The knees are the strongest joint in the human body, allowing the legs to bend and straighten while carrying almost all of the weight of the individual when they are standing. The knees are a hinge joint, but still have substantial capacity for lateral (side-to-side) motion.
As an active, weight-bearing joint, the knee is a source of pain and problems for many people. This pain may be acute or chronic, and may be a result of injury, overuse or growth. It can stem from the tendons, ligaments, bones, cartilage or any other structure within the knee.
The patella, commonly known as the kneecap, helps increase leverage and support within the knee joint. Pain may develop in the patella as a result of overuse or injury, and often causes a fracture. Patella fractures can involve a single crack across the kneecap or a break into several pieces, and usually causes severe pain and swelling.
Surgery may be required for more intense patella fractures, and aims to repair the patella by realigning the fractured ends and holding them in place with pins, screws and wires. Part of the bone may just be removed in smaller fractures. During the healing process, the knee must be kept straight, and patients will often undergo physical therapy to help restore movement to the joint.
The anterior cruciate ligament (ACL) works together with the other ligaments in the knee to connect the femur to the tibia and support the knee joint. A tear in the ACL is one of the most common knee injuries, causing the joint to become unstable and slide forward too much. This injury occurs most often in athletes and causes pain, swelling, tenderness and limited motion.
ACL reconstruction is usually not performed until several weeks after the injury, when swelling and inflammation have been reduced. The torn ligament is completely removed and replaced with a new ACL. Simply reconnecting the torn ends will not repair the ACL. Part of another ligament, usually in the knee or hamstring, is used to create a graft for the new ACL.
Arthroscopy offers patients many benefits over traditional surgery, including no need to cut muscles or tendons, less bleeding, smaller incisions and shorter recovery times. However, arthroscopy is not appropriate for all patients. Your doctor will decide whether or not arthroscopy is right for you.
Some knee conditions that can often be treated through arthroscopy include meniscal tears, ACL or PCL tears, synovitis, patellar misalignment, arthritis and more. During the arthroscopy procedure, a thin tube with a camera on the end (arthroscope) is inserted into the joint, along with several tiny surgical instruments so that your surgeon can adequately visualize the area while repairing any damage that is found.
Total Knee Replacement
A knee replacement is recommended for patients with arthritis and certain knee injuries or diseases that have not responded well to conservative treatments such as anti-inflammatory medications or cortisone injections. The replacement devices are designed to relieve pain caused by cartilage damage, and usually last up to 20 years in most patients.
During the knee replacement procedure, the entire joint is replaced with an artificial prosthesis. The end of the femur is replaced with a metal shell, while the end of the tibia is fitted with a plastic cup and metal stem that fit into the shell. The posterior cruciate ligament and kneecap may be replaced if needed or may be left in place. This procedure can take up to three hours to perform and usually provides immediate pain relief and a return to regular activities.