WHAT IS KNEE JOINT PRESERVATION?
It is an emerging field in orthopaedic surgery whose goal is to prevent or delay the onset of osteo-arthritis in the knee joint in young patients. Young patients are very active and have a high demand.
The procedures include anterior cruciate ligament reconstruction, osteotomies, meniscal repair, cartilage repair, subchondroplasty etc. If you already have cartilage damage that cannot be reversed completely, I can try to lessen symptoms and delay the degenerative process.
Ligament reconstruction- In the knee, ACL repair or reconstruction is the main procedure. It is a form of joint preservation because it protects the meniscus. I am also keen on ACL repair in fresh cases. ACL reconstruction is done for chronic ACL deficiency with a wide separation between the ends. Partial ACL tears can be treated with healing stimulation and stem cells.
Meniscal repair & replacement– Meniscal tears can occur in isolation or along with other injuries. Menisci serve several important functions in the knee. Preserving the menisci is crucial to delay osteo-arthritis. Fresh meniscal tears in the vascular zone can be repaired surgically and will heal. In those cases where the meniscus has already been removed, a meniscal replacement is now available.
Osteotomies- Patients with uni-compartmental arthritis and mal-alignment can be treated with osteotomies to unload the affected part and transfer load to the unaffected part. This works through biological methods. It can postpone or delay a knee replacement by several years. High tibial osteotomy ( HTO) and lower femoral osteotomy (LFO) are the commonly performed procedures.
Preservation of Joint cartilage- In the past two decades, cartilage repair procedures have made vast progress. Autologous chondrocyte implantation (ACI) is one of the procedures. I was the first to use a fourth generation autolgous chondrocyte implantation (ACI) in Chennai. See a patient testimonial here. Currently I use MSC’s to repair cartilage defects in young patients. See a patient testimonial here.
Knee distraction– This is an option for those patients who already have osteo-arthritis but want to avoid a knee replacement. It involves use of an external fixator for six weeks followed by mobilization.
Conservative treatments– I explore other possibilities before suggesting a surgical procedure. These include use of a brace, footwear modifications etc. Conservative treatment means prevention. It means early rehabilitation. It may also involve early surgery to prevent further damage. It means adequate comprehension of clinical ‘bio mechanics’ or ‘joint dynamics’
Hip procedures- The hip joint deserves special mention in India. Avascular necrosis (AVN) is the commonest hip condition in India. It affects the young population. It is caused by death of bone. Early cases of AVN can be treated with core decompression and stem cells. Other joints with AVN can be also treated with the same principles. Early cartilage damage can be treated with biological methods using stem cells.
Other joints– The shoulder and ankle are other joints where joint preservation can be tried. Arthroscopy is a major tool to address some of these conditions. Rotator cuff repairs can be augmented with stem cells or PRP. Labral tears can be treated with stem cells. Ankle instability can be treated with targeted stem cells. If arthritis has already developed in the ankle, distraction arthroplasty has shown promising results in the literature as opposed to ankle fusion. I have used marrow stimulation in the shoulder to cure symptoms.