JOINT LUBRICATION

The knee can be affected by a variety of different conditions ranging from traumatic injuries to gout, rheumatism and arthritis. Unknown to most, many of these conditions are likely to benefit from conservative management. Injections using hyaluronic acid have proven to be particular popular with patients as they a relatively painless, easy to administer and often provide significant pain relief. They are not only suitable for patients with stiff and arthritic joint, but younger patients with very early degenerative changes who experience pain after sporting activities. Hyaluronic acid increases the natural viscosity of the joint fluid thereby improving lubrication without joint swelling. The effect becomes apparent within 3 to 4 weeks and can last up to 18 months. For further reading please click here to read the article in full.

ARTICULAR CARTILAGE REPAIR

A variety of cartilage repair techniques are now available allowing patients to return to their desired level of activity. Micro-fracture has proven successful in patients of all ages by enabling natural healing mechanisms to create cartilage re-growth into damaged surfaces. Further progress in tissue engineering has now enabled us to use the patient’s own cartilage cells for the repair process. Matrix autologous chondrocytes implantation or MACI® and HYALOGRAFT-C are two of those new techniques which have provided excellent results in clinical studies. Synthetic resorbable scaffolds like the TruFit® plug have opened another avenue in cartilage repair. These plugs provide immediate fill of the surface defect, enabling the patient to enter a more rapid rehabilitation programme. Clinical results have been encouraging and many patients have gone back to sporting activities within 3 months following surgery.

MENISCUS REPLACEMENT

Overzealous removal of shock-absorber cartilage can affect joint mobility and potentially lead to arthritis. Surgeons in the USA have developed MENAFLEX®, a synthetic collagen based implant that allows for any portion of meniscus to be replaced. This implant has now been FDA approved and CE marked allowing for its use in the UK and US. We are now for the first time in a position to offer patients the opportunity of a shock-absorber reconstruction even if only part of it has become deficient. In situations where the entire meniscus has been lost a meniscal transplant however remains the current gold standard of treatment. Further research will be necessary to see whether the synthetic implant will also be suitable in such situations.

LIGAMENT RECONSTRUCTION

We have shifted away from using patella tendon to hamstring tendons for the reconstruction of the anterior cruciate ligament (ACL). The results have been excellent providing equal levels of knee stability without the pain and weakness associated with patellar tendon harvest. Patients are able to resume exercising as early as 4 weeks following surgery. A return to high level sporting activities such as football, rugby or skiing is possible within 8 to 9 months but largely dependent on the patient’s fitness level. We therefore monitor the recovery process with isokinetic muscle strength assessments and KT-2000 knee laxity testing, working closely together with the patient’s physiotherapist. Newly designed custom-made derotation braces are recommended in the early rehabilitation phase to protect the knee during ligament healing.

GLUCOSAMINE SULPHATE

Evidence on the efficacy of Glucosamine in the protection of joint cartilage is increasing. Clinical studies have shown that oral Glucosomine intake has the ability to considerably slow down the rate of cartilage degeneration and with it the onset of symptomatic arthritis. It is hoped that regular intake of Glucosamine sulphate at a dosage of at least 1500mg per day may reduce the likelihood of developing knee arthritis altogether. Further studies are currently underway to determine whether a higher dosage may provide additional benefits. Chondroitin has also been linked with cartilage protection and preservation, but scientific evidence has so far only been able to show limited effects on symptom relief.  For further reading please click here to view the PDF article.