Knee
Knee Anatomy
The knee is a complex joint made up of different structures including bones, tendons, ligaments and muscles. They all work together to maintain normal function and provide stability to the knee during movement.
Having a well-functioning healthy knee is essential for our mobility and ability to participate in various activities. Understanding the anatomy of the knee enhances your ability to discuss and choose the right treatment procedure for knee problems with your doctor.
Bones
The Knee is a hinge joint made up of two bones, the thigh bone (femur) and the shinbone (tibia). There are two round knobs at the end of the femur called femoral condyles which articulate with the flat surface of the tibia called the tibial plateau. The tibia plateau on the inside of the leg is called the medial tibial plateau, and on the outside of the leg it is called the lateral tibial plateau.
The two femoral condyles form a groove on the front (anterior) side of the knee called the patellofemoral groove. A small bone called the patella sits in this groove and forms the knee cap. It acts as a shield and protects the knee joint from direct trauma.
A fourth bone called the fibula is the other bone of the lower leg. This form a small joint with the tibia. This joint has very little movement and is not considered a part of the main joint of the knee.
Articular Cartilage and Menisci
Movement of the bones causes friction between the articulating surfaces. To reduce this friction, all articulating surfaces involved in movement are covered with a white, shiny, slippery layer called articular cartilage. The articulating surface of the femoral condyles, tibial plateaus and the back of the patella are covered with this cartilage. The cartilage provides a smooth surface that facilitates easy movement.
To further reduce friction between the articulating surfaces of the bones, the knee joint is lined by a synovial membrane which produces a thick clear fluid called synovial fluid. This fluid lubricates and nourishes the cartilage and bones inside the joint capsule.
Within the knee joint between the femur and tibia there are two C shaped cartilaginous structures called menisci. Menisci function to provide stability to the knee by spreading the weight of the upper body across the whole surface of the tibial plateau. The menisci help in load bearing by preventing the weight from concentrating onto a small area, which could damage the articular cartilage. The menisci also act as a cushion between the femur and tibia by absorbing the shock produced by activities such as walking, running and jumping.
Ligaments
Ligaments are tough bands of tissue that connect one bone to another bone. The ligaments of the knee function to stabilize the knee joint. There are two important groups of ligaments that hold the bones of the knee joint together, collateral ligaments and the cruciate ligament.
Collateral ligaments are present on either side of the knee. They function to prevent the knee from moving too far during side to side motion. The collateral ligament on the inside is called the medial collateral ligament (MCL) and the collateral ligament on the outside is called the lateral collateral ligament (LCL).
Cruciate ligaments- This group of ligaments, present inside the knee joint, control the back and forth motion of the knee. The Cruciate ligament in the front of the knee is called anterior cruciate ligament or ACL and the cruciate ligament in the back of the knee is called posterior cruciate ligament or PCL.
Muscles
Muscles: There are two major muscles, the quadriceps and the hamstrings, which enable movement of the knee joint. The quadriceps muscles are in the front of the thigh. When the quadriceps muscles contract, the knee straightens. The hamstrings are in the back of the thigh. When the hamstring muscles contract, the knee bends.
Tendons
Tendons are structures that attach muscles to the bone. The quadriceps muscles of the knee meet just above the patella and attach to it through a tendon called the quadriceps tendon. The patella further attaches to the tibia through a tendon called the patella tendon. The quadriceps muscle, quadriceps tendon and patellar tendon all work together to straighten the knee. Similarly, the hamstring muscles at the back of the leg are attached to the knee joint with the hamstring tendon.
Knee Pain
The knee is one of the largest joints in the body, formed by the lower end of the femur, upper end of the tibia and the patella or knee cap. Several ligaments and muscles attach to the bones of the knee joint to maintain normal motion of the joint. Special cartilaginous tissues known as menisci are placed between the two articular ends of the joint. These act as a cushion between the articular surfaces and absorb the shock during movement.
Anterior Knee Pain
Anterior knee pain is a characterized by a chronic pain over the front and center of the knee joint. It is common in athletes, active adolescents (especially girls) and overweight individuals. Anterior knee pain refers to a variety of conditions which include runner's knee or patellar tendinitis and chondromalacia of the patella. There is an inter-individual variation in the duration and presentation of pain.
Knee Arthritis
Arthritis is a general term covering numerous conditions where the joint surface or cartilage wears out. The joint surface is covered by a smooth articular surface that allows pain free movement in the joint. This surface can wear out for several reasons; often the definite cause is not known.
Osteonecrosis of the Knee
Osteonecrosis is a condition in which death of a section of bone occurs because of lack of blood supply to it. It is one of the most common causes of knee pain in older women. Women over the age of 60 years of age are commonly affected, three times more often than men.
Non-surgical Treatments
Pharmacological
The knee is a complex joint which consists of bone, cartilage, ligaments and tendons that make joint movements easy and at the same time more susceptible to various kinds of injuries. Knee problems may arise if any of these structures get injured by overuse or suddenly during sports activities. Injuries to the knee can be caused by degenerative disease such as arthritis, traumatic injuries and sports injuries.
Viscosupplementation
Viscosupplementation refers to the injection of a hyaluronan preparation into the joint. Hyaluronan is a natural substance present in the joint fluid that assists in lubrication. It allows smooth movement of the cartilage covered articulating surfaces of the joint.
Cortisone Injection
Cortisone is a corticosteroid released by the adrenal gland in response to stress and is a potent anti-inflammatory agent. Artificial preparations containing cortisone are injected directly into the affected joint to relieve pain and reduce inflammation.
Physical Therapy
Physiotherapy or physical therapy is an exercise program that helps you to improve movement, relieve pain, encourage blood flow for faster healing, and restore your physical function and fitness level. The main aim of physical therapy is to make your daily activities such as walking, getting in and out of bed, or climbing stairs easier. It can be prescribed as an individual treatment program or combined with other treatments.
Surgical Treatment
Knee Arthroscopy
Knee Arthroscopy is a common surgical procedure performed using an arthroscope, a viewing instrument, to look into the knee joint to diagnose or treat a knee problem. It is a relatively safe procedure and a majority of the patients are discharged from the hospital on the same day of surgery.
Minimally Invasive Knee Replacement
Total knee replacement is a very successful surgical treatment for knee arthritis. Over the years, minimally invasive knee replacement surgical techniques have been developed to lessen tissue trauma and improve patient outcomes. This minimally invasive approach involves much smaller incisions than the usual 10-12 inch incisions used in the traditional knee replacement and spares the quadriceps muscle and tendon, which control bending of the knee, from being cut to access the knee joint.
Total Knee Replacement
The knee is made up of the femur (thighbone), the tibia (shinbone), and patella (kneecap). The meniscus, the soft cartilage between the femur and tibia, serves as a cushion and helps absorb shock during motion. Arthritis (inflammation of the joints), injury, or other diseases of the joint can damage this protective layer of cartilage, causing extreme pain and difficulty in performing daily activities.
Unicompartmental Knee Replacement
Arthritis is inflammation of a joint causing pain, swelling (inflammation), and stiffness.
Osteoarthritis is the most common form of knee arthritis in which the joint cartilage gradually wears away. It most often affects older people. In a normal joint, articular cartilage allows for smooth movement within the joint, where as in an arthritic knee the cartilage itself becomes thinner or completely absent.
Patellofemoral Knee Replacement
Traditionally, a patient with only one compartment of knee arthritis would undergo a total knee replacement surgery. Patellofemoral knee replacement is a minimally invasive surgical option that preserves the knee parts not damaged by arthritis as well as the stabilizing anterior and posterior cruciate ligaments, ACL and PCL.
What is New in Knee Replacement
If you are considering knee replacement surgery, there are new developments under study which can help enhance their quality of life. These include:
Revision Knee Replacement
Revision knee replacement surgery involves replacing part or all your previous knee prosthesis with a new prosthesis. Although total knee replacement surgery is successful, sometimes the procedure can fail due to various reasons and require a second revision surgery.
Outpatient Total Knee Replacement
Total knee replacement is the surgical treatment for knee arthritis, where the damaged knee is removed and replaced with an artificial knee implant. Traditionally performed as an inpatient procedure, total knee replacement surgery is now being conducted on an outpatient basis, allowing patients to go home the same day of the surgery.
Signature Knees
The knee joint, made up of the ends of the femur (thighbone) and tibia (shinbone) is cushioned by a spongy tissue called cartilage. Damage and wear and tear of the cartilage causes painful rubbing of the joint bones, leading to disability. This condition can be successfully treated with knee replacement surgery, which involves the replacement of the damaged tissue with a prosthetic implant.
Knee Implants
Knee implants are artificial devices that form the essential parts of the knee during a knee replacement surgery. The knee implants vary by size, shape, and material. Implants are made of biocompatible materials that are accepted by the body without producing any rejection response. Implants can be made of metal alloys, ceramics, or plastics, and can be joined to the bone.
Arthroscopic Surgery
Arthroscopy is a surgical procedure during which the internal structure of a joint is examined for diagnosis and treatment of problems inside the joint. In arthroscopic examination, a small incision is made in the patient’s skin through which pencil-sized instruments that have a small lens and lighting system (arthroscope) are passed.