The knee is a complex hinge joint with remarkable versatility and function. Stabilized by a series of ligaments and surrounded by strong muscular attachments, the knee is an essential part of our ability to function. Running, jumping, and climbing are only a part of the activities the knee supports in addition to allowing thousands of steps every day! As a hinge joint, side to side stability is provided by the medial and lateral collateral ligaments (MCL and LCL). In the center of the joint, two crossed ligaments, the anterior and posterior cruciate ligaments (ACL and PCL), provide stability of rotation, anterior/posterior shifting and hyperextension of the knee. Two types of cartilage are described for the joint itself. Articular cartilage covers the bone ends and carries our weight with ambulation. Damage to this cartilage is referred to as arthritis. Meniscal cartilage, or meniscus, is a cushion or shock absorber between the two bones and damage results in tears. Complex repair of these structures can be performed using a combination of open and arthroscopic procedures.
Although open incisions are required for total joint replacements and complex fracture surgery, arthroscopy has revolutionized our ability to return the knee to function. Reconstruction of ligaments, meniscus and articular cartilage defects are performed using small incisions, cameras and specialized equipment. These techniques provide better visualization and access allowing us to repair the injury and return the knee to as close to normal function as possible. Surgical procedures range from simply cutting out the damaged tissue (e.g. Meniscal tear) or large ligament reconstructions. Reconstructive techniques, using local tissue grafts, are used to make new ligaments or fill defects of articular cartilage. Meniscal cartilage tears may be removed or possibly repaired with special anchors. Typically, evaluation of the entire articular space of the knee is done and damaged tissue addressed.
KNEE SURGERY RECOVERY
Given the complexity of the knee, recovery from surgery is dependent on the procedure performed. Local anesthetic blocks, pain medications, ice and immobilization are among the numerous tools used for post-operative pain control. Although our goal is to regain mobility and strength in the long term, initial post-operative use of crutches is typical. For more complex procedures including ligament reconstruction and meniscal repairs, more prolonged crutch use may be necessary. Dr. Heinen will tell you when you can start walking. After this period of non-weight bearing, home exercises and formal physical therapy are utilized. Motion exercises followed by progressive strengthening and return to activities is expected. Recovery from simple meniscal injuries is measured in weeks, ligament reconstruction surgery and total joint replacement surgeries typically require a more prolonged rehabilitation.