Joint Preserving Surgery
Knee Replacement Surgery
Revision Knee Replacement Surgery
Knee Arthroscopy
Minimally Invasive Knee Surgery
Joint Preserving Surgery

Joint preserving surgery of the knee encompasses issues related to ligament stability, cartilage surfaces, and limb alignment. Ligament stability issues are best managed by surgeons who specialize in sports medicine. Management of cartilage loss in the knee can be addressed in a number of ways. These include simple "microfracture" techniques where areas of exposed bone in the joint are treated by making small cracks in the exposed bone surface to encourge cartilage to grow back onto the surface. Autogenous chondrocyte transplantation is another method that attempts to restore cartilage surfaces. This involves taking a sample of cartilage from the patient, growing cartilage cells in the laboratory, and reimplanting the cells into the knee. While this technique shows some promise, most cartilage defects in the knee are not well suited to this treatment. This technique is best applied to "pot-hole" type defects rather than more diffuse patterns of cartlage loss which are much more common. A third technique called mosaicplasty can also used for cartilage defects. This method involves taking plugs of normal cartilage with its underlying bone from a less-stressed area of the knee and tranplanting it into the worn area. Again, none of these techniques is as ideal as we would like them to be in terms of reliability and long-term results.

Many knees wear out on the inner side in association with a bowing deformity of the leg. This is because bowing of the leg results in excessive stresses being transferred to the inner part of the knee. If identified before too much damage had taken place, these knees can be treated by realigning the limb to remove the bowing deformity. Realignment of a limb is called osteotomy. There are many ways to do this. Issues related to this are described in the published manuscripts below:

Murphy SB. Tibial osteotomy for genu varum. Indications, preoperative planning, and technique. Orthop Clin North Am. 1994 Jul;25(3):477-82. Review.

Jakob RP, Murphy SB. Tibial osteotomy for varus gonarthrosis: indication, planning, and operative technique. Instr Course Lect. 1992;41:87-93. Review.