Knee Surgery

Knee Arthroscopy

Knee arthroscopy is surgery that is done to check for problems, using a tiny camera to see inside your knee. Other medical instruments may also be inserted to repair your knee.

What happens during the procedure?

Three different types of anesthesia (pain management) may be used for knee arthroscopy surgery:

  • Your knee may be numbed with painkilling medicine, and you may be given medicines that relax you. You will stay awake.

  • Spinal anesthesia. This is also called regional anesthesia. The painkilling medicine is injected into a space in your spine. You will be awake but will not be able to feel anything below your waist.

  • General anesthesia. You will be unconscious and unable to feel pain.

A cuff-like device that inflates may be used around your thigh to help control bleeding during knee arthroscopy.

The surgeon will make 2 or 3 small incisions (cuts) around your knee. Saltwater (saline) will be pumped into your knee to open up the space.

A narrow tube with a tiny camera on the end will be inserted through one of the incisions. The camera is attached to a video monitor in the operating room. The surgeon looks at the monitor to see the inside of your knee. In some operating rooms, the patient can also watch the surgery on the monitor, if they want to.

The surgeon will look around your knee for problems. The surgeon may put other medical instruments inside your knee through the other small incisions. The surgeon will then repair or remove the problem in your knee.

At the end of your surgery, the saline will be drained from your knee. The surgeon will close your incisions with sutures (stitches) and cover them with a dressing.


ACL Reconstruction

ACL reconstruction is surgery to replace the ligament in the center of your knee with a new ligament. The anterior cruciate ligament (ACL) keeps your shin bone (tibia) in place. A tear of this ligament can cause your knee to give way during physical activity.

What happens during the procedure?

You will receive general anesthesia right before surgery. This means you will be unconscious and unable to feel pain. Sometimes, other kinds of anesthesia are used for this surgery.

The tissue that will replace your damaged ACL will come from your own body or from a donor. A donor is a person who has died and, before death, chose to give all or part of their body to help others.

  • Tissue taken from your own body is called an autograft. The two most common places to take tissue from are a tendon in your knee or your hamstring. Your hamstring is a tendon behind your knee.

  • Tissue taken from a donor is called an allograft.

The procedure is usually done by knee arthroscopy. With arthroscopy, a tiny camera is inserted into the knee through a small incision (cut). The camera is connected to a video monitor in the operating room. Your surgeon will use the camera to check the ligaments and other tissues of your knee.

Your surgeon will make other small cuts around your knee and insert other medical. Your surgeon will repair any other damage found. Your surgeon then will replace your ACL by following these steps:

  • The old ligament will be removed with a shaver or other instruments.

  • If your own tissue is being used to make your new ACL, your surgeon will make a larger cut. Then, your surgeon will remove this tissue through the larger cut.

  • Your surgeon will make tunnels in your bone to bring the new tissue through. This new tissue will be in the same place as your old ACL.

  • Your surgeon will attach the new ligament to the bone with screws or other devices to hold it in place. As it heals, the bone tunnels fill in. This secures the new ligament more.

At the end of the surgery, your surgeon will close your incisions with sutures (stitches) and put a dressing on them. Most surgeons take pictures during the procedure from the video monitor so that afterward you can see what was found and what was done.

Meniscus Tears (repair and surgery)

The meniscus is a C-shaped piece of cartilage. Cartilage is found in certain joints and forms a buffer between the bones to protect the joint. The meniscus serves as a shock-absorption system, assists in lubricating the joint, and limits the ability to flex and extend the joint. Meniscal tears are most commonly caused by twisting or over-flexing the joint.

How is a meniscus tear treated?

The goal of treatment is to reduce symptoms and protect the joint from further injury while it heals.

You should not put your full weight on the knee. You may need to use crutches. A knee immobilizer is often applied to prevent further injury to the joint.

Other treatments include:

  • Ice to reduce swelling

  • Nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce swelling and pain

Physical activity is allowed, as tolerated. Physical therapy is recommended to help regain joint and leg strength.

When is surgery needed?

If a meniscus is so badly damaged it cannot be repaired, it may need to be removed or trimmed out. Without the meniscus cushion, persistent knee pain and arthritis can develop.

For many older patients with this condition, a knee joint replacement might be the right option. But active people younger than 55 may be eligible for an alternative treatment: meniscal transplant surgery.

A meniscal transplant replaces the damaged meniscus with donor cartilage.

What happens during a surgery?

If your meniscus is severely damaged or has been removed, it is likely that the articular cartilage protecting your knee will begin to wear. As this cartilage wears away, it becomes frayed and rough. Moving the bones along this exposed surface is painful. This condition is osteoarthritis. The goal of meniscal transplant surgery is to replace the meniscus cushion before the articular cartilage is damaged. The donor cartilage supports and stabilizes the knee joint. This relieves knee pain. The hope is that the transplant will also delay the development of arthritis, but long-term results are not yet available.

Allograft Preparation

Healthy cartilage tissue is taken from a cadaver (human donor) and frozen. This tissue is called an allograft. It is sized, tested, and stored. Correct sizing is one of the most important factors in the success of the transplant. Later, the allograft will be matched by size to a candidate for the procedure.

Allograft Safety

A screening process is done before selecting a possible donor. Someone who knows the donor well is interviewed to help identify risk factors that would prevent the use of the donor tissue.

Once selected, the donor tissue undergoes many tests. The safety of the tissue is monitored by the American Association of Tissue Banks and the United States Food and Drug Administration. The tissue is tested for viruses like those that cause HIV/AIDS, West Nile virus, hepatitis B and C, as well as for bacteria.

Patella Procedures

The patella, also known as the knee cap or kneepan, is a thick, circular-triangular bone which articulates with the femur and covers and protects the knee joint. It can become irritated or injured from prolonged sitting, overuse, misalignment or instability. The patella can also fracture, which may involve a single crack or shattering into several pieces.

Some of the common conditions associated with the patella include:

  • Chondromalacia Patellae (runner’s knee)
  • Prepatellar Bursitis (housemaid’s knee)
  • Patellar Subluxation/Dislocation (unstable kneecap)

How are patella problems treated?

Temporarily resting the knee and taking nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen, or aspirin may help relieve pain. Physical therapy, especially quadriceps strengthening and hamstring stretching, may be helpful.

Limit participation in sports or strenuous activity until the pain has gone away. Avoid activities that increase the knee pain, such as deep knee bends, until the pain improves.

If the alignment of the patella cannot be corrected with therapy, surgery may be an option. Depending on the type of misalignment, the surgery may be arthroscopic (using a camera, which allows a smaller incision) or open.

Fractures (Tibia)

A fracture, or break, in the bone of the upper part of the lower leg (tibia, or shin bone) may result from a low-energy injury, such as a fall from a height, or from a high-energy injury, such as a motor vehicle accident. Proper identification and management of these injuries will help to restore limb function (strength, motion, and stability) and lessen the risk of arthritis.

The soft tissues (skin, muscle, nerves, blood vessels, and ligaments) also may be injured at the time of the fracture. Because of this, the orthopaedic surgeon will also look for any signs of soft-tissue damage and include this in plans for managing the fracture.

Whether the injury is treated with surgery or without, both the bony injury (fracture) and any soft-tissue injuries must be treated together.


Total Knee Replacement

Knee joint replacement is surgery to replace a knee joint with an artificial joint. The artificial joint is called a prosthesis.

What happens during total knee replacement surgery?

You may receive general anesthesia before this surgery. This means you will be unconscious and unable to feel pain. Or, you may have a spinal or epidural anesthesia. In this kind of anesthesia, medicine is put into your back to make you numb below your waist.

After you receive anesthesia, your surgeon will make an incision (cut) over your knee to open it up. Then your surgeon will:

  • Move your kneecap (patella) out of the way, then shape the ends of your thigh bone and shin bone to fit the prosthesis. Your surgeon will also cut the underside of your kneecap to prepare it for the artificial pieces that will be attached there.

  • Fasten the two parts of the prosthesis to your bones. One part will be attached to the end of your thigh bone and the other part will be attached to your shin bone. Both parts will then be attached to the underside of your kneecap. Your surgeon will use a special bone cement to attach these parts.

Usually, artificial knees have metal parts. Now, though, some surgeons are using some different materials, including metal on metal, ceramic on ceramic, or ceramic on plastic.


Partial Knee Replacement (Unicompartmental Knee Replacement)

Partial Knee Replacement may be appropriate if you are age 60 years or older, not obese, and relatively sedentary. Among other specific qualifications, your knee must have:

  • An intact anterior cruciate ligament (ACL).
  • No significant inflammation.
  • No damage to the other compartments, calcification of cartilage, or dislocation.

  • Your doctor will verify that your knee meets the requirements when he or she begins the surgery. (If your knee does not meet these specific requirements, you may need total knee replacement.) The surgeon removes diseased bone and puts an implant (prosthesis) in its place. The two small replacement parts are secured to the rest of your knee. You can get UKA surgery on both knees at the same time if you need it.

Cartilage Lesions

One of the most common knee injuries is an anterior cruciate ligament sprain or tear.

Athletes who participate in high demand sports like soccer, football, and basketball are more likely to injure their anterior cruciate ligaments.

If you have injured your anterior cruciate ligament, you may require surgery to regain full function of your knee. This will depend on several factors, such as the severity of your injury and your activity level.