Disorders of the Knee

Disorders associated with the knee are numerous and not all of them are treated using minimally invasive technique. Of those treated using Arthroscopy, disorders can be classified as chronic or acute. It should be noted that all the disorders of the body can be broadly classified under these two heads for a simple reason that this classification is done on the basis of time. Chronic implies continued over long periods of time and acute means in one instant. Thus, fracture caused due to accident will be classified as acute injury whereas weakness of bone due to osteoporosis will be classified as chronic defect. Osteoporosis cannot occur in a flash. It is a result of bone quality degradation over a period of time. Similarly, in the Knee joint, there are some disorders that happen in a flash whereas others don’t.

Of the acute injuries in the knee, most common is the meniscal tear followed by ACL rupture. Note that though these are very common, they are common only in highly active people who use the joint to the fullest. Frequent sufferers are sportsmen/women who play Football, Basketball, Hockey and other similar physically demanding games. As mentioned earlier on, 80% of the injuries of menisci occur in the medial meniscus. A meniscus gets injured because it gets impinged in between the articulating bones. Naturally, the type of injury is ‘tear’. As a thumb-rule, tears in the white-white zone are treated by resecting the meniscus, in the red-red zone are treated by repairing/stitching the meniscus while those in the red-white zone are upto the discretion of the surgeon depending upon whether the tear will heal or not. This thumb rule is normally followed because tears in red-red zone can heal on repair because of the vascularisation. As white-white is completely devoid of vascular supply, it will not heal even if repaired.

These tears are also classified depending upon their orientation and severity. The details of different types of tears can be read from the module supplied by Endosys. It should be noted that it is very important to know different types of tears because only then can one know how to treat it. Even in case of resection, when using our wide range of hand held instruments, there are different instruments for different parts of the meniscus and different types of tears. Application of different types of instruments for different zones of meniscus and different tears will be dealt with in a unit dedicated to Geofix hand held instruments.

Besides meniscal tears and ACL rupture, the other disorders that occur in the Knee are PCL, MCL and LCL rupture & Synovitis. Generally, PCL rupture is accompanied by rupture of ACL also. PCL in itself is a very strong ligament and is also placed such that it rarely faces strain enough to damage it. If such a strain does occur, it usually does simultaneously/after the rupture of ACL. Synovitis is nothing but inflammation of Synovium. This occurs because of infection and manifests itself as severe pain in the knee. The only remedy for this problem is resection of Synovium which is affected.

Equipped with the knowledge of anatomy and disorders of the Knee, we can now move on to the equipment used for Diagnostic Arthroscopy and Operative Arthroscopy.