For many sports fans, the idea of an ACL tear or arthroscopic procedure sounds commonplace. But knee surgeries can be a major operation. While surgery may not always be necessary, in other cases it clearly may be.
Here are a variety of knee surgery options and for which what conditions they are necessary.
Total knee replacement
A total knee replacement often comes when the knee is severely damaged, either by arthritis or injury. Years of wear-and-tear or a single catastrophic injury could do the damage that necessitates a knee replacement. Cartilage is the cushioning that sits between the two leg bones adjoined at the knee joint. When this substance breaks down through years of use, the patient can be left with an extremely painful, inflamed or creaky joint. When arthritis – the breakdown of cartilage – progresses to the point of no return, a total knee replacement surgery may be necessary. This is generally the last option available to improve quality of life, and though knee replacements are fairly common (600,000 are performed each year in the U.S.), it is a very invasive procedure that requires a hospital stay and months of intensive rehabilitation.
Knee joint resurfacing, also known as a partial knee replacement, is a less invasive procedure that can be performed when cartilage in the knee has broken down, but not necessarily to the extent necessitating a total knee replacement. In this procedure, a doctor can go into the knee and clean out the diseased cartilage, replacing it with a synthetic substance, as would occur in a total knee replacement. However, rather than cutting out large amounts of bone and replacing the entire joint, this surgery removes only the diseased area and puts a "cap" on the bones to prevent bone-on-bone rubbing. This operation requires a six to twelve week recovery period before a patient can realistically regain complete muscle strength and return to full activities.
When NBA players started to undergo this procedure a decade ago, it was thought to potentially be the end of a career. Today, it is much more common. This surgery is conducted to prevent further damage to the cartilage in the joint and under the kneecap, and to maintain knee functionality. This surgery is performed on athletes in the prime of their careers and who would otherwise face a long, slow decline from arthritis. This procedure involves poking tiny holes into the bone near damaged cartilage, triggering the bones to release cartilage-building cells to replace the damaged tissue. This surgery shows best results on people under 40 in good health with recent cartilage damage, designed so patients can return to intense physical activities in roughly six months.
Getting a knee "scoped" is not so much a surgery as it is a diagnostic procedure. Doctors insert a small camera into the joint and take a look around, in order to provide a clear view of the inside of the knee, which is used to diagnose and treat knee problems. Advances in imaging technology – including the use of high resolution cameras – has greatly increased the accuracy of the procedure and in reducing invasiveness. From there, doctors can remove or repair damaged cartilage, reconstruct a ligament, remove loose bone and cartilage fragments or remove inflamed synovial tissue in the joint. Most patients can resume physical activities within six weeks.
The anterior cruciate ligament helps keep your shin bone in place, and tearing this ligament can cause your knee to give way during physical activity. Reconstruction surgery is usually done via knee arthroscopy, where doctors can repair the damaged ligament. First, the torn ligament is removed, and the doctor then drills a tunnel into the leg bone. The doctor takes the new ligament – from a cadaver or from another part of the body – and feeds it through the drilled hole. It is then attached with screws or another device to keep it in place. As the area heals, the bone tunnels fill in, securing the new ligament. While ACL repairs seems commonplace in the sporting world, the recovery period actually covers about six months before a patient can return to regular daily activities, to say nothing to intense physical activity.
Where the ACL is one of the ligaments connecting bones in the knee, the meniscus is the cartilage that sits between the femur and tibia in the knee. The cartilage provides stability and cushions the joint, keeping the bones from rubbing up against one another. A meniscal tear is caused by sudden twisting in the knee, leading to a rip in this tissue. This most often occurs during sports. While the menisci are tough, rubbery and resilient in our youth, they become weakened with age. As we get older, people are more prone to injury, even during simple movements, such as squatting or stepping on uneven surfaces. Arthroscopic surgery is performed to diagnose the issue, and the doctor can trim or repair the meniscus as needed once he is in the knee joint. Surgery can be the best option to preserve the knee from further damage in the future. The knee can recover within roughly two weeks following a meniscal procedure.
Patellar tendon reconstruction
When you go to the doctor and he tests your reflexes by hitting the front of your knee with a little hammer, causing it to kick – the spot he hits is your patellar tendon. It is a major tendon that provides stability to your leg. Tearing this tendon will likely prevent any weight-bearing activities and will cause your knee to swell significantly. Surgery to reconstruct the patellar tendon requires weaving the torn tendon through holes drilled in the leg bones or kneecap, depending on the location of the tear. This is a significant procedure and it could take more than six months before full recovery is experienced.
Walking, running, sitting, standing and generally moving around are all products of a stable knee joint, anchored by the patella (kneecap). If that "cap" slips out of its groove, problems can result. The kneecap connects the muscles in the knee to the bones in your legs, which, if injured, can result in significant instability in the joint. While surgery is not always necessary to correct kneecap displacements, the recommended surgical procedure starts with an arthroscopy, where the doctor can get a feel for what needs to be done to correct the problem. After surgery, strengthening the muscles around the knee – such as through cycling – can greatly enhance the rehabilitation process.
Published On: March 23, 2014