Knee Surgery

The knee is a complex joint made up of the thigh bone (femur), shin bone (tibia) and kneecap (patella). Common knee conditions include anterior cruciate ligament (ACL) tears, meniscal tears and osteoarthritis.

ACL (Knee) Reconstruction

The ACL is a strong ligament inside the knee that is important for normal function and stability. An ACL tear is a common sporting injury which can be caused by a sudden change in direction or landing awkwardly. Often patients will feel a “pop”, the knee will become swollen, and this injury may lead to ongoing instability.

An ACL tear can cause an inability to return to sports, and even instability during normal daily activity (functional instability). Depending on the severity, patients may require physiotherapy, or in severe cases, ACL reconstruction.

The aim of surgery is to provide a stable knee which functions normally, and prevents further damage to other structures such as the menisci or articular cartilage. Surgical reconstruction is performed by using the patients donor tissue (see graft selection below) to reconstruct the non-functional ACL.

ACL reconstruction is performed arthroscopically (keyhole) under a general anaesthetic, and involves an overnight stay in hospital. An intensive, structured physiotherapy rehabilitation protocol will commence from the day after the operation.

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Graft Selection in ACL reconstruction

There are a variety of different ACL graft types available, including quadriceps tendon, hamstring tendon, and patellar tendon. Each offers unique advantages suited to individual patient needs.

Quadriceps tendon graft provide robust strength, potentially reducing graft failure rates and recovery time. Hamstring tendon grafts offer good biomechanical properties and avoids interfering with the extensor mechanism. Patellar tendon graft boasts the highest initial strength and secure fixation, although carries a higher risk of donor site discomfort. Each graft type comes with its own distinct considerations regarding surgical technique, rehabilitation protocols, and risk of complications.

Ultimately, the choice of graft should be tailored to factors such as patient age, sport, activity level, knee stability, with the goal of optimizing outcomes and minimizing postoperative complications.

Knee Arthroscopy (Keyhole Surgery)

The meniscus is tissue in the knee that acts as a protective “shock absorber” for the cartilage surfaces. A twisting injury can result in a tear in the meniscus and cause symptoms such as pain, clicking, locking and catching. Treatment may include pain relief and activity modification, or knee arthroscopy (including trimming or repair in appropriate patients).

Knee arthroscopy is a minimally invasive procedure which enables evaluation and treatment of the internal structures of the knee via two small “keyhole” sized incisions at the front of the knee. Through these incisions, a small camera and precise instruments can be inserted, and any damaged structures (such as meniscal injury, cartilage injury or loose bodies) can be treated via the images displayed on a video monitor.

Knee arthroscopy is usually performed as a day procedure, and patients are able to return to their usual activities.

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Meniscal repair

An improved understanding of knee joint biomechanics, advancements in repair techniques and biologic augmentation have increased the number of meniscal tears that can be successfully repaired. Preserving the meniscus through repair, if possible, is crucial for maintaining knee stability, distributing joint forces, and preventing cartilage degeneration and arthritis.

Meniscal tears encompass a variety of patterns, including radial tears, longitudinal tears, bucket-handle tears, complex tears, and root tears, each influencing the approach to repair. Radial tears extend from the inner edge to the outer rim, often requiring surgical intervention. Longitudinal tears run parallel to the meniscus axis and may be repairable depending on location, stability and tissue quality. Bucket-handle tears are a type of large, displaced, longitudinal tear which typically requires prompt surgical repair.

Meniscus root tears affect the area of meniscal attachment to the tibia, causing complete meniscal dysfunction. Repairing these tears is crucial to prevent further damage to cartilage and rapid development of arthritis. Complex tears are usually degenerative in nature due to “wear and tear” and involve multiple patterns or locations. In order to relieve symptoms, complex tears are usually trimmed to a stable edge due to poor healing potential.

There are variety of surgical techniques that can be utilised for repair, each with specific advantages and considerations. The choice of repair technique is determined by tear characteristics, tissue quality, and surgical expertise, aiming to restore meniscal function and preserve joint health.

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Knee Replacement

Arthritis can affect the knee when the cartilage surfaces between the bones wear out. This can result in pain, stiffness and deformity. Initial treatment may include activity modification, anti-inflammatories, exercise, weight control and physiotherapy. In patients with severe disease where pain functional impairment cannot be controlled by non-operative measures, a partial or total joint replacement with an artificial knee may be required. This can be performed conventionally with manual instrumentation, or with the aid of a robot.

The common causes of arthritis include osteoarthritis (wear and tear), inflammatory arthritis (such as rheumatoid or gout) and post traumatic arthritis. Knee replacement involves a resurfacing of the damaged joint surfaces with a metallic prosthesis and specialised, low-friction plastic bearing surface. Typically patients will stay a few days in hospital, and the replaced knee will allow patients to mobilise immediately under the supervision of a physiotherapist. An intensive, structured physiotherapy protocol will commence from the first post-operative day, in order to recover the strength and range of motion in the knee as rapidly as possible.

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mako Robotic assisted knee replacement

Mako robotic assisted knee replacement represents a significant advancement in knee surgery and provides a number of advantages, offering far superior precision and safety, optimising for a more efficient recovery process. By combining advanced 3-D imaging technology with robotic guidance, Mako enables surgeons to create a personalized surgical surgical plan tailored to each patient’s unique anatomy.

The level of planning and customisation that Mako allows ensures more exact implant sizing, placement, alignment, and stability, leading to improved joint function and implant longevity. The real-time intraoperative feedback provided by the robotic system allows the surgeon to make immediate adjustments as needed, further enhancing accuracy and reducing the risk of complications. Additionally, Mako assisted knee replacement typically results in less soft tissue trauma, reduced blood loss, and potentially less postoperative pain and stiffness. This can result in faster recovery times and a faster return to daily activities compared to traditional techniques.

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Radiofrequency Ablation

Radiofrequency ablation (RFA) has emerged as a newer, less invasive technique in the management of knee osteoarthritis (OA), offering a minimally invasive alternative for pain relief and improved function when conservative treatments fail, or to delay the need for knee replacement.

In this procedure, high frequency energy is delivered to the sensory nerves responsible for transmitting pain signals from the knee joint to the brain, disrupting their function and providing pain relief. By targeting specific nerves, RFA can selectively inhibit pain fibres, thus minimizing the risk of the complications associated with surgical interventions.

The procedure involves the use of X-ray guidance to precisely position the RFA probe, ensuring accurate targeting of the affected nerves while avoiding damage to surrounding tissues. Clinical studies have demonstrated the efficacy of RFA in reducing pain and improving function in patients with knee OA, with significant and sustained improvements reported in pain scores, physical function, and quality of life measures.

RFA offers several advantages over traditional treatments such as corticosteroid injections or oral medications, including longer-lasting pain relief, fewer adverse effects, and reduced reliance on pain medication. For these reasons, RFA is gaining wider adoption as a standard treatment option for knee OA.

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