With a commitment to delivering the highest quality orthopaedic surgery and care, Dr Young will discuss all possible solutions to address your knee injury, and openly communicate the various outcomes.
Explore conditions and available treatments in more detail below.
Arthritis is a condition where the joint surface (articular cartilage) is worn away, by time, injury or – more rarely – other conditions (infection, inflammatory conditions or tumour). The articular cartilage normally distributes the load of the weight-bearing joint, and when worn away, the load borne by the bone is uneven and increased. When this happens joints are often stiff, swollen and painful, and gradually become deformed.
Early treatment includes weight loss and exercise since any reduction to weight borne by the joint may prove beneficial. An exercise bike is a great, low impact way to approach this condition.
Treatment with paracetamol and anti-inflammatory medications is often used next. Used intermittently, such tablets can reduce symptoms and preserve function.
Should these measures be unsuccessful, injections into the knee may be trialled.
Knee arthroscopy is a form of keyhole surgery where the internal structures of the knee can be assessed and problems treated. The surgery is usually performed as day surgery and patients rarely require walking aids (i.e. crutches or sticks) afterwards.
At least two small incisions (0.5cm) are made over the front of the knee, and a device placed into the knee to visualise the structures within. Special instruments are then used to perform the surgery, often including removal of loose and torn fragments.
The goal of knee arthroscopy is to reduce pain and improve function. It is possible that your knee condition requires more substantial treatment than what can be achieved by arthroscopy.
Probable outcomes of arthroscopic surgery are discussed in your pre-operative consultation, and any factors which may alter the results are highlighted.
As always, post-operative exercises are crucial to successful treatment.
Anterior Cruciate Ligament (ACL) reconstruction
The goal of ACL Reconstruction is to restore stability to the knee.
The ACL lies deep within the knee and is key to providing rotational and lateral stability. Patients who have injured their ACL will often complain their knee feels like it will give way if they change direction while walking or running.
ACL surgery takes about one hour and most often the ACL is reconstructed using the hamstring tendons from the inner side of the thigh. This is a common technique as the tendons reform, and so little function is lost in their use.
The tendons are passed into appropriate tunnels within the femur (thigh bone) and the tibia (below the knee) and secured. There are four small incisions, the largest being 3cm long. Patients stay in hospital overnight, and walk the next day using crutches for about five days. Exercise post-surgery, as always, is very important.
Medial Collateral Ligament (MCL) injuries in the knee are relatively common. They occur when undue force is applied to the lateral (outer) side of the leg, usually whilst the foot is on the ground, or force applied to the inner surface of the foot, if in the foot is in the air. These injuries hurt, with pain usually centred on the inner (medial) side of the knee.
In minor injuries often there is little swelling – not enough it seems to justify the pain. The knee is held flexed and when extension is tried the pain increases on the inner side of the knee. This occurs because the MCL is under more tension in extension.
In more substantial injuries there can be bruising on the inner side of the knee and at times induration (when pushed the fingers leave a dent). If there was marked force or a rotatory element to the injury, other structures can be injured too. These include the anterior cruciate ligament, the menisci (the ‘cartilages’ within the knee) and at times the smooth joint surface.
How is MCL assessed?
Assessment is by gentle examination – it is important to know the extent of injury as the treatment differs significantly. An MRI can identify if the ligament is injured but it often tells little in regard the extent of injury.
Most severe injuries (complete MCL disruption) are often associated with the least pain – this is because if all the fibres of the MCL are disrupted there is no longer any tension within those fibres. In this situation the knee is markedly unstable.
Treatment for MCL
Appropriate treatment of MCL injuries required early examination to assess the degree of injury. Most can be treated simply with a brace, however treatment must be early and the angle of the brace properly positioned otherwise a less than satisfactory result will ensue.
The symptoms of knee arthritis often fluctuate – the pain is variable as is the swelling. At times the knee feels unstable. As the condition progresses walking distance diminishes and sleep is interrupted. Generally people become sick of their symptoms and therefore consider treatments such as knee replacement.
The goal of knee replacement surgery is to diminish pain and improve function. It is performed for knees where the joint’s surface has been significantly worn away. Any deformity is also corrected at the time of operation.
Success rates for knee replacement surgery is very high. Most patients report a range of motion from full extension (able to straighten the leg fully, very important for regular walking) to 120 degrees flexion (being able to bend the knee back under the thigh). The ultimate motion achieved is a combination of the surgeon’s efforts and patients’ commitment during recovery.
Doctor Young uses real time (within the operating theatre) computer assistance to provide the most accurate placement of the new knee prosthesis, allowing for the very best outcome. Surgery takes about an hour, with a hospital stay of about two days. Upon going home, patients are able to bend the knee to a right angle, go up and down stairs, and walk with a stick over the following three weeks or so. The reduction of pain and increase in functional ability develop in the months that follow the operation. It is imperative that the post – operative exercises are continued throughout this period, with the replaced knee being its best by 18 to 24 months.
Most knee replacements should last between 20 and 25 years.
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Seeking a treatment that’s right for you? Arrange a consultation with Doctor Young today. Call 02 4958 7777 or make an enquiry below.