Surgical therapy is indicated for complex ligamentous ruptures, bony involvement, or severe instability of the knee joint.
Meniscal Injuries
- In cases of meniscal damage with severe symptoms, arthroscopy (arthroscopy of the joint) with removal of the affected portions or (depending on the extent of damage) removal of the entire meniscus is usually performed (see “Meniscal surgery” below).
- In meniscus tear without stretch / bend inhibition and joint effusion is a joint puncture; meniscus tear with stretch / bend inhibition and joint effusion is a joint puncture in readiness for surgery.
- Patients with a nonobstructive meniscal tear, ie, meniscal tear without blockages, diagnosed by magnetic resonance imaging (MRI), benefited from 8 weeks of physical therapy to the same extent as from partial arthroscopic meniscectomy (partial meniscectomy).
Ligament injuries
- In ligament injuries, the first step is to clarify the indication for surgery:
- In the case of a lateral ligament rupture, there is a strict indication for surgery in the case of an outer wall rupture and distal inner wall rupture. Note: An inner ligament rupture always requires a meniscus clarification!
- An anterior cruciate ligament (ACL) rupture can be treated conservatively. However, it should be noted that the anterior cruciate ligament has a significantly reduced self-healing tendency compared to the posterior.
- Operation of a cruciate ligament rupture:
- In the case of fresh cruciate ligament rupture, a suture is performed; postoperatively, primarily immobilization must be performed for a few weeks, followed by gradual mobilization.Note!In young, athletically active patients, in the case of an isolated cruciate ligament rupture, an initial wait-and-see attitude and, if necessary, cruciate ligamentoplasty is justifiable (this saves every second patient from surgery). This approach is justified in:
- No more severe instability
- No damage to cartilage and meniscus
- In older cruciate ligament rupture or chronic knee joint instability, cruciate ligamentoplasty is performed; postoperatively, immobilization must be performed for a few weeks, followed by gradual mobilization; see cruciate ligament rupture/Operative therapy.
- In the case of fresh cruciate ligament rupture, a suture is performed; postoperatively, primarily immobilization must be performed for a few weeks, followed by gradual mobilization.Note!In young, athletically active patients, in the case of an isolated cruciate ligament rupture, an initial wait-and-see attitude and, if necessary, cruciate ligamentoplasty is justifiable (this saves every second patient from surgery). This approach is justified in:
- For more information on “cruciate ligament rupture” see under the topic of the same name.
Cartilage injuries
- In cases of cartilage contusion (cartilage contusion), the patient receives forearm crutches for complete relief.
- For cartilage damage or flake fracture (osteochondral lesions; avulsion fracture or shear fracture), joint puncture is performed in readiness for surgery.
- In cases of fresh cartilage damage, surgical reduction of the blown-off portions of bone-cartilage may be attempted.
Luxations
- In knee joint dislocation, surgical therapy is usually indicated with reduction and casting, as there are usually concomitant injuries (nerve damage, etc.)
- Patellar luxation (knee joint injury in which the kneecap (patella) jumps out of its guide (luxation)).
- For first-time patellar luxation
- And low risk profile – thus a lower risk of reluxation – conservative therapy.is usually indicated.
- And simultaneous presence of several risk factors, the risk of a new patellar dislocation is increased → if necessary, surgical procedure.
- In the case of recurrent patellar dislocation, a surgical procedure may be indicated; various techniques are used to
- For first-time patellar luxation
