Knee preservation surgery represents a variety of procedures aimed at alleviating pain, improving function, and delaying or avoiding the need for a total knee replacement. This surgical approach is particularly beneficial for patients who are experiencing knee problems but are not yet candidates for total knee replacement due to their young age, activity level, or the severity of their condition. The goal of knee preservation surgery is to either correct the underlying damage or improve the function, while preserving as much of the patient’s natural knee anatomy and function as possible.
Common knee preservation procedures include:
- Osteotomy: This involves cutting and realigning the bones around the knee to relieve pressure on the damaged area. It is also useful for correcting malalignments of the limb. Osteotomies are often recommended for patients with osteoarthritis that is confined to a single part of the knee.
- Cartilage Repair and Regeneration: Various bio-regenerative procedures can be used to repair or regenerate cartilage in focal cartilage defects. Techniques such as microfracture, autologous chondrocyte implantation (ACI), minced cartilage with PRP (like Autocart), Chondrofiller, and osteochondral autograft or allograft transplantation focus on repairing or regenerating damaged knee cartilage. These procedures are often suitable for younger patients with isolated cartilage defects who want to pursue active lifestyles.
- Meniscus Repair or Transplantation: The meniscus acts as a cushion between the knee’s bones. Preserving or restoring it is crucial for preventing further knee damage to the joint. Meniscus tears may be repaired, or, in some cases, if the damage is extensive, a meniscus transplant might be considered.
- Patellar or Quadriceps Mechanism Realignment Procedures: For patients with issues in patellar tracking or patellar instability, procedures to realign the knee cap (patella) can help restore knee function and relieve pain.
- Ligament repair or Reconstruction: Injury to any of the knee ligaments, such as the ACL (anterior cruciate ligament), PCL, MCL, POL, LCL, PLC etc, can lead to instability and further damage if not addressed. If the patient presents early to the surgeon, some of the ligaments can be repaired. However, some ligaments need reconstruction. Ligament reconstruction involves replacing the torn ligament with a graft to stabilize the knee.
Such knee preservation surgeries can offer significant benefits, including reduced pain, improved function, and the potential to delay or avoid the need for knee replacement surgery. However, the success of these procedures often depends on proper patient selection, the skill and experience of the surgeon, and diligent postoperative rehabilitation. Patients considering knee preservation surgery should discuss their options thoroughly with an orthopaedic surgeon specialising in arthroscopy and sports injuries management to know the best possible treatment options based on their specific condition, and to understand the potential risks and benefits.
