What does knee surgery deal with?

The most important and largest joint of our body is the knee, which is exposed to a significant load during a whole day of movement, as it is engaged in walking and carries the whole body. It is no coincidence that the majority of musculoskeletal complaints is related to this joint. At our knee surgery clinic, our orthopedic traumatologists determine the cause of the pain with a physical and, if necessary, instrumental examination and recommend a cure to our patients.

What diseases or complaints are covered?

Medial meniscus injury

Description of the disease: Among the structures that make up the knee joint, the injury of the medial meniscus is the most common. Its shape and position are such that it can tear in the event of injuries with a twisting mechanism. These types of injuries often occur while playing football, basketball, handball, or skiing.

Symptoms: A torn or ruptured piece of meniscus may pinch between the ends of the bones, which can lead to sharp pain, swelling of the joint, and limited movement of the knee.

The torn pieces damage and corrode the surface of the mirror-smooth hyaline cartilage covering the bones. Depending on the circumstances of the injury, the location of the injury, and the patient’s tolerance, the symptoms may be so severe that they may require urgent intervention (stuck knee), but it is also possible that the several weeks or even months can pass by before the surgery.

Treatment: Meniscus injury can be permanently cured with arthroscopic surgery: the torn part is sutured back or removed. Click here to learn more about potential surgical solution(s). Meniscus preserving program.

Lateral meniscus injury

Description of the disease: Injury to the lateral meniscus is much less common. Injury can occur during an accident or in childhood. The cause of the childhood lesion is that due to a congenital disorder, the meniscus is not crescent-shaped but disc-shaped.

Symptoms: When squatting, the enlarged cartilage causes a painful click on the lateral side of the joint.

Treatment: Meniscus injury can be permanently cured with arthroscopy (articular keyhole surgery): the torn part is sutured back or removed. Click here to learn more about potential surgical solution(s). Meniscus preserving program.

Inflammation of cysts and bursae (synovial fluid-filled sacs) around the knee

Description of the disease: Cysts: The gelatinous tubules that form at the height of the knee joint gap are called cysts. These can also develop from the meniscus if the crescent-shaped cartilage is damaged. Another site of occurrence of cysts is the knee pit. Occasionally, these cysts reach the size of a goose egg. If the gelatinous tubing originates from the joint capsule, it is called a Baker’s cyst.

Bursae: in our body there are approximately 70 bursae, or synovial fluid-filled sacs, that cover the bony protrusions and facilitate the movement of muscles or tendons above the bones. These can be inflamed due to minor or major injuries, chronic diseases such as gout and rheumatoid arthritis. During bursitis or inflammation of the synovial fluid-filled sac, bacteria accumulate in the sac, saturating it with large amounts of fluid (in some cases, it can be bloody as well), which can lead to swelling or even redness and pain.

In addition to physical examination, ultrasound is the most reliable way to detect bursitis which can develop not only in the knee but also in the elbow or heel. Rest, icing, painkiller use may eliminate the symptoms, in more severe pain, steroid injections may be the solution but in the most severe cases, if inflammation does not decrease, if bursitis develops after a major injury, or there is underlying gout and purulent bursitis, surgery is the appropriate treatment.

However, if someone’s lifestyle or work regularly forces them into a specific posture that puts a heavy strain on the bursa (e.g., kneeling in case of floor installers or cleaners; people who a lot on their elbows), complaints may return over time.

Symptoms: Fluid build-up can cause swelling around the joint, which can range from a small size to a goose egg size. In many cases, these synovial fluid-filled sacs also exert pressure on blood vessels and nerves, which can result in numbness and circulatory disturbances.  

Treatment method: if the above conservative treatment is not successful, the cysts and other related disorders can be removed by arthroscopy (keyhole surgery) and/or exploration. Click here to learn more about potential surgical solution(s). Elimination of cysts and synovial fluid-filled sacs (bursae) around the knee.

Ligament injuries, joint instability, cruciate ligament rupture

Description of the disease: Higher energy injuries can tear the ligaments that secure the knee. The most common injuries are affecting the medial collateral ligament and the anterior cruciate ligament. While 10-15 years ago, approximately 1000 to 1500 ligament repairs were performed in Hungary annually, this number now exceeds four thousand. Cruciate ligaments most often rupture by a twisting mechanism injury during football, skiing, basketball, or handball.

Symptoms: The patient feels sharp pain, the knee swells, becomes unstable, and the patient becomes unable to perform certain movements (squatting, running). If along ligament rupture, the meniscus is also damaged, then the crescent-shaped cartilage may be torn, which may result in a locked knee.

Treatment:

There are two ways to treat collateral ligament injuries:

1. Conservative treatment: after a ligament injury, we try to stabilize the patient by physiotherapy and rehabilitation in each case. If instability is felt after 6 to 8 weeks of intensive physiotherapy, we recommend surgery.
2. Surgical care: with arthroscopic (articular keyhole surgery) technique, we wash the knee joint, check the menisci and the integrity of the articular surfaces, remove the torn pieces of cartilage, and if the type of meniscus injury is makes it necessary, we perform closed suturing (meniscus preserving program). In many cases, collateral ligament scarring provides adequate stability (collateral ligament scarring)

In case of cruciate ligament injury, we recommend the following options to our patients:

1. Conservative treatment: after a ligament injury, we try to stabilize the patient by physiotherapy and rehabilitation in each case. If instability is felt after 6 to 8 weeks of intensive physiotherapy, we recommend surgery.
2. Surgical solution: There are several types of surgery to replace cruciate ligaments, the latest being the double-bundle technique.In this case, the cruciate ligament is not treated as one bundle, but is replaced as two bundles.  Zsolt Knoll, PhD was one of the first in Hungary to use this type of ligament repair, and has already performed hundreds of successful surgeries. Click here to learn more about potential surgical solution(s). (Customized cruciate ligament repair program).

Intra-articular loose bodies

Description of the disease: Cartilage or fibrous free bodies are often detected in the knee joint. Their origin is variable, some of them broke off from the cartilage envelope of the articular surface, others from the meniscus, and a third of loose cartilage develops as a result of the pathological cartilage-producing disease of the articular endothelium.

Symptoms: Free bodies migrating in the joint can become pinched between the bones, that may cause lightning-like pain and locked knee. Such a locking can greatly damage the cartilage surface covering the bone.

Treatment: Cartilage fragments can be removed by arthroscopic (keyhole) surgery. If the cartilage envelope of the load-bearing surface is damaged, depending on the extent and type of damage, the cartilage surface will also be replaced according to our Cartilage Surface program.

Inflammation of the inner articular membrane

Description of the disease: The membrane covering the inner surface of the knee joint may thicken, become inflamed or overgrow for known or unknown reasons.

Symptoms: The knee joint swells and its movement becomes restricted.

Treatment:

1. Conservative treatment: by eradicating the triggering inflammatory focus, administering an anti-inflammatory drug, or draining articular fluid (puncture).
2. If these do not help, the overdeveloped membrane is removed using a special shaver during an arthroscopy (articular keyhole surgery). This makes it possible to analyze the excised pieces by histological examination and to find the most effective cure. Click here to learn more about potential surgical solution(s). Extirpation inner articular membrane inflammation.

Patellar diseases

Description of the disease: The patella slides on the articular surface on the front side of the lower end of the femur. The cause of the disease is that due to the congenital axial deviation of the femur, the patella does not fit into the trough-shaped articular surface of the femur. Due to the abnormal increase in loads, the joint surfaces soften. This change can be caused by previous injuries, previous fracture of the patella, job associated with kneeling.

Symptoms: When standing up after sitting still for a long time, a sudden, almost locking pain emerges around the patella. From a very young age, stabbing pain can occur with certain movements. When walking upstairs, the patient often feels a “crackle” in his knee.

Treatment:

1. Conservative: Results are primarily expected from a special physiotherapy program and, if necessary, a weight loss program led by our diabetologist.
2. Surgical procedure: Using an arthroscopic surgical method, the unevenness of the cartilage surface can be smoothed using a special shaver, the position of the patella can be corrected by a reconstructive surgery of the articular capsule or by relocating certain tendons, and the sliding surface can be made smoother. Click here for details of the potential surgical solutions(s): Anterior knee pain treatment program.

Osteoarthritis, articular cartilage wear

Description of the disease: Prior injury or overload of the knee joint, limb axis deviation, and other causes (old age, overweight) may lead to the softening, fibrous degeneration, and wear of the smooth cartilage covering the bones.

Symptoms: Smaller and smaller load results in locked knee, sharp pain radiating into the joint space, and joint swelling. The pain often occurs at night when the knee rests. The axis of the leg may change, knock-knees or bowlegs may develop.

Treatment:

1. Conservative: Taking cartilage regenerating drugs can be effective for some time. Anti-inflammatory agents can be used to reduce joint swelling. Regular physiotherapy, physical therapy, and balneotherapy may reduce cruciating complaints.
2. Surgery: In case of unsuccessful conservative treatments, we recommend the Emineo Knee Wear Surgery Program, which offers our patients several choices depending on the severity of the articular disorder. This may include rinsing or shaving the joint, cartilage surface implantation (Condrofiller), synthetic matrix surface implant, axis correction surgery around the knee, or knee replacement with custom-made template.

What happens in a personal consultation?

At Emineo Private Hospital, regardless of the extent and type of damage, in addition to the physical examination, an imaging examination (X-ray, ultrasound) is also performed if necessary. In more complicated cases, our specialist can also request an MRI examination, which we will arrange for our patients in one of our partner institutions as soon as possible.

Possible therapies

At Emineo Private Hospital, which specializes primarily in musculoskeletal complaints, we pay close attention to individualized solutions, the latest methods, and careful individual therapy.

In the vast majority of our cases, surgery can be avoided, and conservative therapy (immobilization, personalized physiotherapy or physical therapy sessions, etc.) can be a good remedy for our patients.

In more complex cases, surgical intervention is recommended and, depending on the type of disorder, a keyhole surgery (arthroscopy) or open procedure is chosen. There are often several solutions at our disposal to treat a disorder, and you can get to know these in our surgical programs. True to a private institution, in all surgeries, we keep in mind to provide the patient with the most appropriate medical solution so that they can return to their normal, normal daily routine as soon as possible.