Knee

The knee joint is one of the largest and most anatomically complex joints of all human joints. It is especially prone to injuries. Knee, cruciate ligament, meniscus and kneecap injuries are common, especially in physically active people. The knee joint becomes injured when its structures have to withstand loads that exceed their physiological endurance.

The most common knee problems

The most frequently damaged part of the knee is the meniscus, which is responsible for shock absorption. The ligaments stabilizing the knee and the patella are also often injured. Joint dislocations, cartilage injuries, inflammation and tendon rupture are also common.

Knee diagnosis

The diagnosis of the knee joint begins at the doctor’s office. During the orthopedic consultation, the doctor conducts an interview and palpation in a standing, sitting and lying position. The orthopedist examines the range of motion and its final resistance, as well as stability. He also performs orthopedic tests.

The doctor may order imaging tests to confirm or detect other pathologies. In the case of the knee, these are: X-ray examination , ultrasound examination and magnetic resonance imaging. X-ray shows the condition of the bones and, indirectly, the articular cartilage, while the MRI shows the condition of all joint structures. Ultrasound examination shows the condition of the soft tissues of the knee joint (menisci, cartilage, ligaments).

Knee treatment methods

The choice of treatment method depends on the diagnosis, as well as the age, efficiency and expectations of the patient. A different method of treatment is offered to young people who want to return to sports activities, and another to older people who want to live without pain.

The knee joint can be treated conservatively by means of pharmacological treatment or using appropriate rehabilitation methods. Sometimes regenerative medicine is also helpful. It reduces pain, strengthens and relieves the knee. Its use accelerates the regenerative abilities of the affected joint.

  • Viscosupplementation – this procedure involves injecting a natural substance into the affected joint: hyaluronic acid. It is a component of the synovial fluid. Its task is to moisturize the cartilage and protect all elements of the joint from damage. If there is not enough of it, damage occurs faster. The injection of hyaluronic acid soothes and eliminates pain.
  • Platelet-derived growth factor concentrates – a substance found in blood plasma. They are obtained by centrifugation and appropriate preparation of a blood sample of each patient. Then they are applied directly into the joint. Growth factors stimulate the healing of damage in the body.
  • Administration of multipotent cells (pericytes) – in the bone marrow haematopoietic cells predominate, while there are relatively few mesenchymal cells with a regenerative effect, which is why the Carolina Medical Center introduced orthopedic therapy using span style=”color: #219e9f;”>autogenous multipotent cells obtained from adipose tissue. Their use may accelerate the regeneration of a damaged joint. It is the latest method that is used, but still requires further research to confirm its effectiveness.

In the case of advanced disorders of the knee joint or when serious injuries occur, surgery is required.

At the Carolina Medical Center, we always put the good of the patient first, which is why we use modern, minimally invasive surgical techniques, referred to by orthopedists as “preserving surgery”. These are methods thanks to which patients do not experience the lack of feeling deep in the muscles and tendons and maintain their own joint. They are dedicated mainly to young people who want to stay physically active at all costs.

One of the methods of saving the patient’s joint is arthroscopy of the knee joint. It enables the diagnosis of the joint, conducting an operation, and removal of the cause of pain. During arthroscopy, various procedures are performed, including ligament reconstruction (e.g., anterior cruciate ligament reconstruction, multi-ligament reconstruction), cartilage reconstruction, suturing or repair of the meniscus (removal of the damaged fragment of the meniscus), removal of loose bodies from the joint.

Among the surgical methods of treating the knee joint, we can distinguish osteotomy, commonly known as “controlled breakdown”. It is designed to minimize the progression of degenerative changes and is an alternative to more invasive surgeries.

In advanced osteoarthritis, knee arthroplasty gives a chance to recover and return to normal functioning in everyday life. It is performed in patients who have not had good results with other methods of treatment and have contraindications for the procedure using the arthroscopic technique.

Knee rehabilitation

Rehabilitation is a fundamental element of conservative and postoperative treatment of injuries and diseases of the knee joint. Thanks to properly selected therapy, it is possible to reduce pain, increase the range of motion and strengthen the weakened parts of the joint. Rehabilitation also improves articular slide (moistening of the cartilage).

The knee is the most commonly treated body part in physical therapy. Patients with knee problems have usually suffered an injury or are struggling with chronic ailments. In acute patients, early intervention is essential, as it protects the patient from additional injuries and ensures optimal healing conditions. In the rehabilitation of the knee joint, the interview and examination are of key importance, on the basis of which the physiotherapist selects an individual therapy taking into account the patient’s condition. The treatment does not end with the knee joint – it is important to have a broader view of the entire lower limb, and even the entire figure. Apart from strengthening the muscles and stabilizing them, functional exercises are also very important. Therefore, it is worth including medical training at a certain stage of rehabilitation.

lek. Łukasz Luboiński

Specjalista ortopedii i traumatologii narządu ruchu

Jestem Ordynatorem Oddziału Ortopedii i Traumatologii Narządu Ruchu w Carolina Medical Center. Specjalizuję się m.in. w przeszczepach łąkotek, rekonstrukcji chrząstki, rekonstrukcjach wielowięzadłowych i osteotomiach w obrębie stawów kolanowych. Wykonuję także artroskopię stawu biodrowego.

Knee treatment methods

Knee arthroscopy

  • Knee arthroscopy and osteotomy (fibula – PFO; tibia, femur)
  • Arthroscopy of the knee joint and reconstruction of the anterior cruciate ligament (simple, tibial osteotomy, with elevation of intra-articular fracture, with meniscus graft and meniscus implant, with reconstruction of the posterolateral complex, with WPP reconstruction and possible WPP suturing)
  • Knee arthroscopy and posterior cruciate ligament reconstruction (simple, with reconstruction of the posterolateral complex)
  • Knee arthroscopy and multi-ligament reconstructions
  • Arthroscopy of the knee joint and cartilage reconstruction (including open cartilage reconstruction), arthroscopy of the knee joint and medialization of the tibial tuberosity (possibly + medial patello-femoral ligament)
  • Knee arthroscopy and meniscus transplant
  • Knee arthroscopy and meniscus implant
  • Knee arthroscopy and suturing of the meniscus
  • Knee arthroscopy and loose body removal Knee arthroscopy and cyst removal – open treatment

Knee arthroplasty

  • Knee replacement
  • Knee prosthesis revision with replacement of the femoral and/or tibial elements
  • Knee prosthesis revision with or without replacement of the prosthesis components

Other knee operating procedures

  • Patellar ligament plastic surgery (jumper’s knee)
  • Reinsertion of muscle attachment in the knee area
  • Pseudarthrosis of the shaft of the femur/tibia
  • Removal of the prepatellar bursa of the knee joint
  • Limb lengthening at thigh level – stabilizer / TSF
  • Applying an 8-plate (or 2 x 8-plate)
  • Suture of the tibial collateral ligament
  • Suture of the peroneal collateral ligament
  • Fracture of the femoral/tibial end or shaft (simple / complex) – fixation with a plate / fixation with screws;
  • Patella fracture – fixation with screws or cerclage band under arthroscope control
  • Fracture of the femoral/tibial shaft – intramedullary fixation / TEN fixation

Knee injuries and ailments

  • Meniscus damage
  • Jumper’s knee
  • Patellofemoral pain
  • Damage to the meniscus
  • Fracture of the kneecap
  • Patellar dislocation
  • Damage to the anterior cruciate ligament
  • Knee flexor injury
  • Acute knee injury
  • Valgus or varus axis of the limb
  • Plica mediopatellaris
  • Fracture of the proximal end of the tibia
  • Anterior cruciate ligament (ACL) Damage
  • Degenerative diseases of the knee

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Iwona Gębicka
03.08.2017
"W Carolinie dostałam konkretną diagnozę i konkretne rozwiązanie problemu."