Knee Surgery

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 a 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 ageing (degeneration).

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

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.

For further information or to book an appointment with one of our knee specialists please contact info@sportssurgeryclinic.com

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.

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 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 ageing 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
  • ACL Reconstruction
  • 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
  • Total Hip Replacement
  • Total Knee Replacement
  • Revision Hip Replacement
  • Revision Knee Replacement
  • Hip Surgery
  • Knee Surgery
Suite: Lymewood Rooms
Fax: +353 1 5262392
Secretary: Lisa Murtagh
Mr Stefan Byrne Surgeon
Stefan Byrne
Consultant Orthopaedic Surgeon
  • Total Hip Replacement
  • Total Knee Replacement
  • Hand Surgery
  • Hip Surgery
  • Joint Replacement
  • Knee Surgery
  • Paediatrics
  • Trauma
  • Wrist Surgery
Suite: 18
Fax: 01 526 2328
Secretary: Jessica Hamilton
Mr Neil Burke Sports Surgery Clinnc
Neil Burke
Consultant Orthopaedic Surgeon
  • Total Hip Replacement
  • Total Knee Replacement
  • Hip Surgery
  • Joint Replacement
  • Knee Surgery
Suite: 18
Fax: +353 1 834 8353
Secretary: Paula Mc Loughlin
Ms Noelle Cassidy
Noelle Cassidy
Consultant Orthopaedic Surgeon
  • Total Hip Replacement
  • Total Knee Replacement
  • Hip Surgery
  • Knee Surgery
  • Paediatrics
  • Spine
Suite: 10
Fax: +353 1 526 2224
Secretary: Sheena Murtagh
Mr Denis Collins SSC
Denis Collins
Consultant Orthopaedic Surgeon
  • Total Hip Replacement
  • Total Knee Replacement
  • Hip Surgery
  • Joint Replacement
  • Knee Surgery
  • Trauma
Suite: 19
Fax: +353 1 526 2382
Secretary: Jenny Castles
Mr Michael Donnelly Sports Surgery Clinic
Michael Donnelly
Consultant Orthopaedic Surgeon
  • Total Hip Replacement
  • Total Knee Replacement
  • Revision Hip Replacement
  • Revision Knee Replacement
  • Hip Surgery
  • Joint Replacement
  • Knee Surgery
  • Trauma
Suite: 15
Fax: +353 1 526 2214
Secretary: Siobhan O'Donoghue
Mr Niall Hogan Sports Surgery Clinic
Niall Hogan
Consultant Orthopaedic Surgeon
  • ACL Reconstruction
  • Total Hip Replacement
  • Total Knee Replacement
  • Arthroscopic Surgery
  • Hip Surgery
  • Joint Replacement
  • Knee Surgery
  • Trauma
Suite: 3
Fax: +353 1 526 2192
Secretary: Orlagh Murtagh / Paula Murtagh
Mark Jackson Knee Surgeon
Mark Jackson
Consultant Orthopaedic Surgeon
  • ACL Reconstruction
  • Total Knee Replacement
  • Arthroscopic Surgery
  • Joint Replacement
  • Knee Surgery
  • Soft Tissue
Suite: 9
Fax: +353 1 5262269
Secretary: Paula Smith
Mr Pat Kiely Sports Surgery Clinic
Pat Kiely
Consultant Orthopaedic Surgeon
  • Hip Surgery
  • Knee Surgery
  • Paediatrics
  • Spine
  • Trauma
Suite: 13
Fax: +353 1 526 2274
Secretary: Sheila Newman
Mr Tom McCarthy Sports Surgery Clinic
Tom McCarthy
Consultant Orthopaedic Surgeon
  • ACL Reconstruction
  • Total Hip Replacement
  • Total Knee Replacement
  • Arthroscopic Surgery
  • Hip Arthroscopy
  • Hip Surgery
  • Knee Surgery
  • Trauma
Suite: 16
Fax: +353 1 526 2368
Secretary: Brenda Maher
Mr Gavin McHugh Sports Surgery Clinic
Gavin McHugh
Consultant Orthopaedic Surgeon
  • Total Hip Replacement
  • Total Knee Replacement
  • Revision Hip Replacement
  • Revision Knee Replacement
  • Hip Surgery
  • Knee Surgery
  • Trauma
Suite: 17
Fax: +353 1 526 2353
Secretary: Therese Gubbins / Lorraine Humphries
Professor Cathal Moran SSC
Professor Cathal J Moran
Professor of Orthopaedics & Sports Medicine, Consultant Orthopaedic Surgeon.
  • ACL Reconstruction
  • Total Knee Replacement
  • Shoulder Replacement
  • Arthroscopic Surgery
  • 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
  • Total Hip Replacement
  • Total Knee Replacement
  • Arthroscopic Surgery
  • Hip Surgery
  • Joint Replacement
  • Knee Surgery
Fax: +353 1 885 8876
Secretary: Anita Harrington
Professor John O'Byrne
Professor John O'Byrne
Consultant Orthopaedic Surgeon
  • Hip Surgery
  • Knee Surgery
Suite: 1
Fax: +353 1 526 2234
Mr Shea O'Flanagan
Shea (James) O'Flanagan
Consultant Orthopaedic Surgeon
  • Total Knee Replacement
  • Arthroscopic Surgery
  • Hand Surgery
  • Knee Surgery
  • Shoulder Surgery
Suite: 7
Fax: +353 1 526 2259
Secretary: Anne Dunlop
Mr Keith Synnott
Keith Synnott
Consultant Orthopaedic Surgeon
  • Total Hip Replacement
  • Total Knee Replacement
  • Hip Surgery
  • Knee Surgery
  • Soft Tissue
  • Spine
Suite: 16
Fax: +353 1 526 2341
Secretary: Sarah Cullen / Orla Tully
Mr Mihai Vioreanu Sports Surgery Clinic
Mihai Vioreanu
Consultant Orthopaedic Surgeon
  • ACL Reconstruction
  • Total Hip Replacement
  • Total Knee Replacement
  • Revision Hip Replacement
  • Revision Knee Replacement
  • Hip Surgery
  • Joint Replacement
  • Knee Surgery
Suite: 5
Fax: 01 526 2204
Secretary: Lisa Gallen
Mr Dan Withers
Dan Withers
Consultant Orthopaedic Surgeon
  • Sports Knee Surgery
  • Partial Knee Replacement
  • ACL Reconstruction
  • Total Knee Replacement
  • Knee Surgery