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Knee Surgery

TEN

Knee Surgery

As technology continues to advance, the

armamentarium of procedures available

for dealing effectively with damage inside

in the knee joint continues to expand

and improve.The number of people

participating in regular exercise and sport

is increasing, and people are living longer

and staying more active into their later

years, with higher expectations.Therefore,

the number of people presenting to knee

surgeons with significant joint damage

to their knees is increasing. It has been

estimated that the number of people

needing knee replacements is set to

increase by over 600% by the year 2030.

Knee replacement surgery is highly

effective, with patient satisfaction rates in

the region of about 90%, and with 95% of

artificial knees working effectively after 10

years, and 80 to 85% still being fine after

20 years. However, the younger a person

is when a knee replacement is put in, the

more impact and the more movement

cycles the prosthesis will be subjected

to; hence, a faster rate of wear and tear.

Furthermore, the younger a patient is,

the longer they will live and therefore the

longer they will need their new knee to last.

This is a ‘double whammy’: if someone has

a knee replacement when they are in their

50s then there is about a 50% chance of the

joint failing within their lifetime, compared

to a risk of only about 5% for patients

having joint replacements in their 70s.This

explains why knee surgeons are reluctant to

put knee replacements in younger patients

unless it is an absolute last resort.

The meniscal cartilages are elastic shock

absorbers sitting in the middle of the knee

between the surfaces of the bones of the

femur and tibia. Meniscal tears are very

common, and although about 25% of tears

can actually be repaired if caught quickly

enough, 75% cannot, and these tend to

end up needing to be trimmed. Removal of

torn meniscal tissue via a knee arthroscopy

has an excellent short-term success rate.

However, in the longer term, the more

meniscal tissue is damaged and lost, the

less of a shock absorber is left in the knee,

and the more wear and tear the joint will

develop.The articular cartilage in the knee

is the smooth, glistening, white layer of

tissue that covers the surfaces of the ends

of the bones, making the surfaces very

low friction.Without a functional meniscal

cartilage shock absorber, these articular

cartilage surfaces are subjected to increased

pressures and increased wear and tear, and

it is the erosion of this articular cartilage

to eventually expose bare bone in the joint

that is the cause of the arthritis that can

develop in the knee joint.

Up until recently, there were very few

options available for younger patients

who had developed early osteoarthritis in

the knee, secondary to previous cartilage

injuries and cartilage loss. However, we

are now able to replace missing meniscal

cartilages using artificial bioabsorbable

scaffolds (for partially missing menisci), or

an entire meniscal cartilage can be replaced

by meniscal allograft transplantation.This

surgery is complex, and is only being

carried out on a regular basis by a very

small number of knee surgeons in the UK.

Although it is a difficult surgery, it carries

a success rate of about 85% at five-year

follow-up for decreasing patients’ pain,

increasing their function and keeping them

going (and delaying the need for further

surgeries).

Missing patches of articular cartilage can

now also be replaced using a variety of

different techniques. One of the newest of

these is the use of chondrotissue

®

articular

cartilage grafts to resurface exposed areas

of bare bone in the knee, getting new

cartilage to re-grow into the scaffolds,

which are then absorbed.

Biological Knee

Replacement

The next step in soft tissue reconstructive surgery of the knee

PATIENT’S NORMAL

MEDICAL COMPARTMENT

Normal

Medical

Meniscus

Normal

Cartilage

on Tibia

Normal

Cartilage

on Femur

PATIENT’S DAMAGED

LATERAL COMPARTMENT

(PRE-RECONSTRUCTION)

Bare

Bone on

Tibia

Missing

Lateral

Meniscal

Cartilage

Bare

Bone on

Femur

www.sportsortho.co.uk