Knee Surgery

Knee Surgery Santry Dublin

 The knee is one of the largest joints in the body, formed between three bones – the thigh bone (femur), the shin bone (tibia), and the kneecap (patella).

At the joint, the surface of each bone is covered in a thin layer of substance called articular hyaline cartilage. This cartilage contributes to the smooth movement of the knee, and protects the bone underneath from getting damaged.

Knee pain can be caused by a number of factors including accidents (trauma), malalignment, the way in which the knee moves (biomechanics), and due to aging (degeneration).

Depending on the nature of your condition, conservative methods of treatment, including physiotherapy and / or injections are often trialled prior to surgery.

For further information or to contact one of our knee specialists,
please call +353 1 5262000 or email info@sportssurgeryclinic.com
Total Knee Surgery Santry Dublin
Image of right knee.

 

 

The knee is a hinge joint. This means that the knee’s main function is to allow the lower leg to bend and straighten up relative to the thigh. The knee also allows a small degree of medial (inner) and lateral (outer) rotation when the knee is bent.

  • A joint capsule surrounds the knee joint to provide strength and lubrication. There are also four main strips of tough tissue, called ligaments, which stabilise the knee joint:
  • The anterior cruciate ligament (ACL) prevents the largest bone on the lower leg, the tibia, from sliding forward too much. This ligament also provides the knee with rotational stability.
  • The posterior cruciate ligament (PCL) prevents the tibia from sliding backwards too much.

 

The medial and lateral collateral ligaments (MCL & LCL) provide lateral stability by controlling the sideways motion of the knee.

 

The knee also has two C-shaped rings of cartilage called the medial and lateral menisci. These act as shock absorbers in the knee, whilst also contributing to the stability and smooth movement of the knee.

 

Small pockets (known as bursae) filled with a fluid called synovial fluid surround the knee joint. These bursae help to cushion and protect the joint from friction.

 

There are also pockets of a tissue called adipose tissue, known as fat pads, which help to cushion the knee from external stress.

 

The main muscles that make up the knee are the quadriceps, the hamstrings, the gastrocnemius of the calf, and some smaller, deeper muscles.

 

When the quadriceps are engaged, the knee is straightened, whereas engaging the hamstrings and gastrocnemius muscle will bend the knee.

 

One of the muscle groups of the hips, the gluteal muscles, are also extremely important for controlling the knee joint.

In this video – Mr Ray Moran Consultant Orthopaedic Surgeon and Dr Eanna Falvey, Director of Sports & Exercise Medicine, discuss the ACL injury in detail.

What is the ACL?

The anterior cruciate ligament (ACL) is one of four major ligaments stabilising the knee joint. A ligament is a tough band of tissue, connecting bones at a joint. In this case, it is linking the femur (thigh bone) to the tibia
(shin bone). It is one of two ligaments crossing each other deep within the centre of the knee joint.
The ligament towards the front (anterior) is the ACL, and the one toward the back of the knee (posterior) is the posterior cruciate ligament (PCL).
The ACL is a vital structure that helps to prevent the tibia from sliding forward and rotating too much.
It mainly provides stability in twisting and turning movements.  The PCL is essential in stopping the tibia from moving backwards and is much less frequently injured. There are two ligaments on the sides of the knee (collateral ligaments). These give stability to sideways motions: the medial collateral ligament (MCL) on the inner side and the lateral collateral ligament (LCL) on the outer side of the knee.

How can the ACL tear?

The most common mechanism is a combination of a sudden stopping motion on the leg while pivoting on the knee.
In 70% of cases, this happens during non-contact movement, e.g. rapidly changing direction, landing from a jump, an abrupt deceleration or twist. Particular sports, e.g. soccer, Gaelic games, basketball and rugby, commonly demand these activities of the knee.
Skiing is another common mechanism of cruciate injury and various falling mechanisms have been described.
A contact injury, e.g. a rugby tackle or road traffic accident is whereby the knee is forced excessively into a stressful position by outside contact.

What other knee structures can be injured when the ACL tears?

Approximately half of ACL injuries will be isolated. Therefore many patients injure another component of their knee when rupturing an ACL.

These include the meniscal cartilage, the articular cartilage surface and other ligaments around the knee.

Any additional damage will be identified on MRI and confirmed during surgery.

Some of these cartilage tears can be left alone; however, some require treatment with either partial removal or repair.

How will my knee function if ACL is ruptured?

It is possible to function without your ACL. If you have appropriate lower limb strength and control, then low-level activities are possible. Young athletes and athletes looking to return to sports involving twisting, turning, and landing will most likely require reconstruction.

Return to these higher-level sporting activities is the principal indication for ACL reconstruction.

Repeated unstable episodes are to be avoided as it increases the likelihood of cartilage damage in the knee and increases wear and tear in the longer term. ACL reconstruction offers excellent stability and outcomes on return to sport for athletes who are motivated and compliant with the rehabilitation programme.

ACL Surgery

An individual embarking on ACL reconstruction should have an understanding of the procedure and fully commit to the rehabilitation process. The operation involves replacing the torn ACL with a graft taken from another part of the knee.

The aim is to position this graft within the knee to take the place of the torn ACL and mimic its stabilising function. The two most commonly used grafts are constructed from either the patellar tendon or the hamstring tendons. The graft chosen will vary according to the patient and depends on other injuries, sports, occupation and individual anatomical variations.

The majority of the operation is performed arthroscopically (key-hole surgery). However, an incision is required to harvest the graft over the front of the knee. During surgery any other structures damaged during the injury will also be repaired.

While viewing the inside of the joint through the arthroscope, guides are used to drill bony tunnels to allow placement of the graft. The graft is then pulled into these bone tunnels and spans the knee joint.

Screws are placed to wedge the graft against the wall of the tunnels to give immediate stability and allow healing of the new graft. This early bonding of the graft takes approximately six weeks for patellar tendon grafts and ten weeks for hamstring tendons.

The graft is strong enough at six months post-surgery to withstand load associated with sporting movement but continues to mature over the course of the following six to twelve months.

Osteoarthritis Knee Surgery Santry

 

 

The ends of our joint surfaces are lined with articular cartilage. This cartilage is made up of small cells called chondrocytes, along with a combination of proteins, collagen, and lots of water. In healthy joints, this durable cartilage allows joint surfaces to move against one another with minimal friction. Cartilage also acts as a shock absorber, by facilitating the transmission of loads to the underlying (subchondral) bone.

 

Losing cartilage in certain areas can often interfere with the normal movement of joints and limbs. This can result in pain and being less able to carry out regular daily or sporting activities.

 

In some cases it may be possible for us to fill missing sections with new cartilage which provides new protection for the joint surface. However, in cases where there are more extensive areas of missing or damaged cartilage there is an increased likelihood of arthritis and other management options may have to be explored.

Osteoarthritis Knee Replacement Santry

The meniscus plays a role in joint stability, as well as load distribution. Tears in the meniscus are common, and often happen because of an acute injury.

 

Meniscal tears are often treated by removing a piece of the torn meniscus, which is called a partial meniscectomy, which may make the joint more vulnerable to degeneration of the articular cartilage.

 

Some meniscal injuries can be repaired via key-hole surgery (arthroscopically), where the torn piece(s) of the meniscus are sutured / stitched back together. This depends on the type of tear, as well as the overall status of the damaged meniscus and age of patient. Unfortunately due to the relatively poor blood supply of the menisci, many tears are not suitable for repair.

Anterior Cruciate Ligament (ACL)

The ACL is important in controlling rotation of the knee, during lateral, multi-directional and landing movements, and is one of the most commonly injured structures among athletes.

 

Typical symptoms of an ACL injury include:

  • An audible “popping” sensation within the knee
  • Swelling
  • Pain
  • A feeling of instability like the knee may “give way”
  • Stiffness / loss of full range of motion

 

Treatment options for ACL injury can vary depending on a person’s specific needs.

 

Reconstructive surgery is often recommended to restore stability of the knee required for multi-directional movement or sport. However for people with a lower level of activity, less invasive measures such as rehabilitation and / or bracing of the knee may be more suitable.

 

As the ACL cannot usually be repaired, restoring a torn ACL through surgery involves replacing the ACL with a piece of tissue taken from another part of the leg (a graft), such as from the patellar tendon or the hamstring. Other graft options are also sometimes considered.

 

 

 

Posterior Cruciate Ligament Knee Surgery Santry

Posterior Cruciate Ligament (PCL)

The PCL prevents the tibia from sliding backwards too much, and also helps stabilise the knee in rotational movements.

 

Injuries to the PCL are generally the result of a direct blow to the front of the knee, when the leg is in a bent position, (such as falling on a bent knee). PCL injuries can also occur when the knee twists or straightens too much (hyperextends).

 

Isolated PCL injuries generally do not cause instability. A large amount of instability may mean there is a PCL injury combined with an injury to another specific section of the knee called the posterolateral corner.

 

Treatment depends on how severe the injury is, and whether it is an isolated or combined injury. Rehabilitation is a vital component of recovery in both surgical and conservative cases.

Medial Collateral Ligament (MCL)

The MCL connects the femur to the tibia and stabilises the inner side of the knee.
Injuries to the MCL are usually caused by a force pushing the knee inwards (valgus) or in combination with a twisting force. The ligament becomes stressed, over–stretched, and damaged. Often, MCL tears occur alongside other knee injuries such as ACL tears. Pain around the inner aspect of the knee and stiffness are common with MCL injury.
Recovery depends on the how severe the injury is. Protecting the range of motion, as well as a structured rehabilitation / strengthening programme forms the basis of conservative treatment for MCL injuries.

 

Lateral Collateral Ligament (LCL)

The LCL connects the femur to the fibula, and stabilises the outer side of the knee.

Injuries to the LCL are usually caused by an outward twisting force, or varus, to the knee. LCL injuries often occur alongside other knee injuries. Surgery is generally the preferred course of treatment if there is a complete (Grade 3) tear to the ligament or if the ligament becomes detached, or avulsed, from the bone. A structured rehabilitation programme is an essential part of recovery from an LCL injury.

 

 

Medial Collateral Ligament (MCL) Knee Surgery Santry

Patellofemoral pain - Knee surgery santryPatellofemoral Pain

Patellofemoral pain is a broad term used to describe pain at the front of the knee.

 

There are various factors that contribute to patellofemoral pain, both internal and external to the knee, including malalignment. However, the main risk factors appear to be overuse and overload.

 

Management of the injury requires a multi-faceted approach. Particular emphasis is placed on load management, along with a structured rehabilitation programme to strengthen the surrounding muscles as well as addressing abnormal movement patterns.

 

 

Patellar Instability

The kneecap (patella) sits in a notch on the femur bone called the trochlea. If this groove is too shallow, the patella can become unstable and slide off, resulting in a partial or complete dislocation of the kneecap.

 

Dislocation can also occur during an acute injury such as a fall, or a rotational type injury of the knee.

 

Patients with a high riding patella that sits above the groove and patients with other anatomical variants are also more prone to dislocation.

 

If the patella becomes dislocated, it needs to be relocated or “reduced”, which often happens spontaneously. If the instability keeps reoccurring, surgery may be needed to stabilise the patella, followed by a rehabilitation programme to strengthen the soft tissue structures of the knee, and to prevent any further dislocations.

 

 

Patellar Fractures

Fractures to the patella bone usually happen because of a fall or hard blow to the front of the knee.

 

Treatment options for this type of injury depend on the type of fracture. An undisplaced fracture of the patella, where the broken bone remains in the correct place, generally responds well to being immobilised in a knee brace or cast. Displaced fractures often require surgical treatment to stabilise the site of the fractured bone.

 

Both conservative and surgical treatments need to be complemented with a rehabilitation programme to strengthen the muscles around the knee.

Proper knee alignment is essential for normal function and for balance in the joint. Poor movement patterns which cause uneven forces throughout the knee can damage both its articular cartilage and ligaments.

 

There are two types of misalignment in the knee, which can contribute to its condition:

  • Knee varus where the weight passes medially, (more through the inside of the knee joint), causing degeneration to the inside of the knee
  • Knee valgus where the weight passes laterally, (more to the outside of the knee joint) causing degeneration to the outside of the knee

 

A corrective surgical procedure called an osteotomy redistributes the forces bearing down on the knee by cutting a wedge of bone from either the tibia or femur, to reposition and realign the knee.

Osteoarthritis is the most common form of arthritis, and often affects the knee joint.

 

Osteoarthritis is caused by aging and wear and tear of cartilage. Symptoms of osteoarthritis in the knee may include knee pain, stiffness, and swelling.

 

Osteoarthritis in kneeKnee Replacement

If the degree of osteoarthritis is quite severe and debilitating, a Total Knee Arthroplasty is often the recommended form of treatment.

 

This open procedure involves removing the damaged areas of cartilage loss, and replacing them with synthetic components (often metal), to recreate the joint surfaces. The inner surface of the patella may also be resurfaced if needed. An artificial “spacer” is inserted between the metal components to allow the new joint to glide smoothly and efficiently.

We carry out an orthopaedic evaluation of your knee through the following three activities:

  • A medical history to gather information about current complaints, duration of symptoms, pain and limitations, injuries, and past treatment with medications or surgery.
  • A physical examination to assess swelling, tenderness, range of motion, strength, instability, and limb alignment.
  • Diagnostic tests, such as X-rays or magnetic resonance imaging (MRI), which may be required to assess both the bony and soft-tissue structures of the knee.

 

We will discuss the results of your orthopaedic evaluation and the various treatment options available to you in detail.

Arthroscopy

Arthroscopic surgery is when the surgeon inserts a thin, pencil-sized device, containing a tiny lens and lighting system, into a small incision to look inside the knee joint. The images inside the joint are shown on a TV monitor and allow the surgeon to make a clear diagnosis.

 

Other surgical instruments can also be inserted so that repairs can be made, depending on the diagnosis.

 

Surgeries such as a partial meniscectomy, meniscal repair, or ACL reconstruction, are generally carried out using these arthroscopic methods.

 

 

Open Surgery

Knee replacement is an open surgery performed through an incision at the front of the knee. Other surgeries such as collateral ligament reconstruction and osteotomy are also performed by open incisions to the knee of varying lengths and location depending on the specific procedure.

Rehabilitation is crucial to maximise the success of any knee surgery, and commitment to a structured rehab programme is an essential part of your recovery.

 

This rehabilitation should be closely followed in consultation with your orthopaedic surgeon and chartered physiotherapist.

Click the following link to download this brochure SSC The Knee 

 

The Knee Surgery Guide Dublin

Suite: 5
Fax: +353 1 526 2204
Secretary: Lisa Gallen
Ray Moran Knee Surgeon
Ray Moran Medical Director
Consultant Orthopaedic Surgeon & Medical Director of the Sports Surgery Clinic
  • Knee Surgery
Suite: 20
Fax: +353 1 526 2317
Secretary: Ann Boyle, Barbara Gibney
Owen Brady Hip Surgeon Knee Surgeon
Owen Brady
Consultant Orthopaedic Surgeon
  • Hip Surgery
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Suite: Lymewood Rooms
Fax: +353 1 5262392
Secretary: Lisa Murtagh
Mr Stefan Byrne Surgeon
Stefan Byrne
Consultant Orthopaedic Surgeon
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Suite: 18
Fax: 01 526 2328
Secretary: Jessica Hamilton
Mr Neil Burke Sports Surgery Clinnc
Neil Burke
Consultant Orthopaedic Surgeon
  • Hip Surgery
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Suite: 18
Fax: +353 1 834 8353
Secretary: Paula Mc Loughlin
Ms Noelle Cassidy
Noelle Cassidy
Consultant Orthopaedic Surgeon
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Suite: 10
Fax: +353 1 526 2224
Secretary: Sheena Murtagh
Mr Denis Collins SSC
Denis Collins
Consultant Orthopaedic Surgeon
  • Hip Surgery
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Suite: 19
Fax: +353 1 526 2382
Secretary: Jenny Castles
Mr Michael Donnelly Sports Surgery Clinic
Michael Donnelly
Consultant Orthopaedic Surgeon
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Fax: +353 1 526 2214
Secretary: Siobhan O'Donoghue
Mr Niall Hogan Sports Surgery Clinic
Niall Hogan
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Fax: +353 1 526 2192
Secretary: Orlagh Murtagh / Paula Murtagh
Mark Jackson Knee Surgeon
Mark Jackson
Consultant Orthopaedic Surgeon
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Suite: 9
Fax: +353 1 5262269
Secretary: Paula Smith
Mr Pat Kiely Sports Surgery Clinic
Pat Kiely
Consultant Orthopaedic Surgeon
  • Hip Surgery
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Suite: 13
Fax: +353 1 526 2274
Secretary: Sheila Newman
Mr Tom McCarthy Sports Surgery Clinic
Tom McCarthy
Consultant Orthopaedic Surgeon
  • Hip Surgery
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Fax: +353 1 526 2368
Secretary: Ann-Marie Briody
Mr Gavin McHugh Sports Surgery Clinic
Gavin McHugh
Consultant Orthopaedic Surgeon
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Secretary: Therese Gubbins / Lorraine Humphries
Professor Cathal Moran Sports Surgery Clinic
Professor Cathal J Moran
Professor of Orthopaedics & Sports Medicine, Consultant Orthopaedic Surgeon.
  • Joint Replacement
  • Knee Surgery
  • Shoulder Surgery
  • Sports Injury
Fax: +353 1 8822655
Secretary: Grace O'Connor
Professor Kevin Mulhall
Professor Kevin Mulhall
Consultant Orthopaedic Surgeon
  • Hip Surgery
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Fax: +353 1 885 8876
Secretary: Anita Harrington
Professor John O'Byrne
John O'Byrne
Consultant Orthopaedic Surgeon
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Suite: 1
Fax: +353 1 526 2234
Secretary: Laura Woodings
Mr Shea O'Flanagan
Shea (James) O'Flanagan
Consultant Orthopaedic Surgeon
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Suite: 7
Fax: +353 1 526 2259
Secretary: Anne Dunlop
Mr Keith Synnott
Keith Synnott
Consultant Orthopaedic Surgeon
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  • Soft Tissue
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Suite: 16
Fax: +353 1 526 2341
Secretary: Sarah Cullen / Orla Tully
Mr Mihai Vioreanu Sports Surgery Clinic
Mihai Vioreanu
Consultant Orthopaedic Surgeon
  • Hip Surgery
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Suite: 5
Fax: 01 526 2204
Secretary: Lisa Gallen
Mr Dan Withers
Dan Withers
Consultant Orthopaedic Surgeon
  • Sports Knee Surgery
  • Partial Knee Replacement
  • Knee Surgery
  • Knee Replacement