Specialties

Knee

Anatomy of the knee

The knee joint consists of the distal part of the femur, the proximal part of the tibia, and the kneecap. The cruciate ligaments in its interior and lateral ligaments on both sides, provide stability.
The entire surface of the knee is covered with a smooth structure called articular cartilage that allows a smooth sliding movement. Inside there are semicircular rings of cartilaginous tissue called menisci which act as pads. The synovial fluid allows for lubrication, thus reducing joint friction.

Meniscus injury

In the interior of the knee there are rings of cartilaginous tissue called menisci which act as pads. Meniscus can be damaged when playing sports or during daily activity, due to repeated impacts or twisting of the knee. When they are injured they produce pain, inflammation and failure.

The treatment of meniscus rupture can be the arthroscopic repair of the injury, or the resection of the damaged meniscus part leaving the rest of the meniscus healthy.

Meniscal arthroscopy is performed without admission and the patient can walk on crutches immediately. Recovery is complete in 90-95% of cases at 4-6 weeks. If there are associated lesions the recovery can be prolonged for several months.

Anterior Cruciate Ligament Injury

The cruciate ligaments (anterior and posterior) act as stabilizers of the knee. The anterior cruciate ligament (ACL) injury is the most frequent and is usually produced by making a sharp turn on the knee in sports such as skiing or football. When injured it causes pain and swelling and difficulty walking.

Conservative treatment is recommended for partial ACL injuries or in complete knee breaks that maintain acceptable stability. It consists of a specific rehabilitation program and avoid activities with torsion of the knee.

In unstable knees, associated meniscus injury or patients performing activities with high demand, surgical treatment is advised. The reconstruction of the damaged ligament is performed by creating a new one from a tendon of the knee. The tendon may be from the knee itself or from a donor (homograft). Patients can walk with the aid of knee and canes. The surgery is effective in 90% of the cases, being able to return to the sport activity at 4-6 months.

Injury of the posterior cruciate ligament

The posterior cruciate ligament (LCP) injury usually occurs in traffic accidents or when performing a sport. It can be injured in isolation or associated with other meniscus and ligament injuries. When it is hurt it causes pain, swelling and difficulty walking.

Conservative treatment for partial lesions or isolated complete tears is recommended on knees that maintain acceptable stability. It consists of a rehabilitation program.

In unstable knees or LCP lesions associated with other ligament injuries, surgical treatment is advised. The reconstruction of the damaged ligament is performed by creating a new one from a tendon of the knee. The tendon may be from the knee itself or from a donor (homograft). Patients can walk with the aid of knee and canes. The rehabilitation lasts for a few months. The surgery is effective in 70-90% of the cases, being able to return to the sport activity at 4-6 months

Joint cartilage injury

The entire surface of the knee is covered with a smooth layer called articular cartilage that allows a smooth sliding movement. When performing sports or daily activity, cartilage lesions may occur isolated or associated with other injuries. The symptoms that occur after cartilage injuries are: pain, swelling, blockages and failures. The treatment of these lesions is their arthroscopic repair. In the presence of small lesions the treatment usually is the polishing of the injury with motorized strawberries or the perforations that allow the repair of the lesion. In more severe lesions the treatment consists of performing osteochondral grafts or chondrocyte transplantation. The recovery process is prolonged (months) and the outcome depends fundamentally on the degree and size of the lesion. Large cartilage lesions can lead to early osteoarthritis of the knee.

Patellar Problems

Sliding image of the patella The patella is the small bone in front of the knee. It slides through the groove of the femur with flexion and extension. It is covered with a smooth surface called articular cartilage allowing a smooth sliding movement.

The main problems related to the patella are cartilage injury (chondromalacia) and patellar instability (dislocations to varying degrees). The main discomfort is pain, mainly with stairs, swelling and knee failure.

Initial treatment is conservative and consists of rehabilitation, medication and orthotics. If this fails, proceed to surgical treatment. It consists of the arthroscopic examination, the softening of the articular cartilage and the release or patellar realignment to allow a correct slip. The results are satisfactory in 70-90% of cases.

Knee osteoarthritis

Osteoarthritis of the knee is characterized by deterioration and loss of articular cartilage and inflammation. The patient has pain, swelling and difficulty walking.

The initial treatment is conservative: medication and physiotherapy. At intermediate stages without severe joint deterioration, hyaluronic infiltrations and arthroscopy may help maintain joint function and pain control. The best results are obtained on knees without major deformities or advanced joint deterioration and preserved movement. Arthroscopy consists of washing and cleaning the joint, polishing the surface of damaged cartilage and resecting the meniscal fragments. The surgery is performed without admission and the patient can walk on crutches immediately. It is a treatment that can relieve discomfort for a few years.

In advanced stages of osteoarthritis with severe joint deterioration the treatment is the knee prosthesis.

Fractures of the knee

In certain impact sports (skiing, soccer, basketball), knee-level fractures can occur. The fundamental symptom is pain associated swelling. The most frequent fractures are those affecting the tibial plateau, tibial spines and osteochondral fractures.

If the fracture is displaced the treatment is surgical. The traditional method consists of open surgery, with an important scar and a very painful postoperative. We perform the repair with arthroscopy obtaining a better esthetic result and a more comfortable postoperative beginning the rehabilitation immediately. In addition the damage to the joint is less allowing a better recovery of the patient.