Surgery Treatments for Knee Pain and Injuries

Menisectomy

Meniscectomy is the official name of the surgery that involves the removal of a portion of the meniscus cartilage from the knee joint. The meniscus is a shock-absorbing wedge of cartilage that sits between the bone ends to provide cushioning and support. Smaller meniscus tears can usually be trimmed to relieve the symptoms of a torn meniscus.

Meniscus Repair

A meniscus repair is a surgical procedure done to repair a damaged meniscus. The meniscus repair can restore the normal anatomy of the knee and has a better long-term prognosis when successful. However, meniscus repair is a more significant surgery than a meniscectomy. The recovery is longer, and, because of limited blood supply to the meniscus, a repair is not always possible.

Lateral Release

The kneecap moves up and down the end of the thigh bone in a groove of cartilage. The kneecap can be pulled to the outside of this groove or may even dislocate from the groove, causing pain with bending of the knee joint. A lateral release is performed to loosen the ligaments that pull the kneecap toward the outside of the groove.

A lateral release used to be commonly performed for people with vague symptoms of knee pain. In recent years, surgeons have been much more careful in determining which patients might be appropriate candidates for this surgical procedure. There are a number of possible complications associated with a lateral release, including knee instability, increased patellofemoral (front of knee) pain, and a reduction in the knee's ability to fully extend.

Plica Excision

A plica is a remnant of tissue left over from fetal development. In early development, your knee was divided into separate compartments. The dividers of the compartments are gradually lost over time, but some remnant remains.

When this remnant tissue is more prominent, it is called a plica. When the plica is irritated, it is called plica syndrome. A plica resection is performed to remove the irritated tissue.

Meniscus Transplant

Meniscus transplantation consists of placing the meniscus from a donor (the graft is obtained from someone who recently died) into an individual who has had their meniscus removed. The ideal candidate for a meniscus transplant is someone who has undergone a menisectomy and subsequently develops knee pain. The surgery is generally reserved for use in people under 50 whose body mass index, or BMI, is under 35.

Meniscus transplantation is not performed for an acute meniscus tear. Rather, it is performed when removal of the entire meniscus has caused persistent pain in the knee.

ACL Reconstruction

The anterior cruciate ligament, or ACL, is one of four major knee ligaments. The ACL is important to knee stability, and people who injure their ACL often complain of symptoms of their knee giving out from under them. Therefore, many patients who sustain an ACL tear opt to have surgical treatment for this injury.

ACL injuries are often associated with sports activities, where they most often occur. However, ACL injuries can also affect people with normal daily activities.

Microfracture

Microfracture is a surgical procure performed to address areas of cartilage damage inside the knee joint. Microfracture causes a healing response so that new cartilage is formed where there was once a gap in cartilage.

The problem with microfracture is that it only works for small areas of damage. Moreover, the healing does not develop in the same way as normal cartilage. Because of this, as many as 42% of people who undergo a microfracture procedure will require additional surgery in the future.

Patellar/Quadriceps Tendon Repair

The patellar tendon and quadriceps tendon on the front of the knee joint can become injured, causing a loss of strength of leg extension. When the tendon is torn, patients have a difficult time straightening the knee joint.

Treatment of a patellar tendon or quadriceps tendon rupture is nearly always a surgical repair. Without surgical repair, not only can straightening the knee be difficult, but even normal walking is sometimes challenging.

Partial Knee Replacement

A partial knee replacement is an option for certain types of knee arthritis. When the cartilage loss is limited to a small portion of the knee joint, it may be possible to replace just the worn-out portion of the joint. However, in cases where the arthritis is more widespread, a total knee replacement will need to be performed.

Partial knee replacements are becoming more common as robotic-assisted surgery has also become more prevalent. The knee joint is generally divided into three compartments, and each of these three compartments (medial, lateral, and patellofemoral) can be replaced with a partial knee replacement.

Broadly speaking, partial knee replacement is considered if you are over 60, weigh less than 180 pounds (82 kilograms), and are unable to fully flex or extend the leg due to joint degeneration and/or deformity.

Knee Replacement Surgery

When a knee replacement is performed, the bone and cartilage on the end of the thigh bone (femur) and top of the shin bone (tibia) are removed. This is performed using precise instruments to create surfaces that can accommodate the implant perfectly. A metal-and-plastic knee replacement implant is then placed to function as a new knee joint.

Depending on the condition of the cartilage underneath the kneecap, the kneecap surface may also be replaced. Total knee replacement surgery is very successful, with about 90% of implant recipients reporting good long-term results.