Knee

Knee Anatomy :: Knee Arthroscopy :: Loose Body Removal
Partial Meniscectomy :: Synovectomies :: Debridement :: ACL Reconstruction
MOON Study :: MARS Study :: Treatment of Osteochondritis Dissecans

Normal Anatomy of the Knee Joint

How does the Knee joint work?
Find out more in this web based movie.

Arthroscopy of the Knee Joint

Arthroscopy is a surgical procedure in which an arthroscope is inserted into a joint. Arthroscopy is a term that comes from two Greek words, arthro-, meaning joint, and -skopein, meaning to examine.

The benefits of arthroscopy involve smaller incisions, faster healing, a more rapid recovery, and less scarring. Arthroscopic surgical procedures are often performed on an outpatient basis and the patient is able to return home on the same day.

Find out more about Knee Arthroscopy from the following links.

Loose Body Removal

Loose bodies are small loose fragments of cartilage or a bone that float around the knee joint The loose bodies can cause pain, swelling, and locking, and catching of the joint. Loose bodies occur if there is bleeding within the joint, death of tissues lining the joints associated with tuberculosis, osteoarthritis, and rheumatoid arthritis. Other causes include fractures, trauma, bone and cartilage inflammation, and benign tumors of the synovial membrane.

Loose bodies are commonly found in individuals who participate in sports since they are more susceptible to fractures and other sports injuries.

Often X-ray helps in diagnosing loose bodies. However, small loose bodies which contain little fragments of bone or no bone may not be visible on an X-ray. In such cases other diagnostic tests such as CT scan or arthrography, MRI scan and ultrasound may be performed to locate the loose body. For small loose bodies your doctor may prescribe anti-inflammatory medications to relieve pain and swelling. However any loose body that is causing the symptoms are removed.

The loose bodies are removed by arthroscopic procedure. Surgery is performed depending on the location and the size of the loose bodies.

A suction tip is used to withdraw the loose body or is held with a small needle and grasped with a surgical instrument called as grasper
If loose bodies are present in the knee joint space, a special instrument, called mechanical burr or a resector is used to break the loose bodies. The broken pieces will be easily degraded by the body by means of a mechanism called enzyme degradation
Large loose bodies which are caused by fractures, inflammation of bone and cartilage (osteocartilaginous loose bodies) are reduced and fixed to the position using screws or pin
If the loose body is caused by benign tumor of the synovial membrane, a procedure called partial synovectomy maybe done. It involves removal of part of the synovium
If loose bodies are present at the back of the knee, a procedure called arthrotomy may be done to remove it. This procedure involves an open surgery where incisions are made into the joint and the loose body is removed

Following surgery, rehabilitation program may be needed to control pain and restore function and strength to the involved knee.

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.

You may have pain over inner and outer side of the knee, swelling, stiffness of knee, restricted movement of the knee, and difficulty in straightening your knee. If the conservative treatment such as pain medications, rest, physical therapy, and use of knee immobilizers fails to relieve pain, then surgery may be recommended. Surgical treatment options depend on the location, length, and pattern of the tear.

For more information on Partial Meniscectomy click here

Synovectomies

Synovectomy is a surgical procedure performed to remove the inflamed synovium. Synovium is a thin layer of membrane which lines the joint capsule and secretes, a clear substance called synovial fluid. The main function of synovial fluid is to lubricate and nourish the cartilage and the bones inside the joint capsule. If the synovium becomes thick and inflamed, it is termed as synovitis, which is commonly seen in individuals suffering from rheumatoid arthritis.

Symptoms of rheumatoid arthritis include swelling, redness, and warmth over the joint. The inflamed synovium may destroy the cartilage or the bone at the joint and makes the joint and muscles weak. The loss of cartilage may lead to damage of the surface of the joint causing pain, stiffness, and difficulty in moving the joints.

Synovectomy is recommended if the pain and inflammation still persists and are not relieved by conservative treatment.

Synovectomy is indicated in:

Synovial chondromatosus, where fragments of cartilage or bone or loose bodies develops in the synovium
Pigmented villonodular synovitis, a condition where there is growth of the synovium
Hemophilia having recurrent hemarthrosis (bleeding inside the joint)

Synovectomy may be performed through open surgery or arthroscopically where the inflamed synovium or the entire synovial membrane is removed using an arthroscope.

This surgery helps to slow the progression of the disease and preserves the knee joint from other surgeries if it is performed very early. Some risks may be observed after surgery which include infection, partial paralysis of the nerve (partial nervous palsy), and inflammation of a vein (phlebitis). These risks can be treated accordingly.

Your doctor may recommend physical therapy to improve the stiffness and increase the range of motion.

Debridement

Osteoarthritis is a most common form of arthritis which affects the articular cartilage (tissue covering the ends of the bones) of the knee and also other joints such as shoulder, hip, ankle and foot. The articular cartilage cushions the joint so that there is smooth and pain-free movement between the bones in the joint. In this condition the articular cartilage is completely worn off, as a result the ends of the bones rub against each other causing pain and inflammation.

Other symptoms include restricted motion of the knee, stiffness in the muscles, and redness and warmth around the joint.

Your doctor will perform physical examination to look for joint swelling, tenderness, and limited range of motion. X-ray of the affected joint may be taken to see the loss of joint space.

If the conservative treatment such as medications and physical therapy does not provide relief then surgery may be considered as the last treatment option.

Arthroscopic debridement or a clean-up is a surgical procedure performed using an arthroscope. In this procedure, the cartilage or the bone that is damaged is removed using surgical instruments and the edges of the articular cartilage that are rough will be smoothened. A wash out or joint lavage is done using a special tool to spray jets of fluid to wash and suck out to remove the remaining debris around the joint. After lavage any remaining loose bodies or fragments are removed. Debridement helps to reduce pain and slows down the progression of arthritis. If you still observe pain and other symptoms because of the underlying cause of arthritis, debridement procedure may be repeated. After undergoing arthroscopic debridement procedure you may return to your sports and other activities much faster in comparison to the other traditional procedures.

Anterior Cruciate Ligament 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 centre of the knee running from the femur to the tibia. When this ligament tears unfortunately it doesn't heal and often leads to the feeling of instability in the knee.

ACL reconstruction is a commonly performed surgical procedure and with recent advances in arthroscopic surgery can now be performed with minimal incisions and low complication rates.

ACL Reconstruction Hamstring Tendon

ACL Reconstruction Patellar Tendon

Treatment of Osteochondritis Dissecans

Osteochondritis dissecans is a condition of loosening or detachment of a fragment of cartilage and underlying a bone in a joint. The fragment may be localized, loosely float in the joint space, or completely detach from the cartilage or bone. Exact cause for osteochondritis dissecans remains unknown and certain factors such as trauma, fractures, sprains, or injury to the joint are considered to increase the risk of developing the condition. Following the injury or trauma, the bones in the area may be deprived of blood flow leading to necrosis and finally the bone fragment may break off. This may initiate the healing process however by this time, articular cartilage will be compressed, flattened, and a subchondral cyst will be developed. All these changes in addition to increased joint pressure cause failure of healing of the joint.

Patients with osteochondritis dissecans experience symptoms such as joint pain, stiffness, restricted motion of joints, and locking at the joint.

For more information on Treatment of Osteochondritis Dissecans click here

Please use the links below to get more information from the American Academy of Orthopaedic Surgeons:

Broken Bones and Injury

Common Knee Injuries
Hamstring Muscle Strain
Muscle Strains in the Thigh

Fractures

Femur (Thighbone) Fractures in Adults
Femur (Thighbone) Fractures in Children Growth Plate Fractures Proximal Tibia Fractures
Shinbone (Tibia) Fractures
Stress Fractures

Tears and Instability

Kneecap, Unstable
Ligament Injuries of the Knee
Meniscus, Tears of
Posterior Cruciate Ligament, Tears of

Pain Syndromes

Osgood-Schlatter Disease (Knee Pain)
Runner's Knee (Patellofemoral Pain)
Shin Splints

Diseases and Syndromes