Knee
Why does my knee hurt
The knee is described as a hinge joint, however it is far more complicated than this simplistic view. The bone surfaces that are in contact with each other are covered in cartilage, a very slippy material. This allows your knee to bend and straighten easily. The knee has three compartments to it; behind the knee (patellofemoral joint), inside (medial compartment) and outside (lateral compartment). Arthritis can affect any of these three parts in any combination. With time the cartilage can wear away leading to the exposed bone rubbing against other exposed bone, this causes pain and stiffness. The pain can be felt at the front, side, or deep inside the knee occasionally even in the hip (referred pain). Gradually mobility is affected and the pain can even disturb your sleep. In the early stages of arthritis people try oral supplements such as cod liver oil, chondrotin and glucosamine and tumeric to improve the pain of the arthritis. Other measures that can help are avoiding impact type activity such as running, exercising the knee, keeping your weight down, icing the knee and anti inflammatories (if you can take them). When the pain becomes unbearable then the only option other than living in pain is a replacement joint.
How can Mr Cope help me?
There are several options available depending on how the arthritis has affected your knee. If it is just behind your kneecap (patellofemoral osteoarthritis) then you may be suitable for a patellofemoral replacement (PFJ). If the inside (medial compartment osteoarthritis) is affected then you may be suitable for a unicompartmental knee replacement (half or partial knee). The majority of patients however have tricompartment arthritis affecting their knee throughout a total knee replacement (TKR) is then the only option. A cut is made down the front of your knee and the kneecap is turned outwards exposing the inside of your knee. The diseased bone ends are then removed and a new knee is inserted and cemented into position. The next day you begin your road to recovery and start to walk, initially with walking aids. You go home typically two days after the operation. The operation itself is only one part to your new knee and you have to put the time and effort in to gain the full benefit by performing the exercises regularly that you will be taught. This is to ensure that the knee moves as well as it is capable of. Around six weeks following the operation you are fit to drive and are usually walking unaided. Mechanical knees do clunk and make noise this is no cause for concern. This is meant as a guide only and all patients heal and recover at different rates.
Attune total knee replacement
Avon patellofemoral replacement
Partial knee replacement
Knee arthroscopy
Does your knee click, become swollen or get painful after minimal exercise? Have you injured your knee and are unable to get back to sport? Then you may have torn your meniscus. These are two horse shoe shaped structures that sit on top of your shin bone (tibia). They deepen the knee joint and reduce stresses within your knee during increased impact activities. Occasionally they become caught in the knee and then tear when the body twists on the knee. An arthroscopy (keyhole surgery) may help you.
This is usually a day case procedure when the inside of the knee is looked at using a camera. This is inserted via two small nicks either side of the patella tendon. The camera is about the thickness of a pen. The other hole is used to insert instruments to the knee. The operation takes about 20 minutes. The torn meniscus is trimmed back to a stable edge, so that it no longer irritates the joint. The wounds heal without requiring stitches. On leaving the hospital you can walk and return back to driving after three days. On average it takes two to six weeks to recover from an arthroscopy but your knee may not feel back to normal fully till three months. You are then able to return to your pre injury activities.
Arthroscopy is not an option for an arthritic knee and is not recommended by NICE for this.
Anterior Cruciate Ligamnent Reconstruction & sports injuries
What Are Ligaments?
Ligaments are strong, stretchy bands of tissue inside your body.
Think of them like rubber bands that connect bone to bone.
Their job is to stop your joints from moving too much or in the wrong direction.
What Can Go Wrong?
A ligament can be:
| Injury type | What it means | Simple words |
| Stretched | Called a "sprain" | Like pulling a rubber band too far – it hurts but still works |
| Partially torn | Some fibres are broken | The rubber band has a small tear – still works but feels weak |
| Completely torn | The ligament is in two pieces | The rubber band snapped – the joint may feel loose or unstable |
Do All Ligaments Need Surgery?
No. Many stretched or partially torn ligaments heal by themselves with:
- Rest
- Ice
- Physiotherapy (special exercises)
But if your knee feels unstable (like it might give way or buckle when you walk or turn), then surgery may be the only option.
ACL Tears – A Very Common Sports Injury
What is the ACL?
ACL stands for Anterior Cruciate Ligament.
It is one of the main ligaments inside your knee.
It stops your shin bone from sliding too far forward.
How Do People Tear Their ACL?
You can tear your ACL during sports like:
- Football (soccer)
- Basketball
- Skiing
- Netball
- Rugby
It often happens when you:
- Twistyour knee suddenly
- Land badlyfrom a jump
- Stop or change directionvery quickly
What Does an ACL Tear Feel Like?
Many people say they heard or felt a "pop" in their knee at the time of injury.
Then you may have:
- Severe pain
- Swellingwithin a few hours (knee becomes puffy)
- Feeling that your knee is loose or giving way
- Trouble walkingor putting weight on that leg
Do I Need ACL Surgery?
Try No Surgery First (for some people)
You may not need surgery if you:
- Do low-impact activities (like walking, swimming, cycling)
- Do not play sports that involve twisting or jumping
- Are older or have other health problems
These patients can often manage with:
- Physiotherapy to strengthen leg muscles
- Wearing a knee brace
- Avoiding certain sports
Surgery is Usually Recommended If:
- You are young and active
- You want to return to sportslike football or skiing
- Your knee keeps giving wayduring normal daily activities
- You have also torn other parts of your knee (like the meniscus)
Why surgery? Without a working ACL, your knee may keep giving way. This can damage other parts of your knee, including the cartilage and meniscus, leading to early arthritis.
ACL Reconstruction – How Mr. Cope Can Help
What Does "Reconstruction" Mean?
We cannot simply sew a torn ACL back together – it does not heal well on its own.
Instead, Mr. Cope will build you a new ligament using a tendon from another part of your body (or sometimes a donor).
Where Does the New Ligament Come From?
Mr. Cope often uses the peroneal tendon (a tendon from your leg) – this is a technique he specialises in.
Other options include:
- Part of your hamstring tendon
- Part of your patellar tendon (kneecap)
What Happens During Surgery?
- You will have a spinal anaesthetic or general anaesthetic (you will be asleep/unable to feel pain)
- Cope makes a few small cuts(keyhole surgery)
- He places a camera inside your knee to see the tear
- He removes the torn ACL remnants
- He drills small tunnels into your thigh bone and shin bone
- He passes the new tendon through the tunnels
- He fixes it in place with screws or other devices
- Over time, your body turns the tendon into a new, working ligament
How Long Does Surgery Take?
About 1 to 1.5 hours.
You will usually go home the same day or the next day.
Recovery After ACL Reconstruction
First 2 Weeks
- You will use crutches(you can put some weight on your leg)
- You will wear a knee brace
- Your knee will be swollen – ice and elevationhelp
- You start gentle exercises straight away
2 to 6 Weeks
- You stop using crutches (usually by week 2–3)
- You start physiotherapy– this is very important!
- You work on bending your knee and straightening it fully
- You begin gentle strengthening exercises
6 Weeks to 4 Months
- You can driveagain (around 6 weeks)
- You walk without a limp
- You start balance and agility training
- You may begin light jogging (around 3–4 months)
4 to 6 Months
- You start sports-specific training
- You do jumping and landing exercises
- Your new ligament is getting stronger
6 to 9 Months
- Most people return to sportbetween 6–9 months
- You must continue strengthening exercises to protect your new ligament
- Your knee may still feel a little different to your other knee – this is normal
9 to 12 Months
- Full recovery
- You can return to competitive sports(with your surgeon's approval)
- Your knee should feel stable and strong
Important: Every person heals at a different speed. Do not rush back to sport too early – this can damage your new ligament.
Complications of surgery
The majority of patients (95%) have a successful outcome with no problems; however surgery does have risks associated with it. Some patients will have higher risks depending on the previous diseases they suffered from. These include:
Major Medical Problems
* cardiac disease
* diabetes
* previous stroke
Severe Respiratory Disease
* previous blood clots
* deep vein thrombosis (DVT)
* pulmonary embolism (PE)
Medications
* anticoagulants
* steroids
* immunosuppressants
Previous Joint Surgery
* fracture fixation
* previous infection
* previous joint replacement
The risks to all joint surgery are:
* Medical (heart attacks and strokes) (see above)
* Infection of new joint requiring removal (less than 1% or 1 in 200 people)
* Deep vein thrombosis (blood clots) (1% or 1 in 100 people)
* Fatal pulmonary embolism (blood clot goes to lung) (0.0001% or 1 in 10000 people)
All joint replacements are artificial and as such can wear out sooner than expected leading to another (revision) operation. There are also risks specific to the individual procedure, which include:
Total Knee/Uncompartmental/Patellofemoral Replacement
* On-going pain and discomfort (2% or 1 in 50 people) However pain is usually less than previously experienced from the arthritis.
* Stiffness (0.5% or 1 in 200 people)
* Most knees should move from 0 (straight) to at least 90 (bent). Stiffer than this may require an operation to manipulate it whilst you are asleep. Mr Cope is only pleased if you reach 120.
* Nerve/Blood vessel injury (0.001% or 1 in 1000 patients)
* Progression of arthritis in the case of unicompartmental and patellofemoral replacements requiring further surgery to convert to a total knee replacement.
Any further concerns you have about the complications should be addressed to Mr Cope or his team when you meet him in clinic.