| Osteoarthritis, the commonest form of arthritis | | | | Normally in the standing position, there should be no |
| affects the knee joint most often in India. Elderly | | | | gap between the inner side of the knee and ankle |
| afflicted by this chronic painful disease need joint | | | | joint. If a gap exists between the knees, then the |
| replacements as a permanent solution to improve | | | | person has bow legs (Genu varum) and if a gap |
| their quality of life and put an end to disabling pain. | | | | exists between the ankles, then the legs diverge at |
| However it is increasingly common to see many | | | | the ankle, causing knock knees (Genu valgum). Both |
| young people also suffer from the earlier | | | | these deformities can lead to one sided wear of the |
| manifestations of the disease. In this group alternate | | | | knee joint and arthritis in one half of the knee. |
| solutions have to be recommended considering the | | | | Surgical solutions are available to prevent or treat |
| age, increased demands like participation in sports and | | | | early arthritis. These alternatives avoid knee pain |
| work. Joint replacements cannot obviously be a | | | | from arthritis. |
| solution to young men and women. | | | | These knee reconstructive procedures attempt to |
| Osteoarthritis is a age related wear of Articular | | | | restore the anatomy of the joint and are mainly of a |
| cartilage which covers the end of the long bones in a | | | | biological nature. They do not involve joint |
| joint. It is smooth, elastic, shining tissue. It is | | | | replacement. Examples are |
| responsible for lubrication, shock absorption, and | | | | 1) Knee ligament reconstruction- ACL reconstruction |
| pain-free movements. Unlike other tissues of the | | | | is possible through tiny key-hole incisions (arthroscopic |
| body, it has limited capability of regeneration and | | | | surgery). Graft is taken from the patient's own body |
| repair as it has no blood supply and nerve supply. This | | | | (autograft) or from a brain dead person, (allograft). |
| limited repair capacity decreases with aging and leads | | | | This tendon graft is threaded through bony tunnels in |
| to depletion in the arthritis knee. Pain and stiffness | | | | the leg and thigh bones and is fixed with screws, |
| ensue, necessitating medication or surgery. | | | | buttons or other devices. |
| Osteoarthritis does not involve the whole of the joint | | | | 2) Meniscal suture- This is a procedure in which |
| to begin with. A localized area of cartilage damage | | | | attempt is made to suture a torn meniscus if situated |
| called a lesion is the precursor and harbinger of the | | | | in a suitable position. Concomitant ACL reconstruction |
| disease. If left untreated, lesions greater than 1. 5 cm | | | | is required if there is an injury to this ligament also. |
| will lead to arthritis after 15 years. | | | | This is done through arthroscopic surgery. |
| Some generalized and local conditions predispose to | | | | 3) Meniscal transplant- This procedure is to be |
| early cartilage damage. These are mechanical, | | | | introduced shortly. In this menisci are harvested from |
| chemical, and biological. Occupations, Obesity, | | | | the knee joints of brain dead living donors or non |
| mal-alignment or structural damage can predispose to | | | | heart beating donors. These are preserved and then |
| cartilage damage. | | | | grafted into the damaged knee. |
| Ligaments and menisci stabilize the knee. Menisci | | | | 4) Reparative cartilage procedure are available to |
| dissipate stresses, help in lubrication, increase joint | | | | salvage localised cartilage defects and prevent their |
| conformity and confer additional stability. The | | | | progression to extensive involvement. These are |
| ligaments inside the joint are called the cruciate | | | | microfracture wherein small holes are made in the |
| ligaments. These are torn in many sports, or two | | | | raw area to generate a super clot and in growth of |
| wheeler accidents. An ACL injury is the commonest | | | | fibro cartilage. In mosaicplasty, cartilage plugs are |
| ligamentous injury. Unrepaired ACL's lead to further | | | | harvested from non weight bearing portion of the |
| tearing of the menisci and both in association can lead | | | | knee and re-implanted into the lesions. |
| to osteo-arthritis. | | | | 5) Corrective osteotomy- Mal-aligned joints can be |
| Meniscal tears can occur in isolation in sports or | | | | corrected by an osteotomy (division of bone). After |
| domestic accidents. After the importance of the | | | | this surgery, stresses across a joint are distributed |
| menisci was realized and arthroscopic surgery came | | | | more evenly excess wear from one half of the joint |
| into vogue, attempts are made to resect and | | | | is minmized. This again prevent rapid progression of |
| remove only the damaged portion of the menisci and | | | | osteoarthritis and can postpone the need for a |
| preserve the rest. However, it is not always possible | | | | replacement. |
| to do so as the damage is beyond repair and a total | | | | These surgical alternatives are available in Chennai to |
| or subtotal Menisectomy is necessary. Such knees | | | | treat painful knees in young people and prevent |
| are also predisposed to develop secondary | | | | progression to arthritis. By availing these alternate |
| osteoarthritis (occurring in younger persons at an | | | | surgical procedures where one is indicated, one can |
| earlier age) cf Primary osteoarthritis which occurs in | | | | preserve and continue with natural cartilage and |
| the elderly. | | | | postpone or avoid joint replacement by a decade or |
| Some people have deformities around the knee. | | | | more. |
| These may be situated in the thigh bone or leg bone. | | | | |