Knee problems in adults often arise when the knee joint undergoes a degenerative process due to repetitive wear and tear as the patient ages. Young adults usually injure one- or more of the stabilizing ligaments such as the ACL or the collateral ligaments during traumatic events such as rugby tackles or other twisting injuries at the knee. Other structures which are commonly injured are the medial- and lateral meniscus. Recently it has become evident that bone bruising of the femur and tibia may also result from such traumatic events. This may be diagnosed with An MRI scan.
Ligament injuries often require surgical reconstruction, however, there are specific injury patterns which may be treated non-surgically. It is important that these are managed by a specialist in this field in order to prevent chronic knee instability with resultant cartilage injury and accelerated development of knee arthritis.
Meniscal tears are common injuries and used to be treated with complete removal of the damaged meniscus. This resulted in rapid arthritis of the knee and has been abandoned in favor of removal of the diseased part of the meniscus via keyhole (arthroscopic) surgery. The meniscus may be repaired in certain cases. This depends on the type of tear as well as the age of the patient.
Knee arthritis may develop early in adulthood secondary to fractures of the joint, inflammatory conditions such as rheumatoid arthritis or infections. Cartilage loss and subsequent bone loss due to wear and tear (osteoarthritis) usually develops between 50 and 60 years of age but this may be highly variable. Treatment for knee arthritis is mostly non-surgical. Anti inflammatory medications, weight loss and a walking aid may provide relief for many years. Often mechanical symptoms such as a sensation that the knee wants to give way (functional instability) or a locked knee develop and these can be treated with keyhole surgery, which is a fairly minor procedure. Once the pain becomes unbearable or the knee becomes so stiff or deformed that activities of daily living are impaired, a knee replacement procedure may be required. Under certain circumstances, a unicompartmental knee replacement or a patello-femoral resurfacing procedure may be appropriate.
Knee replacement surgery is complicated and requires accurate implant placement as well as excellent post-surgical management by specialist physiotherapists in order to optimize the results. A poorly performed knee replacement may make the patient worse than before the surgery. The latest advances in knee replacement surgery include implants which allow for bone ingrowth and therefore eliminate the need for cement. Computer assisted surgery allows for precise implant placement.
