Most people who partake in sports are used to simple injuries of the knee, and will often follow the time-honoured regime of 'RICE' rest, ice, compression and elevation, following injury. Many will seek early advice from a physiotherapist.
Some knee injuries are more severe and where there is a suspicion of a severe internal derangement, early consultation with a knee specialist is advisable. In difficult cases the use of MR Arthrography or a 3-tesla (3T MR scan) offers an accurate diagnosis of not only common injuries such as cartilage tears, but also gives excellent visualisation of injuries to the joint surface, compared to conventional MR scanning.
Total knee replacement is now considered as being as successful as total hip replacement and there are many patients who have had excellent long-term satisfaction from their total knee replacement.
However, many patients do not require total joint replacement and there are many simple treatments which help relieve pain including steroids or hyalgan injections, which can be administered in the out-patient setting, with minimal disruption to activities or working life.
In end stage arthritis total knee replacement is the treatment of choice, long-term results show that on average a replacement will last in the order of 10-15 years. With current techniques and post-operative rehabilitation protocols, many patients simply spend in the order of 1 - 3 days in hospital following a total knee replacement. In most cases when a joint replacement has become worn, modern techniques allow good results from revisional knee surgery.
However, many patients with arthritis do not require a total joint replacement. In early arthritis arthroscopic surgery (keyhole) will often give good pain relief and allow a return to normal activities with minimal disruption to the working life.
At times either before or after keyhole surgery injections such as steroids or hyalgans can be given safely, in the out-patient clinic, which through relieving pain allow a return towards normal activities. These treatments should be viewed as holding manoeuvres and with time, more aggressive treatments may become necessary.
In some patients where arthritis does not involve the whole knee, then either partial knee replacements or kneecap replacement surgery should be considered. At times, some patients may be suitable to have the bones of the leg re-aligned rather than undergoing partial joint replacement surgery.
Knee injuries are common. Simple injuries can often cause cartilage tears, or injuries to ligaments. Often, with the more minor injuries an initial course of physiotherapy may settle a knee completely. However should an injury fail to settle as expected, referral to a specialist would allow appropriate investigation and an accurate diagnosis. Many simple knee disorders can now be diagnosed by MRI or ultrasound scanning, though for more subtle injuries more sensitive MRI scans (MR Arthrography or 3-tesla) are required.
In more severe injuries early assessment and investigation will offer an accurate diagnosis and allow the appropriate treatment to be started at an early stage following injury. Many simple knee injuries and disorders are amenable to keyhole surgery or injection therapy, which may be under ultrasound guided control to improve accuracy.
With joint surface injuries (articular cartilage) current treatments include arthroscopic surgery, though in the more severe cases relining of the joint surface can be undertaken (microfracture techniques or cartilage cell transplantation), allowing the possibility of normal joint lining tissue to develop in the injured area.
As with all medical conditions you should discuss this with your GP who will be able to offer initial advice.
For further information please contact our Practice Manager on 0161 728 5994, 0161 793 7056 or use our on-line enquiry form. Alternatively, you may book an appointment with Mr Maxwell at the Oaklands Hospital.