Common Treatments for Knee Injuries
Often knee pain that results from an activity that's more strenuous than usual can be managed nonsurgically. Chronic knee pain from arthritis may be managed by weight loss, exercise, and modifying your activities. Other treatments might include rest, ice, compression, elevation and medication.
Your surgeon can see inside your joint without having to make a large incision with arthroscopy. During arthroscopy, he or she can even repair some types of joint damage with pencil-thin surgical instruments inserted through small incisions. This procedure can be used not only to diagnose knee problems, but to perform many other common knee procedures.
ACL Tear - Nonsurgical and ACL Reconstruction
Your doctor can help you decide if you need surgery plus rehabilitation, or only rehabilitation for an ACL tear. The extent of damage to your knee and your willingness to modify your activities will affect your choices.
For a reconstruction, the ligament is usually replaced with a piece of tendon from another part of your knee (autograft) or from cadaver tissue (allograft), as a torn ACL cannot be successfully sewn back together. Small incisions around your knee joint are made. A fiber-optic viewing scope is used to position the ACL graft.
Meniscus Tear - Nonsurgical and Partial Meniscectomy or Repair
Often treatment for a meniscus tear begins conservatively. Your doctor may recommend rest, ice, medication or physical therapy.
However, your doctor may recommend surgery if the knee remains painful. It's sometimes possible to repair a torn meniscus. If this is not an option, the meniscus may be surgically trimmed. One of the most commonly performed surgical procedures is knee arthroscopy where a miniature camera is inserted through a small incision. Your surgeon can then work with tiny instruments to repair or trim the tear.
Articular Cartilage Damage (or Cartilage Injuries)
The two ways articular cartilage can be damaged are by normal wear and tear, or injury. Doctors have developed surgical techniques to stimulate the growth of new cartilage. Some of the benefits of restoring articular cartilage include pain relief and the ability to function at a higher level.
Chondroplasty is a procedure done with arthroscopy — inserting thin surgical instruments in small incisions around your knee. Your surgeon then smooths and trims roughened arthritic joint surfaces. The recovery time for this treatment is typically faster than other cartilage surgeries, as it is less invasive.
An arthroscope is used to perform a microfracture. A small sharp tool makes multiple holes in the base of the cartilage defect, allowing the underlying bone to bleed, which creates a healing response. As new blood reaches the joint surface, cells will form cartilage. Allow four to six months for recovery.
OATS (Osteochondral Autograft Transfer)
Cartilage is transferred from one part of the joint to another in osteochondral autograft transplantation. A graft of healthy cartilage tissue is taken from an area of the joint that is non-weightbearing. This is taken as a cylindrical plug of cartilage and underlying bone, which is then matched to the surface area of the defect and impacted into place. The result is a smooth cartilage surface in the joint. It can take six to nine months for full recovery.
Autologous Chondrocyte Implantation (ACI)
ACI surgery involves growing new cartilage cells and then implanting them in the cartilage defect. This is a two-step procedure.
A non-weightbearing area of the bone is used for removal of healthy cartilage tissue. An arthroscopic procedure is done for this first step. The tissue, which contains healthy cartilage cells, is then sent to the laboratory where it is cultured and increased in number over time.
For step two, an incision is then made to implant the newly grown cells. A layer of bone-lining tissue is sewn over the cartilage defect and sealed with fibrin glue. The newly grown cells are then injected into the defect. Allow nine to twelve months for recovery time.
Allograft OATS Procedure
An allograft may be considered if a cartilage defect is too large for an autograft, or if the lesion involves both cartilage and bone defects. This is a tissue graft taken from a cadaver. Recovery time can last nine to twelve months.
Runner’s Knee Treatment
Nonsurgical options for runner’s knee include rest, ice, compression, elevation, physical therapy exercises, medication and orthotics.
Surgical treatment for runner’s knee pain is only done for severe cases. These surgeries may include arthroscopy or tibial tubercle transfer. During arthroscopy, your surgeon inserts a small camera into your knee joint. The camera displays images on a screen which help to guide tiny surgical instruments. In tibial tubercle transfer, the kneecap is realigned by moving the patellar tendon along with a portion of the tibial tubercle.
Osteoarthritis - Nonsurgical and Knee Replacement (Partial and Total)
Nonsurgical treatments for osteoarthritis include medications, physical therapy, braces or shoe inserts. Other treatments to consider include cortisone shots and lubrication injections.
If surgery is recommended, partial and total knee replacement are two possibilities, depending on your individual evaluation. A total knee replacement, or arthroplasty, involves removing damaged bone and cartilage and replacing it with an artificial joint comprised of sophisticated plastic and metal.
Patients with osteoarthritis that is limited to just one part of the knee may be candidates for a partial or unicompartmental knee replacement. Only the damaged compartment is replaced with metal and plastic parts in this scenario, and the rest of the knee is untouched.