

Tibial eminence spine avulsion fracture is avulsion (tear away) of the tibial eminence (an extension on the bone for attachment of muscles) which most commonly involves the anterior cruciate ligament (ACL) insertion site. This injury represents the childhood equivalent of the anterior cruciate ligament (ACL) rupture and may occur because of abnormal outward bending or twist, injuries caused by sudden halt of moving joints, excessive flexion (bending inwards) and internal rotation as happens in skiing and in motor vehicle accidents.

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Osteonecrosis of the Knee

Osteonecrosis is a condition in which death of a section of bone occurs because of lack of blood supply to it. It is one of the most common causes of knee pain in older women. Women over the age of 60 years of age are commonly affected, three times more often than men.

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Knee Angular Deformities

Angular deformities of the knee are common during childhood and usually are variations in the normal growth pattern. Angular deformity of the knee is a part of normal growth and development during early childhood. Physiologic angular deformities vary with age as:

  • During first year: Lateral bowing of tibia
  • During second year: Bow legs (knees and tibia)
  • Between 3-4 years: Knock Knees

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Procedures

Non-surgical Treatments

Pharmacological

The knee is a complex joint which consists of bone, cartilage, ligaments and tendons that make joint movements easy and at the same time more susceptible to various kinds of injuries. Knee problems may arise if any of these structures get injured by overuse or suddenly during sports activities. Injuries to the knee can be caused by degenerative disease such as arthritis, traumatic injuries and sports injuries. These conditions may affect the bones & joints and impair the mobility as well as the quality of life of the patients.

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Platelet Rich Plasma (PRP)

Our blood consists of a liquid component known as plasma. It also consists of three main solid components which include the red blood cells (RBCs), white blood cells (WBCs), and platelets. Platelets play an important role in forming blood clots. They also consist of special proteins, known as growth factors, which help with our body’s healing process. Platelet-rich plasma or PRP is a high concentration of platelets and plasma. A normal blood specimen contains only 6% platelets, while platelet-rich plasma contains 94% of platelets and 5 to 10 times the concentration of growth factors found in normal blood, thus greater healing properties.

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Viscosupplementation

Viscosupplementation refers to the injection of a hyaluronan preparation into the joint. Hyaluronan is a natural substance present in the joint fluid that assists in lubrication. It allows smooth movement of the cartilage covered articulating surfaces of the joint.

Synvisc is one of the most commonly used hyaluronan preparations. It is indicated in the management of shoulder, knee, hip or ankle osteoarthritis that has not responded to non-surgical treatment options such as pain medications, physical therapy and corticosteroid injections.

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Cortisone Injection

Cortisone is a corticosteroid released by the adrenal gland in response to stress and is a potent anti-inflammatory agent. Artificial preparations containing cortisone are injected directly into the affected joint to relieve pain and reduce inflammation. The effects may last for several weeks and cortisone injections are recommended in injuries that cause pain & inflammation and those don’t require surgical treatment. One such condition frozen shoulder and cortisone injection into shoulder joint relieves pain & inflammation.

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Physiotherapy

Physiotherapy or physical therapy is an exercise program that helps you to improve movement, relieve pain, encourage blood flow for faster healing, and restore your physical function and fitness level. The main aim of physical therapy is to make your daily activities such as walking, getting in and out of bed, or climbing stairs easier. It can be prescribed as an individual treatment program or combined with other treatments.

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Surgical Treatment

Knee Arthroscopy

Knee Arthroscopy is a common surgical procedure performed using an arthroscope, a viewing instrument, to consider the knee joint to diagnose or treat a knee problem. It is a relatively safe procedure and most the patient’s discharge from the hospital on the same day of surgery.

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Knee Replacement and Reconstruction

Knee Osteotomy

Knee Osteotomy is a surgical procedure in which the upper shinbone (tibia) or lower thighbone (femur) is cut and realigned. It is usually performed in arthritic conditions affecting only one side of your knee and the aim is to take pressure off the damaged area and shift it to the other side of your knee with healthy cartilage. During the surgery, your surgeon will remove or add a wedge of bone either below or above the knee joint depending on the site of arthritic damage.

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High Tibial Osteotomy

High tibial osteotomy is a surgical procedure performed to relieve pressure on the damaged site of an arthritic knee joint. It is usually performed in arthritic conditions affecting only one side of your knee and the aim is to take pressure off the damaged area and shift it to the other side of your knee with healthy cartilage. During the surgery, your surgeon will remove or add a wedge of bone either below or above the knee joint depending on the site of arthritic damage.

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Tibial Tubercle Osteotomy

Tibial tubercle osteotomy is a surgical procedure which is performed along with other procedures to treat patellar instability, patellofemoral pain, and osteoarthritis. This is a quite safe procedure and provides excellent access and surgical exposure during a difficult primary or revision total knee arthroplasty. Surgical treatment is indicated when physical therapy and other nonsurgical methods have failed and there is history of multiple knee dislocations.

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Unicompartmental Knee Replacement

Unicompartmental knee replacement is a minimally invasive surgery in which only the damaged compartment of the knee is replaced with an implant. It is also called a partial knee replacement. The knee can be divided into three compartments: patellofemoral, the compartment in front of the knee between the knee cap and thigh bone, medial compartment, on the inside portion of the knee, and lateral compartment which is the area on the outside portion of the knee joint.

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Patellofemoral Knee Replacement

Patellofemoral Knee Replacement surgery may be recommended by your surgeon if you have osteoarthritis contained to the patellofemoral compartment and you have not obtained adequate relief with conservative treatment options.

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What is new in Knee Replacement

For a patient considering knee replacement surgery, there are new developments under study which can help enhance their quality of life. These include:

  • Use of cementless parts that allow new bone to grow into a porous prosthesis and hold the parts in place, creating a biologic fixation
  • Use of bioactive joint surfaces such as hydroxyapatite
  • The use of mobile-bearing knee replacement in which a polyethylene insert creates a dual-surface articulation by articulating with the femoral as well as tibial components. This will enhance the life of the implant by reducing wear.
  • Development of systems with improved kinematics
  • Better fixation

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Computer Navigation for Total Knee Replacement

A total knee replacement surgery is the last resort to relieve pain and restore function in knee damaged by arthritis or an injury when non-surgical treatments do not relieve the condition. The procedure involves replacing the damaged surfaces of the articulating bones with the artificial implant. Most of these implants wear with use. Thus, the risk of need for revision surgery is high in young and active people if the implant must last the lifetime of the patient. The life of the implant can be extended by precise alignment of the implant and this can be achieved using computer navigation for total knee replacement surgery.

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Total Knee Replacement

Total knee replacement, also called total knee arthroplasty, is a surgical procedure in which the worn out or damaged surfaces of the knee joint are removed and replaced with artificial parts. The knee is made up of the femur (thigh bone), the tibia (shin bone), and patella (kneecap). The meniscus, the soft cartilage between the femur and tibia, serves as a cushion and helps absorb shock during motion. Arthritis (inflammation of the joints), injury, or other diseases of the joint can damage this protective layer of cartilage, causing extreme pain and difficulty in performing daily activities. Your doctor may recommend surgery if non-surgical treatment options have failed to relieve the symptoms.

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Revision Knee Replacement

Revision knee replacement surgery involves replacing part or all your previous knee prosthesis with a new prosthesis. Although total knee replacement surgery is successful, sometimes the procedure can fail due to various reasons and require a second revision surgery.

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Robotic Assisted Partial Knee Surgery

Robotic assisted partial knee surgery is an innovative alternative to the conventional surgical procedure in patients suffering from degenerative knee diseases such as osteoarthritis. It is performed using robotic-arm technology that allows the surgeon to precisely perform the surgery through a smaller incision as compared to traditional surgery.

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Medial Patellofemoral Ligament Reconstruction

Medial patellofemoral ligament reconstruction is a surgical procedure indicated in patients with more severe patellar instability. Medial patellofemoral ligament is a band of tissue that extends from the femoral medial epicondyle to the superior aspect of the patella. Medial patellofemoral ligament is the major ligament which stabilizes the patella and helps in preventing patellar subluxation (partial dislocation) or dislocation.

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Distal Realignment Procedures

Distal realignment procedures, also known as TTT or tibial tubercle transfer procedures are performed to reposition the kneecap by realigning the tendon under the kneecap to the underlying tibial tubercle. Tibia tubercle is the bony lump on the tibia (bone in the lower leg) below the knee cap. This serves as an attachment point for the patellar ligaments, tendons, and muscles. These procedures are done to prevent patellar subluxation or dislocation.

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Arthroscopic Reconstruction of the Knee for Ligament Injuries

The knee is the most complex joint in the body and is formed by the articulation between the thigh bone (femur) and the shinbone (tibia). A knee cap is present over the front of the joint to provide extra protection. These bones are held together by four strong rope like structures called ligaments. Two collateral ligaments are present on either side of the knee and control the sideway movements of the knee.

Find out more about Arthroscopic Reconstruction of the Knee for Ligament Injuries, click on below link.

 

PCL Reconstruction

Posterior cruciate ligament (PCL), one of four major ligaments of the knee are situated at the back of the knee. It connects the thighbone (femur) to the shinbone (tibia). The PCL limits the backward motion of the shinbone.

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LCL Reconstruction

Lateral collateral ligament (LCL) is a thin set of tissues present on the outer side of the knee, connecting the thighbone (femur) to the fibula (side bone of lower leg). It provides stability as well as limits the sidewise rotation of the knee. Tear or injury of LCL may cause instability of the knee that can be either reconstructed or repaired to regain the strength and movement of the knee.

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ACL Reconstruction

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

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Outpatient Total Knee Replacement

Total knee replacement is the surgical treatment for knee arthritis, where the damaged knee is removed and replaced with an artificial knee implant. Traditionally performed as an inpatient procedure, total knee replacement surgery is now being conducted on an outpatient basis, allowing patients to go home the same day of the surgery. This is made possible with recent advances such as improved perioperative anesthesia, minimally invasive techniques and initiation of rehabilitation protocols soon after surgery.

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Tricompartmental Knee Replacement

Tricompartmental knee replacement, also called total knee arthroplasty, is a surgical procedure in which the worn out or damaged surfaces of the knee joint are removed and replaced with artificial parts. The knee is made up of the femur (thigh bone), the tibia (shin bone), and patella (kneecap). The meniscus, the soft cartilage between the femur and tibia, serves as a cushion and helps absorb shock during motion. Arthritis (inflammation of the joints), injury, or other diseases of the joint can damage this protective layer of cartilage, causing extreme pain and difficulty in performing daily activities.

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After Knee Replacement

Knee replacement is a surgery performed to replace parts of a diseased knee joint with an artificial prosthesis. The goal of knee replacement is to eliminate pain and return you to your normal activities. You can help in recovery and improve the outcomes of the procedure by following certain precautions and changing the way you carry out your daily activities.

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Patient Specific Knee Options

Custom - fitted Total Knee Arthroplasty

Custom fitted total knee arthroplasty is a newer technology in total knee replacement surgery. It is an advanced procedure using an individualized patient-specific knee implant for replacement of all three components of the knee. The difference with custom knee replacement from other knee replacement surgeries is the use of an MRI scan prior to the surgery that provides a clear view of the shape and structure of the different components of the joint.

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Signature Knees

The knee joint, made up of the ends of the femur (thigh bone) and tibia (shin bone) is cushioned by a spongy tissue called cartilage. Damage and wear and tear of the cartilage causes painful rubbing of the joint bones, leading to disability. This condition can be successfully treated with knee replacement surgery, which involves the replacement of the damaged tissue with a prosthetic implant.

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Knee Implants

Knee implants are artificial devices that form the essential parts of the knee during a knee replacement surgery. The knee implants vary by size, shape, and material. Implants are made of biocompatible materials that are accepted by the body without producing any rejection response. Implants can be made of metal alloys, ceramics, or plastics, and can be joined to the bone. The metals used include stainless steel, titanium, and cobalt chrome; whereas, the plastic used is polyethylene.

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Cartilage Restoration

Patellar Tendon Repair

Patella tendon rupture is the rupture of the tendon that connects the patella (knee cap) to the top portion of the tibia (shin bone). The patellar tendon works together with the quadriceps muscle and the quadriceps tendon to allow your knee to straighten out.

Find out more about Patellar Tendon Repair, click on below link.

 

Knee Ligament Reconstruction

The knee is the most complex joint in the body and is formed by the articulation between the thigh bone (femur) and the shinbone (tibia). A knee cap is present over the front of the joint to provide extra protection. These bones are held together by four strong rope like structures called ligaments. Two collateral ligaments are present on either side of the knee and control the sideway movements of the knee.

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Cartilage Replacement

Cartilage replacement is a surgical procedure performed to replace the worn-out cartilage with the new cartilage. It is usually performed to treat patients with small areas of cartilage damage usually caused by sports or traumatic injuries. It is not indicated for those patients who have advanced arthritis of knee. Articular or hyaline cartilage is the tissue that covers bone surface of the knee which helps in smooth interaction between the two bones in knee joint. It has less capacity to repair by itself because there is no direct blood supply to cartilage.

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Cartilage Repair and Transplantation

Articular Cartilage is the white tissue lining the end of bones where these bones connect to form joints. Cartilage acts as cushioning material and helps in smooth gliding of bones during movement. An injury to the joint may damage this cartilage which cannot repair on its own. Cartilage can be damaged with increasing age, normal wear and tear, or trauma. Damaged cartilage cannot cushion the joints during movement and the joints may rub over each other causing severe pain and inflammation.

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OATS

OATS is “osteochondral autograft transfer system”. It is one of the two types of cartilage transfer procedures and the other procedure is “Mosaicplasty”. Cartilage transfer procedures involve moving healthy cartilage from a non-weight bearing area of the knee to a damaged area of the cartilage in the knee. In mosaicplasty, plugs of cartilage and bone are taken from a healthy cartilage area and moved to replace the damaged cartilage of the knee. Multiple tiny plugs are used and once embedded, resembles a mosaic pattern, hence the name.

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Resurfacing

Bicompartmental Knee Resurfacing

The knee can be divided into three compartments: Patellofemoral, the compartment on the front of the knee which contains the knee cap, medial compartment, the compartment on the inside of the knee, and lateral compartment which is the area on the outside of the knee joint.

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Partial Knee Resurfacing

Partial knee replacement is an alternative to total knee replacement in patients with arthritis on only one side of the knee. Partial knee replacement is a surgical procedure which involves resurfacing and replacement of only the diseased surface of the joint instead of the entire joint.

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Others

Autologus Chondrocyte Implantation

Autologous chondrocyte implantation (ACI) is a procedure to treat the articular cartilage defects of the knee. This procedure is effective for treating small areas of cartilage damage that causes pain and swelling and restricts the range of motion. Autologous chondrocyte implantation is not indicated for those patients who have advanced arthritis of knee.

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Subchondroplasty

Knee osteoarthritis (OA) is a common form of arthritis that causes joint pain and stiffness. It is a progressive disease in which the joint cartilage gradually wears away and may lead to disability.

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Partial Meniscectomy

Partial meniscectomy is a surgical procedure to remove the torn portion of the meniscus from the knee joint. Meniscus is the C-shaped cartilage located in the knee that lubricates the knee joint, acts as shock-absorber, and controls the flexion and extension of joint. Meniscal tears can occur at any age, but are more common in athletes playing contact sports. These tears are usually caused by twisting motion or over flexing of the knee joint. Athletes who play sports, such as football, tennis and basketball are at a higher risk of developing meniscal tears.

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Meniscal Surgery

Meniscus tear is the commonest knee injury in athletes, especially those involved in contact sports. A suddenly bend or twist in your knee cause the meniscus to tear. This is a traumatic meniscus tear. Elderly people are more prone to degenerative meniscal tears as the cartilage wears out and weakens with age. The two wedge-shape cartilage pieces’ present between the thighbone and the shinbone are called meniscus. They stabilize the knee joint and act as “shock absorbers”.

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Limb Lengthening

Limb lengthening is a reconstructive procedure where the deformed bone is straightened or missing bone is replaced. It is performed in children and adults who have variations in their leg length because of diseases, injuries or birth defects. Limb lengthening procedure can be performed by minimally invasive techniques and may require a hospitalization of 1-2 nights.

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