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Competence knees

Knees

Cruciate ligament tear (anterior cruciate ligament)

Cruciate ligament tear (anterior cruciate ligament)

The typical injury mechanism is excessive load on the knee joint in flexion or external rotation, and genu varum. In this case, rotational forces acting on the knee injure the medial collateral ligament, and sometimes also the inner or outer meniscus. This results in over-stretching or tearing of the anterior cruciate ligament.

The anterior cruciate ligament is an essential stabilizer. If the cruciate ligament is torn, the patient complains about a feeling of instability and about the knee joint "giving up", especially when exercising. Even very well trained muscles can only partially compensate for the instability. It is usually no longer possible to practise sports such as football, handball, tennis, basketball, or alpine skiing (= rotational sports). In the long run, instability and the associated disorder of the joint mechanics (increased friction, changed pivot point, changed pressure distribution) cause further damage to the inner or outer meniscus and the cartilage. This is how osteoarthritis begins. Therefore, unstable knee joints should be treated surgically early on, especially in athletic patients. The primary goal of the surgery is to make the joint "stable" in order to avoid consequential damage to the meniscus and articular cartilage. Since sole suture repair does not provide stability for biological reasons, reinforcement or replacement with the body's own tendon material is necessary.

Meniscus tear

Meniscus tear

The intact inner and outer meniscus play a key protective role for the articular cartilage. It consists of rubber-like fibrous cartilage and increases the contact area between the upper and lower leg. It acts as a shock absorber and distributes the forces evenly, thus stabilizing the knee joint. Damage to the meniscus often causes pain in the knee joint. Heavy wear in the knee joint causes the meniscus to become brittle. This results in microcracks. They may cause knee pain already on their own. Further wear causes larger cracks. The zones of the meniscus that are torn in this way can no longer transmit and distribute load, and slide in the nearby areas where they do not belong. Children and adolescents, as well as people who are not sporty may develop such meniscus tears. The inner meniscus is most often affected, and the tears are usually accompanied by other injuries, such as torn ligaments. Patients typically experience pain when climbing stairs. In the case of very large tears, the meniscus jams and blocks the knee joint. Stretching or bending is suddenly no longer possible, and the patient limps or needs walking aids. Surgery is often necessary to repair the damage. The available options include meniscus suture or partial meniscus removal using minimally invasive keyhole technology (arthroscopy).

Discoid meniscus

Discoid meniscus

Congenital variant with a fault line. This particular meniscus, which is too large since birth, may tear due to everyday stress and friction between the thigh and the lower leg. It will cause the same symptoms as a large meniscus tear caused by an accident. Surgery is often necessary to alleviate the pain.
 

Meniscus ganglion

Meniscus ganglion

When small nodules cause great pain

A rare form of meniscus wear causes fluid formation in the middle of the meniscus. These liquid-filled nodules sometimes push out to the outside of the joint and may cause pressure sores. They may sometimes be palpable as pea-sized firm bulges. If they cause discomfort, they can be pierced or surgically removed.

Knee joint wear (knee osteoarthritis)

Knee joint wear (knee osteoarthritis)

Joint pain that may render you immobile

In addition to the ligaments, a crucial component of the knee joint is the articular cartilage, which covers the bone in the joint like a protective coating. The cartilage is not supplied with blood. Therefore, it must be nourished via the synovial fluid. Only intact cartilage guarantees "smooth" movement. The causes of cartilage damage are very diverse. Broken bones with joint involvement, joint instability, meniscus tears, or overuse during sport or at work may damage the cartilage coating. Knee pain depends on the size and location of the damage. Initially, knee pain only occurs when the patient is under load. In the later stages, the patient complains of persistent knee pain. Over the course of several years, cartilage damage increases and joint destruction progresses. The knee swells and can no longer be fully bent or stretched. At this stage, we are dealing with knee osteoarthritis.
Many symptoms may appear at the same time or alone:

  • from mild uncomfortable pressure to severe and piercing pain.
  • Pain may be present at rest, with light exercise, or only when practising heavy sports.
  • Feeling of pressure and tension.
  • Swelling, overheating, and a sensation of warmth.
  • Blockages, entrapment, snapping, clicking, rubbing, or feeling as if something were slipping out or re-set.
  • A mild feeling of instability with rapid fatigue up to severe instability with a permanent dislocation.
  • Warm-up pain, especially in the morning when you get up.
  • Pain only under specific loads, such as going down the stairs.

The treatment concept depends on the size and exact position of the cartilage damage. The age of the patient also plays a major role, since the capacity of the cartilage to heal itself is still very high in young patients. We can offer various treatment options and tailor them precisely to the individual patient (such as plasma therapy, hyaluronic acid, injections, kinesio tape, cartilage smoothing, microfracture, cartilage transplantation, or orthopaedic techniques). If non-surgical treatment fails, the axis can be corrected, or a unicondylar knee replacement (partial joint replacement) or a total endoprosthesis (total knee replacement) can be performed to restore mobility and reduce pain.

Kneecap wear

Kneecap wear

When the knee grates and cracks while walking

When the knee joint is moved, the kneecap moves back and forth inside a recessed groove at the front of the thigh. It is pressed into this groove ever more as the flexion increases, for example when you squat. If the cartilage covering is damaged, the friction increases causing pain. At first, you have pain behind or around the kneecap. Later on, you can hear rubbing and cracking noises, and your kneecap pops out when you move. Climbing the stairs becomes difficult, exercising hurts, and the knee swells. Sometimes the skin surrounding the knee feels really hot. The causes are diverse and range from injuries and congenital malformations, including kneecap dislocation, to overuse in sport, everyday life, and work. The symptoms are similar to knee osteoarthritis (see above).We can offer various treatment options and tailor them precisely to the individual patient (such as plasma therapy, hyaluronic acid, injections, kinesio tape, cartilage smoothing, microfracture, or cartilage transplantation).

 

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