Introductory Chapter: Unveiling the Intricacies of Knee Surgery

Abstract

This Chapter introduces our work on the anatomy, approaches, and techniques from arthroscopic to open of the menisci, patella, and knee in general. Through examining, investigating, and understanding the anatomy and intricate dynamics involved in maintaining biomechanics stability and function, we are able to tailor surgery to the individual patient to repair and reconstruct. Nothing is more crucial than the rotatory function of the Anterior cruciate ligament, the menisci as secondary stabilisers, the maintenance of anterior knee alignment via the sesamoid patella and the subsequent congruency of the condyles via reconstructed total knee replacement and its variants (including hybrid prosthesis).

1. Introduction

1.1 Introduction to the human Knee: an Orthopaedic Surgeon’s Perspective

The knee, an intricate marvel of anatomical precision, serves as a crucial joint in the human musculoskeletal system. This weight-bearing structure, fundamental to ambulation and biomechanical functionality, has been a focal point of interest for orthopaedic surgeons. In this comprehensive exploration, we will delve into the various facets of the knee, examining its anatomy, static and dynamic functions, pathologies affecting different components, principles of arthroscopy, soft tissue and open surgical interventions, and emerging regenerative procedures.

2. Anatomy of the knee: bridging stability and mobility

The knee’s intricate anatomy comprises a delicate interplay of bones, ligaments, tendons, cartilage, and synovial fluid. The femur, tibia, and patella form the bony framework, while ligaments such as the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) provide stability. Understanding this complex arrangement is fundamental for diagnosing and treating knee conditions. The knee’s functionality extends beyond mere weight-bearing; it orchestrates a dynamic ballet between stability and mobility. As the largest hinge joint in the body, it permits controlled flexion and extension, crucial for activities ranging from walking to more complex movements. Static structures, such as ligaments and cartilage, collaborate with dynamic muscles to maintain equilibrium during motion.

3. Pathology of the joint: unravelling the intricacies in soft tissue and bone

Dysfunction in the patellofemoral joint, involving the patella and femur, often leads to conditions such as patellar dislocation or chondromalacia patellae. Surgical approaches aim to realign the patella or address cartilaginous irregularities. Injuries to the ACL, PCL, medial collateral ligament (MCL), or lateral collateral ligament (LCL) can compromise knee stability. Reconstruction surgeries, often through arthroscopy, aim to restore ligament integrity [1]. Meniscal tears, common in athletic injuries, necessitate precise arthroscopic interventions to repair or, if necessary, remove damaged portions while preserving joint function. Surgical interventions may range from arthroscopic procedures to joint replacement. Cartilage lesions, whether focal defects or generalised wear, pose significant challenges. Surgical techniques, including cartilage restoration procedures, aim to promote healing and prevent degeneration.

4. Surgery of the knee: navigating the minutiae to an open strategic approach

Arthroscopy, a minimally invasive technique, has revolutionised knee surgery. By employing a fibreoptic scope and specialised arthroscopic instruments, surgeons gain unparalleled access to the joint. Arthroscopic procedures include diagnostic arthroscopy, meniscal repair, and ligament reconstruction. While arthroscopy is often the preferred modality, certain conditions necessitate open surgical approaches. This may include complex fractures, extensive ligamentous reconstructions, or cases where a more comprehensive view is essential for successful intervention. We navigate through the intricacies of joint line restoration, soft tissue balancing, and the evolving role of robotics in enhancing precision [2]. Beyond the technical aspects, from preoperative counselling to postoperative rehabilitation, the surgeon’s role extends to ensuring a seamless patient experience. The psychological impact of knee surgery, the importance of shared decision-making, and the evolving landscape of patient expectations shape the narrative, underscoring the holistic responsibility that comes with reshaping a patient’s knee [3]. Patellar dislocations, commonly attributed to the ‘miserable malalignment syndrome’, covers anatomy, clinical evaluation, radiological assessment, and treatment options [4]. It successfully incorporates a broad range of factors influencing the condition, with an evidence-based approach and treatment algorithm [5].

5. Regenerative procedures: nurturing the future of knee health

Emerging technologies in regenerative medicine offer promising avenues for knee treatment. From platelet-rich plasma (PRP) injections to mesenchymal stem cell therapies, this section will explore cutting-edge approaches aimed at enhancing tissue healing and mitigating degenerative processes.

6. Conclusion

In this introductory chapter, we have embarked on a profound exploration into the vast landscape of knee surgery. From the foundational understanding of knee anatomy to the precision of arthroscopic interventions and the transformative artistry of total knee replacement, this textbook aspires to be a guiding compass for orthopaedic surgeons. As we navigate the complexities of knee surgery, let the scalpel be guided by not only knowledge and skill but also an unwavering commitment to the art of healing and the well-being of the individuals entrusting their knees to our care.