Knee

Normal Anatomy of the Knee Joint

The knee is made up of four bones. The femur or thighbone is the bone connecting the hip to the knee. The tibia or shinbone connects the knee to the ankle. The patella (kneecap) is the small bone in front of the knee and rides on the knee joint as the knee bends. The fibula is a shorter and thinner bone running parallel to the tibia on its outside. The joint acts like a hinge but with some rotation.

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Conditions

Knee Arthritis

Arthritis is a general term covering numerous conditions where the joint surface or cartilage wears out. The joint surface is covered by a smooth articular surface that allows pain free movement in the joint. This surface can wear out for a number of reasons; often the definite cause is not known.

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Patient Info

Knee Pain

The knee is one of the largest joints in the body, formed by the lower end of the femur, upper end of the tibia and the patella or knee cap. Several ligaments and muscles attach to the bones of the knee joint to maintain normal motion of the joint. Special cartilaginous tissues known as menisci are placed between the two articular ends of the joint. These act as a cushion between the articular surfaces and absorb the shock during movement.

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Iliotibial Band Syndrome

Iliotibial band syndrome is an overuse injury resulting from the inflammation of iliotibial band. Iliotibial band is a tough group of fibers that begins at the iliac crest of hip and runs along the outside of the thigh, to get attached to the outer side of the shin bone just below the knee joint. Its function is to coordinate with the thigh muscles and provide stability the knee joint. Iliotibial band syndrome occurs when the iliotibial band and the lower outside portion of the thigh bone at the knee joint rub against each other. It commonly occurs in athletes, cyclists, and runners.

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Knee Dislocation

Patella (knee cap) is a protective bone attached to the quadriceps muscles of the thigh by quadriceps tendon. Patella attaches with the femur bone and forms a patellofemoral joint. Patella is protected by a ligament which secures the kneecap from gliding out and is called as medial patellofemoral ligament (MPFL).

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Patellar Tendonitis

Patellar tendinitis, also known as “jumper’s knee” is an inflammation of the patellar tendon that connects your kneecap (patella) to your shinbone. This tendon helps in extension of the lower leg. Patellar tendinitis usually results from repetitive trauma or overuse, particularly from sports activities involving jumping such as basketball or volleyball. Therefore, this condition is also known as jumper’s knee. This condition may also occur because of an acute injury to the tendon that has not healed properly.

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Patellofemoral Pain Syndrome

Patellofemoral pain syndrome, also referred to as PFPS, is one of the most commonly reported knee problems, accounting for one in four knee complaints seen by Orthopaedists. To learn more about patellofemoral pain syndrome, let us first learn about normal knee anatomy and function.

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Torn Knee Cartilage

Articular or hyaline cartilage is the tissue lining the surface of the two bones in the knee joint. Cartilage helps the bones move smoothly against each other and can withstand the weight of the body during activities such as running and jumping. The Articular cartilage does not have a direct blood supply to it. So it has less capacity to repair itself. Once the cartilage is torn it will not heal easily. It can lead to degeneration of the articular surface, leading to development of osteoarthritis.

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Torn Medial Meniscus

Of the menisci within the knee, it is the medial that is more easily injured. Differences in the anatomical attachments of the medial meniscus compared to the lateral mean that the medial meniscus becomes distorted during combined flexion and rotation movements in a manner not experienced on the lateral side.

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Ankylosing Spondylitis

The term ankylosis refers to loss of mobility of the spine, whereas spondylitis means inflammation of the spine. Therefore, ankylosing spondylitis is a condition where chronic inflammation of the spine and sacroiliac joint results in complete fusion of the vertebrae leading to pain and stiffness in the spine. Sacroiliac joints are located in the lower back where the sacrum part of the vertebrae joins the iliac bones.

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Septic Arthritis

Septic arthritis, also called as infectious arthritis, is characterized by joint inflammation due to a bacterial or fungal infection that usually affects the large joints of the body such as knee or hip. Normally, fluid lubricating a joint, called synovial fluid, is aseptic in nature. But with septic arthritis, microbes can grow in the affected joint fluid and make the condition worse.

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Avascular Necrosis (osteonecrosis) of the Knee

Osteonecrosis is a condition in which death of a section of bone occurs because of lack of blood supply to it. It is one of the most common causes of knee pain in older women. Women over the age of 60 years of age are commonly affected, three times more often than men.

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Osteoarthritis

Osteoarthritis, also called degenerative joint disease is the most common form of arthritis. It occurs most often in older people. This disease affects the tissue covering the ends of bones in a joint (cartilage).In a person with osteoarthritis, the cartilage becomes damaged and worn out causing pain, swelling, stiffness and restricted movement in the affected joint. This condition most commonly affects the joints in hips, knees, hands, and spine. Rarely, the disease may affect the shoulders, wrists and feet.

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Post Traumatic Osteoarthritis

Osteoarthritis, also called degenerative joint disease is the most common form of arthritis. Post-traumatic osteoarthritis of the knee, is a prevalent sub-type of osteoarthritis, in which the joint that has been subjected to any kind of physical injury becomes damaged and worn out. Symptoms include swelling, joint pain and accumulation of fluid in the joint.

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Rheumatoid Arthritis

Rheumatoid arthritis (RA) is an autoimmune disease. It causes pain, swelling, stiffness, and loss of function in the joints. RA usually affects the same joint on both sides of the body.

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Knee Fracture

A fracture is a condition in which there is break in the continuity of the bone. In younger individuals these fractures are caused from high energy injuries, as from a motor vehicle accident. In older people the most common cause is weak and fragile bone.

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Meniscus Tear

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Patellofemoral Instability

The knee can be divided into three compartments: patellofemoral, medial and lateral compartment. The patellofemoral compartment is the compartment in the front of the knee between the knee cap and thigh bone. The medial compartment is the area on the inside portion of the knee, and the lateral compartment is the area on the outside portion of the knee joint. Patellofemoral instability means that the patella (kneecap) moves out of its normal pattern of alignment. This malalignment can damage the underlying soft structures such as muscles and ligaments that hold the knee in place.

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Procedures

Total Knee Replacement (TKR)

Total knee replacement, also called total knee arthroplasty, is a surgical procedure in which the worn out or damaged surfaces of the knee joint are removed and replaced with artificial parts. The knee is made up of the femur (thigh bone), the tibia (shin bone), and patella (kneecap). The meniscus, the soft cartilage between the femur and tibia, serves as a cushion and helps absorb shock during motion. Arthritis (inflammation of the joints), injury, or other diseases of the joint can damage this protective layer of cartilage, causing extreme pain and difficulty in performing daily activities. Your doctor may recommend surgery if non-surgical treatment options have failed to relieve the symptoms.

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Arthroscopy of the Knee Joint

Knee Arthroscopy is a common surgical procedure performed using an arthroscope, a viewing instrument, to look into the knee joint to diagnose or treat a knee problem. It is a relatively safe procedure and a majority of the patient’s discharge from the hospital on the same day of surgery.

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Unicondylar Knee Replacement

Unicompartmental knee replacement is a minimally invasive surgery in which only the damaged compartment of the knee is replaced with an implant. It is also called a partial knee replacement. The knee can be divided into three compartments: patellofemoral, the compartment in front of the knee between the knee cap and thigh bone, medial compartment, on the inside portion of the knee, and lateral compartment which is the area on the outside portion of the knee joint.

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Patient Specific Knee Implants and Guides

Knee implants are artificial devices that form the essential parts of the knee during a knee replacement surgery. The sizes of the implants may vary depending upon the patient’s needs. Patient specific implants, can provide better alignment of the bones, and may be used depending on the preference of the orthopedic surgeon.

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Patient Info

Computer Navigated Knee Replacement

A total knee replacement surgery is the last resort to relieve pain and restore function in knee damaged by arthritis or an injury when non-surgical treatments do not relieve the condition. The procedure involves replacing the damaged surfaces of the articulating bones with the artificial implant. Most of these implants wear with use. Thus the risk of need for revision surgery is high in young and active people if the implant has to last the lifetime of the patient. The life of the implant can be extended by precise alignment of the implant and this can be achieved by the use of computer navigation for total knee replacement surgery.

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Robotic Knee Replacement

Robotic assisted partial knee surgery is an innovative alternative to the conventional surgical procedure in patients suffering from degenerative knee diseases such as osteoarthritis. It is performed using robotic-arm technology that allows the surgeon to precisely perform the surgery through a smaller incision as compared to traditional surgery.

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Complex Total Knee Replacement

Complex total knee replacement procedure is usually indicated for major knee deformity, severe arthritis, knee ligaments weakness and bone loss due to fracture or arthritis.

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Revision Knee Replacement

Revision knee replacement surgery involves replacing part or all of your previous knee prosthesis with a new prosthesis. Although total knee replacement surgery is successful, sometimes the procedure can fail due to various reasons and require a second revision surgery.

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Click on the topics below to find out more from the orthopedic connection website of American Academy of Orthopedic Surgeons.

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