Knee Preservation: Why and How it’s Performed - Orion Ortho
Knee Preservation: What is it?
Knee Preservation is a general term used to describe different techniques and procedures to manage knee pain without replacing it. These methods can be either surgical or non-surgical.
The idea of knee preservation is to treat specific pathologies or problems in the knee so that patients experience less pain and may return to their active lifestyle with their native knee. This is especially so for younger and more active patients in whom a knee replacement is not appropriate.
Knee Preservation versus Knee Replacement
Patients experience knee pain due to a variety of reasons. Pain may come for areas of inflammation and swelling which respond well to anti-inflammatory medication, physiotherapy, knee injections and activity modification. MRI scans of the knee may indicate tears of the meniscus, early thinning of the cartilage or even ruptures of ligament such as the anterior cruciate ligament (ACL). These conditions are well managed with arthroscopic or ‘key-hole’ procedures to repair the torn meniscus or reconstruct the ruptured ACL. Occasionally the knee pain is due to malalignment of the knee such as ‘bowed’ or ‘knock’ knees. These deformities may be corrected with realignment procedures.
A Knee Replacement is a surgical procedure to replace part or the entire knee with an implant. This implant replaces parts of the knee that are worn out and serves to improve the general movement and function of the knee while relieving the patient of pain. It is also used to correct deformities around the knee due to degeneration or trauma. The implant itself is made out of cobalt-chrome metal alloy as well as polyethylene liner. This replacement procedure is more suitable for patients above 55 years old and those who do less impact exercises. These implants are at risk of loosening if patients enjoy regular impact exercises and the polyethylene liner may wear out earlier if patients are too heavy.
Due to the reasons below, your orthopaedic surgeon will assess if you are suited for knee preservation or replacement procedures:
While age is just a number, knee preservation techniques may be more suited for younger and more actieve people. This group of patients also have less knee degeneration in general.
The amount of stress on the knee joint is directly proportional to the weight of a person. Losing weight and participating in moderate physical activities are effective ways to improve knee pain
Muscles control joint movement and protect the knee. Stronger muscles ensure the knee movements are balanced and help reduce knee pain.
The severity of the defect
In moderate to severe arthritis, there is widespread cartilage damage in the knee. In such cases, knee replacement procedures might be more suited and effective than joint preservation techniques.
Who might benefit from Knee Preservation techniques?
Knee preservation techniques target problems of inflammation, cartilage defects, meniscus tears and knee malalignment which occur due to degeneration or injury. Our intention is to manage these underlying knee problems so our patients may return to their active lifestyles.
Indications for knee joint preservation include:
- Cartilage degeneration and osteoarthritis
- Meniscus tears
- Cruciate ligament ruptures
- Runners’ knee
- Jumpers’ knee
- Leg malalignment (Valgus or varus)
How is Knee Preservation performed?
Before any intervention, the underlying cause of knee pain must be understood and investigated. Your orthopaedic surgeon will take a detailed clinical history and perform a thorough clinical examination before organising an appropriate investigation such as an xray or MRI scan.
Knee joint preservation could be either surgical or non-surgical. Conservative or non-surgical methods include the following:
The following are non-surgical methods of knee joint preservation:
Weight loss helps reduce the pressure around the knee joint and reduces pain. This may be done with diet control and moderate low-impact physical activities including brisk walking, swimming and cycling.
Physical therapy helps relieve knee pain by stretching out tight structures, strengthening weak muscles and improving the balance around the knee. The physiotherapist will also teach patients how to perform such exercises to prevent future injuries.
Moderate and low impact exercise help strengthen muscles around the knee joint and improve its movement. Balanced knee movements improve distribution of weight and pressure around the knee and help prevent recurrent knee pain. Different exercises will benefit different body-types and patients with different injuries
Use of painkillers
The use of Non-Steroidal Anti-inflammatory Drugs (NSAIDS) and paracetamol help reduce knee pain.
Injections into the knee joint help reduce pain and inflammation. They allow quick return to physical activities and have little downtime. They include:
- Steroids: short-term pain relief
- Hyaluronic acid: viscosupplementation
Joint Preservation Surgical Techniques
Listed below are several techniques used to reduce pain and improve knee function while preserving the knee joint,
Some patients experience pain due to tears or degeneration of their meniscus. These are shock absorbers in the knee. Repairs may be done through key-hole incisions to improve knee pain. If these tears cannot be repaired, the meniscus will be debrided or smoothened out to help improve knee pain.
Management of cartilage defects
Cartilage are shock absorbers of the knee and help with smooth and painless movement.
Osteochondral Autologous Transfer Surgery (OATS) is a surgical procedure which involves the transfer of cartilage plugs taken from non-weight bearing areas of the joint and transferring them into the damaged area of the joint.
- Microfracture is a key-hole procedure to stimulate stem cells from the knee to differentiate into new cartilage to cover areas of cartilage defects.
Joint Realignment Procedures
The knee joint can wear out faster if the leg itself is misaligned (bow legged or knock knees). Realignment procedures are aimed at straightening out the leg and balancing the weight distribution around the knee
Proximal Fibula Osteotomy involves removing about 2cm of bone from the fibula to allow better distribution of weight around the tibia bone. It does not involve any metal implants and patients are allowed to weight bear immediately.
High tibial osteotomy involves realigning the tibia bone to improve weight distribution of the knee. It involves metal implants and patients may weight bear after several weeks of rehabilitation
Anterior Cruciate Ligament (ACL) Reconstruction
The ACL provides stability to your knee when you twist and turn. Without it, you may feel instability when you walk down stairs or participate in pivoting sports such as basketball or football. ACL reconstruction is done by minimally invasive techniques using your own hamstring grafts.
Knee preservation describes surgical and non-surgical techniques that help restore the function of the knee joint so that patients may return to their hobbies and active lifestyles. Your orthopaedic surgeon will assess multiple factors such as age, weight, daily activities and condition of your knee to determine the best way to manage your knee pain.