For the treatment of cartilage disorders, conservative and physical therapy methods are primarily employed. Through a programme of muscle development, in combination with injections of cartilage revitalising drugs into the joint, effective action can be taken against early stages of degenerative conditions (osteoarthritis) and softening of the cartilage. Should complete relief not be attained, further diagnostic measures are required – particularly magnetic resonance imaging – in order to gain further insight into the cause of complaint. If the problem is shown to be in the ligaments, meniscus or severe cartilage disorders then arthroscopy (endoscopy) is necessary.
Most arthroscopic procedures are carried out due to tears in the meniscus. Both the inner and outer meniscus are poorly supplied with oxygen and have the tendency to degenerate in certain zones, which become fragile and tear. Twisting the knee in accidents is another trigger for a torn meniscus. If the tears are recent and near the rim of the meniscus, the suitable procedure is to suture the meniscus – otherwise the torn zone can be sparingly removed.
If the cartilage is soft and deteriorated, shaving or for very severe disorders drilling is performed. If a defective area does not exceed a diameter of 3 cm, it can be filled up using a graft of healthy cartilage from the same knee joint [Cartilage Transplantation OATS Technique].
If the cartilage degeneration occurs in the kneecap malpositioning may be the cause, i.e. outward displacement. In such cases, the outer capsule is endoscopically divided using an electric knife, in order to allow the overstrained cartilage to rebuild. Bone and cartilage fragments, which result as a consequence of an accident, can be reattached using absorbable materials in an arthroscopic procedure.
Injuries resulting from a twisted knee, statistically most common in football, skiing and snowboarding, have benefitted from the development of arthroscopic instruments and techniques.
These days we have first-class arthroscopic instruments at our disposal, especially useful in ligament surgery. For ligament injuries it is preferable to replace the anterior and posterior cruciate ligaments using the semitendinosus tendon of the same knee. This procedure is now completed in less than one hour and allows full weight-bearing and mobility after 14 days of functional rehabilitation. The attachment of the transplanted tendon can be achieved using absorbable screws and flip buttons.
The indications for the replacement of a knee joint consist of the total dissolution of the cartilage and a significant reduction in the weight bearing capacity of the lower extremities, thereby having a severe effect on the quality of the patient’s life.
If the osteoarthritis of the knee is so far advanced, uni- or bicondylar replacements are employed. We are able to offer the patient remarkable endoprostheses, which have had the benefit of 20 years’ experience on the market. The LCS and the PFC knee joint manufactured by DePuy meets the requirements of all conditions such as loosening of the ligaments or incorrect axis. The implantation takes place with or without the use of cement.
The stay at the private clinic lasts approximately 8 days, after which physical rehabilitation therapy follows.