Over the last years, an increasing number of “younger patients with old knees” have needed surgical treatments for their painful joints. When treating joint disorders, it’s important to realize that cartilage repair does nothing other than treat the surface of the knee joint. An article published in the KSSTA states “that in some cases cartilage repair alone is able to solve the problem but only if nothing else was causing the symptoms of the patient. In most cases, a cartilage lesion is just the tip of the
iceberg.” This simplistic approach to cartilage repair is now being replaced by a more holistic method. Recently, surgeons have embraced a set of elements that should be considered in order to provide the patient with the best chance for a successful outcome. These elements are: joint stability, mechanical alignment, meniscus integrity, surface restoration and rehabilitation.
In order to treat cartilage lesions properly, it is important to access the patient’s joint alignment. When thinking of joint alignment, it is helpful to think of the tires on your car. Even if you purchase an expensive tire, it will wear out prematurely if the wheel alignment is crooked or tilted. Ensuring that the axis of your knee joint is aligned helps to evenly distribute stresses across the joint. This allows normal movement and helps to avoid premature wear.
When considering surgery, it is also important to consider the stability of the joint. The knee is reliant on the function of the ACL and PCL along with other soft tissue structures around the joint to keep the knee stable. These structures allow your knee to move naturally through the full range of motion. If a ligament is torn or damaged, the knee becomes unstable and this can add stress to the joint surface.
Your doctor should also evaluate your meniscus, which acts as a shock absorber in the joint. The thighbone and shinbone are more prone to rub against each other and wear out the cartilage if the meniscus is damaged or non-existent (bone on bone). The study states “The amount and quality of meniscus tissue needs to be on an optimal level” to determine a healthy knee joint.
Even if the previous elements are properly addressed, an improperly followed rehab program (i.e. physical therapy) is still crucial to a positive outcome. Especially for biological treatments such as grafting, staged and lengthy rehab is usually required for an optimal outcome. This is because biological treatments are dependent on a sequence of cellular processes that may take as long as 18 months to complete. Knee implants, such as the Arthrosurface HemiCAP® systems, usually offer a quicker return to work and activity because they are artificial surfaces that don’t depend on biological integration in order to be functional.
Knee Surgery, Sports Traumatology, Arthroscopy
© Springer-Verlag 2011