Category: Knee

Kneecap replacement surgery (patellofemoral arthroplasty) is a surgical procedure used to treat isolated damage to the kneecap and surrounding joint area. It is considered a less invasive alternative to total knee replacement for patients with damage limited to the patellofemoral compartment. This surgery can provide pain relief, improve function, and preserve healthy parts of the knee while offering a faster recovery compared to more extensive procedures.

When Is Kneecap Replacement Surgery Recommended?

This procedure is typically recommended for patients experiencing specific symptoms and conditions affecting the kneecap. These include:

Persistent Pain in the Kneecap Area: Kneecap replacement is often recommended for those with ongoing pain around the front of the knee that does not respond to treatments such as medication or physiotherapy.

Difficulty Performing Daily Activities: Tasks like walking, climbing stairs, or rising from a seated position can become challenging when the kneecap is damaged.

When Non-Surgical Treatments Have Failed: Surgery is considered after other interventions, including physiotherapy, injections, and oral medications, have not provided sufficient relief.

Localised damage to the kneecap: Imaging studies, such as X-rays or MRIs, that show isolated degeneration or damage in the kneecap and its groove may indicate the need for this surgery.

Benefits of Kneecap Replacement Surgery

Kneecap replacement offers targeted solutions for specific knee problems, particularly those affecting the kneecap.

Relief from pain: By replacing the damaged areas of the kneecap and trochlear groove (the groove where the kneecap rests and moves), patients typically experience reduced or eliminated knee pain.

Preservation of healthy knee components: Unlike total knee replacement, this procedure retains the unaffected parts of the knee joint, ensuring a more conservative approach with the preservation of knee ligaments and other unaffected compartments.

Faster recovery: Recovery times are generally shorter compared to total knee replacement, allowing patients to return to daily activities sooner.

Improved mobility: Patients often regain the ability to perform activities that were previously limited due to knee pain.

Preparing for Surgery

Proper preparation can improve the success of surgery and recovery. Key preparation steps include:

Medical Evaluation

A thorough medical assessment ensures that you are healthy enough to undergo surgery. Your doctor will review your medical history, including any chronic conditions like diabetes or heart disease, as these can affect surgical outcomes. Blood tests, an ECG, or other evaluations may also be performed to identify any potential risks before the procedure.

Imaging Studies

X-rays or MRIs are used to confirm the extent and location of the knee damage. These studies help the surgeon plan the procedure by mapping the damaged cartilage and bone that needs to be replaced. Accurate imaging ensures that the prosthetic components are properly selected and positioned for optimal results.

Medication Adjustments

Your doctor may advise stopping or adjusting certain medications, such as blood thinners or anti-inflammatory drugs, to minimise bleeding risks during surgery.

Fasting Before Surgery

Fasting for several hours before surgery is necessary to reduce risks associated with anaesthesia, such as aspiration. Your surgeon will provide specific guidance on when to stop eating and drinking.

What Happens During Kneecap Replacement Surgery

The procedure involves several key steps to replace the damaged kneecap and restore joint function. These include:

Anaesthesia Administration

The surgery begins with either general anaesthesia, which puts you to sleep, or regional anaesthesia, which numbs the lower body while keeping you awake. The choice depends on your health and the surgeon’s recommendation.

Making the Incision

A small incision, typically 8–10 cm long, is made at the front of the knee to access the joint. This allows the surgeon to visualise the kneecap and trochlear groove directly. The surrounding soft tissues are carefully moved aside to avoid unnecessary damage and provide a clear surgical field.

Removing Damaged Tissue

The surgeon identifies and removes only the areas of the kneecap and groove that are worn or damaged. Healthy cartilage and bone are preserved to maintain as much natural function as possible. Precision tools are used to prepare the surface for the prosthetic implant.

Placing the Prosthetic

A specially designed prosthetic, typically made of metal and plastic, is positioned to replace the removed portions of the kneecap and trochlear groove. The prosthetic is secured using specialised fixation techniques. This ensures stability and restores smooth movement within the joint.

Testing and Closure

The surgeon tests the new joint by bending and straightening the knee to confirm proper alignment and movement. The incision is then closed with sutures or staples, and the knee is dressed with a sterile bandage.

Recovery After Kneecap Replacement Surgery

Most patients remain in the hospital for 1–3 days, during which pain management and basic movement exercises are initiated. Medications are provided to manage pain and support early mobility.

Physiotherapy begins soon after surgery to restore strength, flexibility, and range of motion, with exercises tailored to the individual’s condition. Walking with assistance is usually possible within a few days, and unassisted walking is often achieved in 4–6 weeks. Full recovery typically takes 3–6 months, depending on the progress of rehabilitation and the patient’s adherence to their prescribed recovery plan.

Potential Risks and Complications

While kneecap replacement surgery is generally safe, there are some risks, such as infection, blood clots, and knee joint stiffness. Prosthetic loosening or wear over time may also occur, sometimes requiring revision surgery. Rare complications include nerve damage or an allergic reaction to prosthetic materials. These risks are managed with preventive measures and close monitoring, making complications relatively rare.

Long-Term Outcomes and Prosthetic Longevity

Patients who undergo kneecap replacement often experience significant improvements in mobility and pain relief. With appropriate care, prosthetic components can last 10–20 years or longer. Maintaining a healthy weight and avoiding high-impact activities are key to extending the life of the implant. In some cases, additional surgeries may be required due to wear and tear, though this typically happens after many years.

Conclusion

Kneecap replacement surgery offers targeted treatment for individuals with isolated patellofemoral damage, providing significant pain relief and improved mobility. With proper preparation, surgery, and recovery, most patients achieve lasting results and return to an active lifestyle. Consulting a specialist can help determine if this treatment is appropriate for you.

If you’re considering kneecap replacement surgery, schedule a consultation with Dr LS Wang today to explore your options for long-term knee health.

Knee microfracture surgery is a procedure that aims to repair damaged cartilage in the knee by stimulating new cartilage growth. It is often recommended for patients with small to medium-sized cartilage defects who have not found relief through other treatments such as physiotherapy or medications. The procedure involves creating tiny fractures in the underlying bone to encourage the formation of new cartilage, helping to improve knee function and reduce pain.

When is Knee Microfracture Surgery Recommended?

Knee microfracture surgery is primarily considered when cartilage damage disrupts daily activities and non-surgical treatments have been ineffective. It is most suitable for treating localised cartilage defects that cause pain, stiffness, or limited movement.

The procedure can also be an option for early-stage knee osteoarthritis with isolated cartilage lesions, aiming to slow further degeneration. Additionally, it addresses cartilage damage from injuries or trauma, such as those sustained during sports, by promoting new cartilage growth to restore knee function and relieve discomfort.

Key Benefits of Knee Microfracture Surgery

The procedure offers several advantages for patients, particularly those experiencing persistent knee issues affecting daily activities.

Reduces Chronic Pain

The procedure stimulates the formation of fibrocartilage (cartilage-like tissue), which fills damaged areas, reducing friction and pressure within the knee joint. This can alleviate chronic pain that restricts movement.

Enhances Knee Mobility

Restoring cartilage enhances the smoothness of joint movements, which can improve flexibility and range of motion. Patients often find it easier to perform daily tasks such as walking, climbing stairs, and engaging in low-impact exercise after recovery.

Slows Joint Deterioration

Addressing cartilage issues early can help prevent the deterioration that leads to more severe joint conditions. By treating small defects, the procedure can slow the progression of cartilage wear and potentially delay the need for more extensive surgeries, like total knee replacement, in the future.

Preparing for Knee Microfracture Surgery

Before undergoing knee microfracture surgery, a comprehensive evaluation is necessary to determine if the procedure is suitable for the patient. This typically involves:

Medical Evaluation

The surgeon assesses knee stability, range of motion, and overall joint health. The patient’s medical history is reviewed, focusing on any previous knee injuries or surgeries, which helps plan the surgical approach.

Imaging Tests (X-rays or MRI)

X-rays are used to evaluate bone structure and joint alignment, while MRI scans provide detailed images of cartilage. These help pinpoint the exact location and extent of the damage, ensuring the procedure targets the specific area needing repair.

Pre-Surgery Guidelines

Routine blood tests assess general health, and adjustments to blood thinners may be needed to minimise bleeding risks. Fasting may be required for general anaesthesia, and patients are advised to avoid strenuous activities before the procedure.

Procedure Overview

Knee microfracture surgery is performed under general or regional anaesthesia and involves several key steps to repair cartilage damage:

Anaesthesia and Pre-Surgical Preparation

Patients receive either general anaesthesia (to be fully asleep) or regional anaesthesia (numbing from the waist down). The chosen method depends on individual health and surgery requirements.

The knee area is cleaned to minimise infection risks, and the leg is positioned for easy access. Diagnostic arthroscopy (a minimally invasive procedure using a small camera to examine the inside of the knee joint) is often performed first to confirm the problem and adjust the surgical plan as needed.

Arthroscopic Access

Small incisions are made around the knee, allowing the insertion of the arthroscope and surgical tools. This enables the surgeon to visualise the joint and locate the damaged cartilage.

Preparing the Cartilage

Loose or damaged cartilage is removed, and the surrounding area is smoothed to prepare the bone surface for effective treatment.

Microfracture Technique

Small perforations are made in the bone beneath the damaged cartilage to trigger blood flow, which releases bone marrow cells. These cells form a clot that promotes the growth of fibrocartilage over time.

Dr LS typically uses bioaugmentation with collagen scaffold infused with bone marrow aspirate concentration (stem cells) to increase the success of cartilage regeneration.

Closure

After the microfractures are made, the instruments are withdrawn, and the incisions are closed with sutures. A dressing is applied and the knee is wrapped for support during early recovery.

What to Expect During Recovery

Recovery from knee microfracture surgery typically spans several months. In the first 1-2 weeks, patients should rest, avoid weight-bearing, use crutches for mobility, and manage pain with medication and ice. By weeks 3-6, light physical therapy focuses on maintaining flexibility and preventing stiffness. A knee hinge brace to control range of motion may be required for 4-6 weeks.

From months 2-6, weight-bearing exercises are gradually introduced to rebuild strength and improve stability. High-impact activities may remain restricted, depending on the surgeon’s advice. Full recovery usually takes 3-6 months, depending on the extent of damage and adherence to rehabilitation.

Potential Risks and Complications

Knee microfracture surgery is generally safe but carries some risks, including infection, bleeding, blood clots, and joint stiffness. Persistent pain or incomplete cartilage regrowth may occur, especially in larger damaged areas. Rarely, nerve damage or weakness can develop. Following post-operative care and regular monitoring can help minimise these risks and improve recovery outcomes.

Conclusion

Knee microfracture surgery is a minimally invasive option for repairing cartilage damage, offering relief from persistent knee pain and improving joint function when non-surgical treatments have been unsuccessful. By promoting the growth of fibrocartilage, the procedure can enhance mobility and potentially delay the need for more extensive surgeries in the future. Successful outcomes rely on proper preparation, adherence to rehabilitation protocols, and regular follow-ups with your surgeon.

Dr LS routinely uses the latest cartilage regenerative techniques, including bioaugmentation with stem cells and collagen scaffold (Autologous Matrix Induced Chondrogenesis).

If you’re considering knee microfracture surgery, schedule a consultation with Dr LS Wang to discuss your options and develop a tailored treatment plan.

Partial knee replacement is a surgical procedure used to relieve pain and improve mobility in patients with damage confined to one part of the knee joint. Unlike total knee replacement, this procedure replaces only the affected compartment while preserving much of the natural knee structure, resulting in quicker recovery and more natural joint movement. If you’re considering this procedure, here are six key factors to help guide your decision.

1. Candidate Eligibility

Partial knee replacement is suitable for patients with osteoarthritis limited to a single compartment of the knee – usually the medial compartment and less commonly the front compartment (patellofemoral). Suitable candidates typically have stable joints, intact ligaments, and minimal deformity and good range of motion. Diagnostic imaging, such as X-rays or MRIs, is used to determine the extent and localisation of the damage.

However, this procedure may not be appropriate for everyone. Patients with inflammatory arthritis, such as rheumatoid arthritis, or with extensive damage affecting multiple compartments of the knee are usually better suited for total knee replacement, as it can address widespread inflammation or joint instability.

2. Benefits of Partial Knee Replacement

Partial knee replacement offers several advantages over total knee replacement. It preserves unaffected parts of the knee, including natural ligaments, leading to movement patterns that feel more natural. The procedure uses smaller incisions, which causes less disruption to surrounding tissues and results in less post-operative pain and a shorter recovery period.

While these benefits are significant, outcomes depend heavily on patient selection, surgical precision, and post-operative care. Proper evaluation and follow-up are necessary to ensure the best results.

3. Surgical Process

During partial knee replacement, only the damaged compartment is replaced with a prosthetic component made of metal and plastic, leaving the rest of the knee intact. Surgical techniques, including robotic assistance, can enhance precision and minimise disruption to surrounding tissues, reducing recovery time and the risk of complications.

The procedure typically lasts about an hour and is performed under general or spinal anaesthesia. Most patients can begin walking with assistance on the same day and are discharged within 24 to 48 hours.

4. Recovery Process and Expectations

Recovery from partial knee replacement is typically faster than recovery from a total knee replacement, but it still requires careful adherence to a structured rehabilitation plan. Most patients can resume light activities, such as driving, within 3 to 4 weeks and gradually progress to low-impact exercises like swimming or cycling within a few months.

A personalised physiotherapy programme helps rebuild strength, restore flexibility, and improve joint stability. During the initial recovery phase, walking aids like crutches or walkers are often recommended to reduce strain on the knee and support proper healing. Patients should avoid high-impact activities, such as running or jumping, to protect the joint while it heals.

5. Potential Risks and Complications

While partial knee replacement is generally safe, it carries some risks. Potential complications include infection, blood clots, and issues with the prosthesis, such as loosening or wear. Over time, arthritis may develop in the untreated compartments of the knee, which could require additional surgical intervention.

To minimise these risks, follow your surgeon’s post-operative instructions, including proper wound care and taking prescribed medications. Attending follow-up appointments monitors healing progress and addresses any concerns. If you experience unusual symptoms, such as persistent swelling, redness, fever, or increased pain, seek medical attention promptly to prevent further complications.

6. Longevity of Partial Knee Replacement

The vast majority of a partial knee replacement would last more than 10 to 15 years and are intended to last a lifetime.

More than 90% of patients still have a good functioning partial knee replacement at 10 years, but this can vary depending on factors such as patient activity levels, body weight, and adherence to post-operative care. Younger, more active patients may require revision surgery sooner due to increased wear and tear.

Maintaining a healthy weight, engaging in low-impact activities, and avoiding high-impact sports or strenuous movements are key to extending the life of the implant.

Conclusion

Partial knee replacement is an effective option for relieving pain and restoring mobility in patients with localised knee damage. By preserving much of the natural knee structure, this procedure offers quicker recovery and more natural joint movement compared to total knee replacement. However, success depends on careful patient selection, surgical expertise, and adherence to a structured rehabilitation plan.

If you are considering partial knee replacement, consult Dr LS Wang to assess your condition and develop a personalised treatment plan tailored to your needs.

Knee replacement surgery involves replacing damaged or diseased parts of the knee joint with artificial components (prostheses) to alleviate pain and improve mobility. Depending on the extent of the damage, either part of the joint (partial knee replacement) or the entire joint (total knee replacement) may be replaced.

Recovery requires adherence to a structured plan, including physiotherapy, pain management, and gradual reintroduction to daily activities. Here are six mistakes to be mindful of after knee replacement surgery and how to address them.

1. Skipping Physiotherapy

Physiotherapy restores joint strength, flexibility, and mobility following knee replacement surgery. Skipping physiotherapy sessions or not performing prescribed exercises can result in joint stiffness, reduced range of motion, and weakened muscles, delaying recovery.

Some patients may feel discouraged by the initial discomfort during therapy, but it is necessary to persist and follow the programme. Physiotherapists provide tailored exercises to suit your stage of recovery, so attending these sessions and practising at home can help avoid long-term limitations.

2. Neglecting Pain Management

Proper pain management is necessary for maintaining comfort and participating in rehabilitation. Some patients avoid taking prescribed pain medications, fearing dependence or side effects, while others rely excessively on over-the-counter painkillers without consulting their doctor.

Poorly managed pain can make it difficult to perform physiotherapy exercises, delaying progress. Follow your doctor’s prescribed pain management plan, which often includes a combination of medications, rest, and icing to reduce inflammation. Effective pain control not only improves comfort but also facilitates active participation in your recovery.

3. Overexerting Yourself Too Soon

While staying active after surgery is necessary, overexertion can be counterproductive and even harmful. Many patients make the mistake of returning to strenuous activities such as running, excessive stair climbing, or lifting heavy objects before their knee has fully healed. This can cause increased swelling, pain, or even damage to the surgical implant.

Recovery should be approached gradually; light activities, such as walking short distances or performing gentle stretches, should be increased progressively under the guidance of your surgeon or physiotherapist. Ignoring your body’s warning signs, such as persistent pain or fatigue, can lead to complications.

4. Improper Wound Care

The surgical wound requires careful attention to avoid infections, which can significantly complicate recovery. Many patients neglect wound care by failing to keep the area clean and dry or by removing dressings prematurely. Additionally, overlooking signs of infection, such as redness, swelling, warmth, or unusual discharge, can delay prompt treatment.

Always follow your surgeon’s wound care instructions, including how often to change dressings and when it is safe to bathe. If you notice any concerning symptoms, contact your healthcare provider immediately to prevent more severe complications.

5. Disregarding Dietary Recommendations

A well-balanced diet is required for tissue healing and overall recovery, yet it is often overlooked. Some patients may consume excessive processed or sugary foods, which can increase inflammation, while others may not eat enough, leading to nutrient deficiencies.

Protein is especially important for tissue repair, and vitamins and minerals such as vitamin C, zinc, and calcium support healing and bone health. Hydration is also needed to maintain energy and circulation. Focus on nutrient-dense meals to optimise your recovery.

6. Failing to Use Assistive Devices Correctly

Assistive devices, such as walkers, crutches, or canes, are provided to ensure safety and support during early recovery. However, some patients abandon these aids too soon, risking falls or placing undue stress on the surgical knee. Others may use the devices incorrectly, which can lead to poor posture or imbalance.

Follow your doctor’s recommendations regarding the use of assistive devices and ensure you learn how to use them properly. Transitioning to unassisted mobility should be done only if advised by your doctor.

Conclusion

A smooth recovery after knee replacement surgery depends on following post-operative guidelines and avoiding key mistakes that can hinder progress. Skipping physiotherapy, neglecting pain management, overexerting too soon, improper wound care, poor dietary habits, and misusing assistive devices are common pitfalls that can be easily avoided with the right approach. Staying consistent with your recovery plan is necessary for achieving the best results and restoring mobility.

Schedule a consultation today for personalised advice and support during your recovery journey.

What is an MCL Tear?

The medial collateral ligament (MCL) runs along the inner part of the knee, helping maintain stability. An MCL tear occurs when this ligament is overstretched or torn, often caused by sports injuries or accidents that force the knee inward or twist it. Common symptoms include pain, swelling, and difficulty moving the knee. Exploring the various treatment options allows individuals to make informed choices about managing the injury and when to seek advice from an orthopaedic knee specialist.

Non-Surgical Treatment Options

Non-surgical treatments are typically recommended for mild to moderate tears, focusing on pain management and allowing natural healing. These methods aim to avoid surgical intervention and restore function. Common methods include:

Rest and Activity Modification

Reducing or avoiding activities that strain the knee allows the ligament to heal without additional stress. This can help prevent the injury from worsening.

Ice and Compression

Applying ice reduces swelling and relieves pain by minimising inflammation. Using compression bandages helps further reduce swelling and restrict excessive knee movement, aiding the recovery process.

Physiotherapy

Physiotherapy helps restore knee strength and function. Therapists guide patients through exercises that strengthen the muscles surrounding the knee, providing better support to the joint and improving flexibility.

Bracing

Using a knee brace provides external support, reducing excessive movement and helping stabilise the knee during healing. Braces can also prevent further damage by protecting the ligament during recovery.

Surgical Treatment Options

Surgery is typically recommended for severe MCL tears, such as complete ligament tears or injuries involving multiple knee structures. Surgery aims to restore knee function and stability by repairing or reconstructing the damaged ligament. Surgical options include:

MCL Repair

If the ligament is torn at one of its attachment points, the surgeon may reattach the ligament using stitches or special anchors. This approach is commonly used when the ligament is still largely intact but detached from the bone.

MCL Reconstruction

For more severe tears where the ligament is damaged beyond repair, reconstruction may be required. This procedure involves replacing the damaged MCL with a graft, which can be from the patient’s own tissue or from a donor. The graft is then secured in place to function as a new ligament.

Combined Procedures

In some cases, an MCL tear may occur alongside other knee injuries, such as damage to the anterior cruciate ligament (ACL) or meniscus. When this happens, surgery may involve repairing or reconstructing multiple structures in a single operation.

When to See an Orthopaedic Knee Specialist?

Consult an orthopaedic knee specialist if pain from an MCL tear does not improve with rest or if the knee feels unstable. Other symptoms requiring medical attention include persistent swelling, restricted knee movement, or if the injury involves other knee structures, such as ligaments or cartilage. Early diagnosis by a specialist ensures appropriate treatment and minimises the risk of complications.

Conclusion

The treatment approach for an MCL tear depends on the severity of the injury. Mild to moderate tears often heal with non-surgical treatments like rest, ice, physiotherapy, and bracing. Severe tears or injuries involving other knee structures may require surgical repair or reconstruction to restore stability and function. Prompt treatment and specialist advice help ensure a smooth recovery and reduce the risk of future complications.

If you’re experiencing persistent knee pain or instability, consult Dr LS Wang to explore your treatment options.

An ACL (anterior cruciate ligament) or MCL (medial collateral ligament) tear can significantly affect knee function, often leading to pain and limited mobility. While many individuals assume these two injuries are similar, they involve different ligaments and have distinct roles, causes, and symptoms. Recognising these differences is necessary for timely diagnosis and treatment, which can prevent long-term complications and improve recovery outcomes.

Anatomy and Function of the ACL and MCL

Both the ACL and MCL are necessary for knee stability.

Anterior Cruciate Ligament (ACL): Located in the centre of the knee, the ACL controls forward motion and rotational stability.

Medial Collateral Ligament (MCL): Positioned on the inner side of the knee, the MCL prevents the knee from bending inward and maintains side-to-side stability.

Injuries to the knee can damage the ACL, MCL, or both, leading to knee pain, swelling, and instability, making everyday activities such as walking, turning, or bearing weight difficult.

Causes and Mechanisms of Injury

ACL Tears: Often occur during activities that involve sudden stops, direction changes, or awkward landings, such as basketball, soccer, and skiing.

MCL Tears: This commonly results from a direct impact to the outer knee, pushing it inward, often during contact sports like football or rugby.

Key Differences in Symptoms of ACL vs MCL Tears

Recognising the symptoms of ACL and MCL tears is necessary for accurate diagnosis and treatment. Here are the primary distinctions:

Instability

An untreated ACL tear often results in a feeling of instability, where the knee may “give out” during pivoting or twisting movements. In contrast, an MCL tear typically causes discomfort during side-to-side movements but does not usually lead to knee buckling.

Swelling

ACL injuries cause rapid and significant swelling due to internal bleeding in the knee joint. MCL tears, however, result in more localised and gradual swelling on the inner side of the knee.

Location of Pain

Pain from an ACL tear is generally more widespread and severe, whereas MCL tear pain is localised to the inner knee and may be accompanied by tenderness.

Sound at the Time of Injury

A loud “pop” is a classical symptom of an ACL tear and is less commonly associated with MCL injuries.

Stiffness and Range of Motion

Both ACL and MCL injuries can lead to difficulty bending the knee with stiffness.

Treatment Options for ACL and MCL Tears

Non-Surgical Approaches

Both ACL and MCL tears can often be treated without surgery, particularly if the injury is mild. The primary approach includes:

R.I.C.E. Treatment Method

The R.I.C.E. method is a first-line treatment for both ACL and MCL tears to help reduce swelling and manage pain. Rest prevents further injury and allows healing to begin. Ice should be applied for 15-20 minutes every few hours to minimise inflammation. Compression controls swelling with a bandage, and elevation keeps the knee raised above heart level to reduce fluid build-up and improve blood flow.

Physiotherapy

Physiotherapy aids in regaining knee strength, flexibility, and stability. For ACL tears, it focuses on restoring rotational stability. For MCL injuries, it emphasises side-to-side stability. Tailored exercises support recovery and reduce the risk of future injuries.

Surgical Options for ACL and MCL Tears

In more severe cases, surgical intervention, such as ligament repair or reconstruction, may be necessary, especially for athletes or active individuals.

ACL Tear Surgery

ACL tears which are complete or high grade with instability or with other associated injuries often require surgical treatment, particularly in active individuals or athletes. The damaged ligament is replaced with a graft, which can be taken from the patient’s own tissue (e.g., hamstring or patellar tendon) or from a donor. The goal is to restore knee stability and function, with rehabilitation typically lasting several months to fully regain strength.

MCL Tear Surgery

Surgery for MCL tears is less common and usually reserved for severe injuries or cases involving complete tears or with additional damage. The procedure may involve reattaching the torn ligament or reconstructing it with a graft. Many MCL tears, however, can heal with non-surgical treatment. Post-surgery recovery usually includes physiotherapy to restore side-to-side stability and prevent stiffness.

Conclusion

ACL and MCL tears impact knee stability differently, with ACL injuries often requiring surgical reconstruction and isolated MCL injuries frequently responding well to non-surgical care. Recognising the differences in symptoms and treatment options is necessary for a successful recovery and avoiding long-term complications. Timely and appropriate intervention can make a significant difference in restoring knee function.

If you are experiencing knee pain or instability, consult Dr LS Wang to discuss your treatment options.

What are Kneecap Fractures?

A kneecap fracture or patella fracture occurs when the small bone at the front of the knee breaks due to direct trauma or high-impact injuries. The patella serves to protect the knee joint and assist with leg extension by connecting the quadriceps muscles to the lower leg. Fractures of the patella can range from small cracks to complete breaks in multiple pieces. This guide explores the causes, symptoms, diagnosis, and treatment options for kneecap fractures, along with prevention tips to maintain knee health.

Recognising Symptoms of Kneecap Fractures

The symptoms of a kneecap fracture can vary widely based on the severity and type of break. Here are some common symptoms to be aware of:

Severe Knee Pain

Sharp, intense pain occurs over the kneecap, worsening with movement or pressure and often making weight-bearing difficult. Even simple leg movements can be excruciating, interfering with daily activities.

Swelling and Bruising

Swelling and bruising develop rapidly around the knee, sometimes spreading to nearby areas. The severity can vary but often signals significant tissue damage and inflammation.

Difficulty Straightening the Leg

A fractured kneecap may prevent fully extending the leg, causing pain and instability. This difficulty arises because the patella’s function in leg extension is compromised.

Visible Deformity

The knee may appear deformed or misaligned in severe fractures, with the kneecap visibly out of place. This symptom strongly indicates a serious injury needing urgent medical attention.

Causes and Risk Factors

Kneecap fractures often result from a combination of direct trauma and high-impact activities, with several common causes and contributing factors:

Direct Trauma

A direct blow to the knee, such as from a fall, car accident, or sports injury, can break the patella. This type of trauma is one of the most common causes of kneecap fractures.

Indirect Trauma

Sudden, forceful muscle contractions during activities like jumping or heavy lifting can pull the patella apart. These contractions place extreme stress on the bone, leading to fractures.

High-Impact Sports

Participation in high-risk sports such as football, rugby, and gymnastics increases the likelihood of knee injuries. The frequent and intense impact involved in these sports makes fractures more likely.

Types of Kneecap Fractures

Kneecap fractures can be classified into different types based on the pattern and severity of the break:

Stable Fractures

These involve a simple break where the bone pieces remain in proper alignment and are not significantly displaced. They typically heal with immobilisation and do not require surgery.

Displaced Fractures

In these fractures, the bone fragments are misaligned and may not heal properly without surgical correction. Surgery is often needed to realign and secure the fragments to restore normal knee function.

Comminuted Fractures

The patella is shattered into multiple fragments, resulting in severe damage that complicates the healing process. These fractures generally require complex surgical procedures to reconstruct and stabilise the bone.

Open Fractures

The broken bone punctures the skin, creating an open wound and a high risk of infection. This type of fracture needs immediate medical attention and urgent surgical treatment to clean and stabilise the injury.

Diagnosing Kneecap Fractures

If a kneecap fracture is suspected, a doctor will perform a thorough physical examination and may order imaging tests such as:

X-rays: The primary tool for diagnosing patella fractures, X-rays provide clear images of the bone to determine the type and severity of the fracture.

CT Scan: In more complex cases, a CT scan may be used to get a detailed view of the fracture and surrounding structures.

Kneecap Fracture Treatments

The treatment for a kneecap fracture depends on the type and extent of the break. Here are the main options:

Non-Surgical Treatment

Stable fractures that do not require realignment can often be managed without surgery. Treatment may include:

Immobilisation

A knee brace or cast is used to keep the knee joint in a fixed position, preventing movement that could interfere with healing. This ensures the bone fragments stay aligned while they heal, and the duration depends on the fracture’s severity and overall healing progress.

Pain Management

Over-the-counter pain relievers, such as acetaminophen or ibuprofen, can help reduce pain and swelling. In severe cases, stronger medications may be prescribed by a doctor to manage discomfort.

Physical Therapy

Exercises focus on restoring the knee’s range of motion, strength, and flexibility following the initial healing period. Therapists guide patients through a gradual increase in activity levels to prevent re-injury and improve overall knee function.

Surgical Treatment

Surgery is necessary for fractures where the bone pieces are misaligned, shattered, or have broken through the skin. Types of procedures include:

Open Reduction and Internal Fixation (ORIF)

This procedure involves making an incision to reposition the bone fragments into their correct alignment. The fragments are then secured using metal screws, plates, or wires to stabilise the knee and promote proper healing. ORIF is commonly used for displaced fractures to prevent future complications.

Partial Patellectomy

In cases where part of the kneecap is severely damaged, this surgery removes only the affected section. This method aims to preserve as much of the patella as possible while addressing the injury.

Total Patellectomy

This method is used in severe cases where the entire kneecap must be removed. A total patellectomy is performed when the fracture is too complex to repair, aiming to alleviate pain and restore some function to the knee joint. However, it may lead to reduced strength and mobility compared to having an intact kneecap.

Tips to Prevent Kneecap Fractures

Preventing kneecap fractures involves strengthening the leg muscles through regular exercise to provide better knee support and stability. Using protective gear, such as knee pads, is necessary during high-risk sports or activities to cushion potential impacts. For older adults, taking precautions to prevent falls, like using handrails and wearing appropriate footwear, can also reduce the risk of fractures. Staying active to maintain bone density and practicing safety habits are required for overall knee health.

Conclusion

Kneecap fractures are serious injuries that can impact mobility and daily life, but with prompt diagnosis and treatment, many people can achieve a successful recovery. Learning about the types, symptoms, and treatment options is necessary for managing these injuries effectively and preventing long-term complications. Preventive measures, such as strengthening the knee muscles and practicing safety precautions, can reduce the risk of knee injuries and maintain joint health.

If you are suffering from knee pain or suspect a fracture, contact Dr LS Wang today for personalised advice on treatment options.

An ACL (anterior cruciate ligament) tear is a common injury often caused by sudden stops or changes in direction, particularly in sports like football or basketball. The ACL helps maintain knee stability and allows for smooth joint movement. While surgery is often recommended to repair the damage and restore functionality, some individuals choose to forego surgery, opting instead for rehabilitation and lifestyle adjustments. But what happens when an ACL tear goes untreated by surgery? This article explores six potential consequences of managing an ACL tear without surgical intervention.

1. Chronic Knee Instability

Without surgical intervention, the knee may remain unstable. This can cause it to give way unexpectedly during basic activities like walking, standing or climbing stairs, making daily movements challenging. The lack of ACL support leads to improper knee alignment, which not only causes discomfort but increases the risk of further injury to surrounding ligaments and tissues.

2. Cartilage and Meniscus Damage

An untreated ACL tear places additional stress on the knee’s cartilage and the meniscus (the cushion between the bones). Over time, this excessive strain accelerates wear and tear, increasing the risk of meniscus tears and cartilage degeneration. When these structures break down, the knee’s ability to absorb shock diminishes, causing pain and swelling. This damage is often irreversible and can significantly further impair joint function and cause pain.

3. Early Development of Osteoarthritis

Constant stress on the knee joint, combined with cartilage and meniscus damage, can increase the risk of developing osteoarthritis. This condition causes the protective cartilage in the knee to wear away, leading to stiffness, pain, and swelling. Over time, osteoarthritis can severely reduce mobility, making it difficult to perform everyday activities. In advanced stages, more invasive treatments, such as joint replacement surgery, may become necessary to manage symptoms. It is estimated that there is an 10-11 fold increase in radiological arthritis of the knee after an ACL tear in 10 years.

4. Decreased Physical Activity

Knee instability caused by an ACL tear often forces individuals to avoid high-impact and pivoting activities such as running, jumping, or participating in sports. This limitation can lead to a more sedentary routine as the knee is no longer able to handle intense movements or pressure. Over time, reduced activity not only impacts physical fitness but can also affect overall well-being, contributing to weight gain and cardiovascular issues.

5. Muscle Weakness and Atrophy

Reduced physical activity due to knee instability often results in muscle atrophy, particularly in the quadriceps and hamstrings. When these surrounding muscles are underused, they begin to weaken and shrink, further destabilising the knee joint. As muscle strength declines, regaining mobility through rehabilitation becomes more difficult, prolonging recovery and increasing the risk of long-term disability.

6. Altered Gait and Posture

Chronic knee instability due to an untreated ACL tear often forces individuals to adjust their walking patterns (altered gait) to compensate for the instability. Over time, these adjustments can lead to uneven weight distribution across the body, causing strain on other joints such as the hips, lower back, and ankles. This altered gait may result in poor posture and increased wear and tear on other parts of the musculoskeletal system, potentially leading to further injury or chronic pain in areas beyond the knee.

Conclusion

Leaving an ACL tear untreated by surgery can result in a range of long-term effects that extend beyond just knee instability. Recognising the potential consequences makes it clear that early intervention and treatment are necessary to maintain knee health and avoid further complications.

Consult with Dr LS Wang today to see if ACL surgery is the right option for you and protect your knee from long-term damage and instability.

What is Knee Osteoarthritis?

Knee osteoarthritis occurs when cartilage in the knee gradually wears down, leading to pain, stiffness, and limited mobility. While it typically develops with age, it can also result from a previous injury or chronic stress on the joint. The condition advances through stages, from mild to severe, based on the extent of joint damage. Learning about these stages provides insight into the condition’s progression and helps identify the most appropriate treatments.

Stages and Symptoms of Knee Osteoarthritis

Stage 1: Minor Knee Osteoarthritis

There is minimal joint wear, and most people experience little to no pain. The cartilage is still healthy enough to cushion the bones, though small bone spurs may start to form. Symptoms, if present, are usually mild and appear after strenuous activities.

Stage 2: Mild Knee Osteoarthritis

Stage 2 is marked by more noticeable wear on the cartilage, causing mild discomfort, stiffness, and occasional pain, particularly after rest or inactivity. X-rays may show larger bone spurs, though the joint space remains adequate to avoid bone-on-bone contact.

Stage 3: Moderate Knee Osteoarthritis

At this stage, cartilage loss becomes significant, leading to more persistent pain during activities like walking or bending. Symptoms often include joint stiffness, swelling, and grinding sensations. X-rays show reduced joint space and the presence of larger bone spurs.

Stage 4: Severe Osteoarthritis

In Stage 4, the cartilage is nearly worn away, leading to constant pain even at rest, along with significant joint stiffness and swelling. Bone-on-bone contact becomes evident on X-rays, and basic activities become increasingly difficult.

Treatment for Knee Osteoarthritis at Different Stages

The treatment approach for knee osteoarthritis is tailored to the specific stage of the condition. As the disease progresses, the focus shifts from preventative measures and symptom management to interventions aimed at relieving pain and improving joint function.

Treatment for Stage 1

In Stage 1, the focus is on preventing further joint damage by managing weight to reduce stress on the knees and engaging in low-impact exercises like swimming or walking to maintain joint flexibility. Simple lifestyle modifications, such as avoiding activities that place excess strain on the knees, can help protect the cartilage and slow the progression of the condition. In certain cases, joint keyhole arthroscopic surgery can be helpful to manage mechanical symptoms.

Treatment for Stage 2

In Stage 2, the goal is to manage symptoms and maintain mobility. Physical therapy is recommended to strengthen muscles around the knee, providing better support. Over-the-counter pain relievers can reduce discomfort, and supplements such as glucosamine and chondroitin may be considered. Continuing low-impact exercises is key to keeping the joint flexible and functional.

Treatment for Stage 3

At Stage 3, more intensive treatments are necessary. This may include prescription medications to manage pain and inflammation, as well as corticosteroid or hyaluronic acid injections to reduce swelling. Braces or assistive devices can help alleviate pressure on the knee, and continued physical therapy focusing on quadriceps and hamstring strengthening can improve joint support and function.

Treatment for Stage 4

With severe joint damage in Stage 4, the focus is on pain relief and restoring mobility. Stronger medications, including opioids, if necessary, and corticosteroid injections are often used to manage pain. In many cases, knee replacement surgery becomes the most effective option for improving mobility and reducing discomfort.

Conclusion

Knee osteoarthritis progresses through different stages, from mild discomfort to severe joint damage. Early intervention with lifestyle changes, such as weight management and low-impact exercises, can help slow its progression. As the condition worsens, tailored treatments like physical therapy, medications, and eventually surgery can help manage symptoms and improve mobility. Recognising these stages is key to taking proactive steps in managing knee osteoarthritis effectively.

If you’re experiencing knee pain or stiffness, consult Dr LS Wang today for a personalised treatment plan to manage your osteoarthritis and maintain your mobility.