Conditions we treat


Here at Phoenix we have highly respected consultants who are at the top of their fields who specialise specifically in the diagnosis and treatment of knee problems.

Not all knee issues need surgery, but all patients with significant symptoms do need and deserve a proper diagnosis, followed by a detailed discussion about what they’ve got, what this means (particularly for them, as an individual) and what the various potential treatment options might be.

 

Articular cartilage damage

The articular cartilage is the thin, smooth, white, shiny layer of slightly soft tissue that covers the surface of the bones in a knee joint.

If there is articular cartilage damage in the knee joint then this tends to cause pain plus swelling. If there are unstable flaps of articular cartilage, or if some cartilage breaks off and becomes a ‘loose body’ in the joint, then this can cause ‘mechanical symptoms’, such as painful clicking, catching, giving way or locking. Importantly, articular cartilage damage is something that only ever normally tends to get worse with time, not better.

 

Knee arthritis

‘Arthritis’ can be divided into ‘osteoarthritis’ or ‘inflammatory arthritis’ Osteoarthritis means that the layer of articular cartilage (the thin white shiny layer of tissue that covers the surface of the bones in a joint, to make them low-friction for smooth movement) wears away. If the wear is only partial, then we tend to refer to this as ‘wear and tear’ or ‘early degeneration’. However, if the articular cartilage layer wears away completely, to reveal exposed bare bone in the joint, then this is fully-blown osteoarthritis.

 

Knee ligament injuries

There are a number of important ligaments in and around a knee joint. The main ligaments are:

  • the anterior cruciate ligament (ACL), which stops the shin bone (tibia) wobbling forwards,
  • the posterior cruciate ligament (PLC), which stops the shin wobbling backwards,
  • the medial collateral ligament (MCL), which stops the lower leg wobbling inwards, and
  • the lateral collateral ligament (LCL), which stops the lower leg wobbling outwards.

There are other ligaments, such as ‘the posterolateral corner’ and also ‘the anterolateral ligament’, but these are smaller ligaments that are rarely ever damaged in isolation, and they are normally only damaged as part of larger injury involving other of the knee ligaments too.

If you have a minor partial tear (a sprain) of a ligament, then these can often heal up very well with just time plus rest and appropriate rehab. However, if there is a complete rupture / tear of a ligament and if the knee then feels wobbly and unstable, then there is a good chance that you might end up needing a surgical reconstruction to stabilise your knee.

 

ACL tears

The ACL (anterior cruciate ligament) is the main ligament at the front of the middle of the knee that prevents the shin bone (the tibia) wobbling forwards. It also helps control rotation too. This is the ligament that tends to end up tearing from major twisting injuries, such as bad football tackles of falls from skiing where the bindings fail to come off. There is often a ‘pop’ or a ‘crack’ heard or felt in the knee, followed by severe pain and significant joint swelling, and the knee then tends to feel wobbly and unstable.

 

The locked knee

If you twist your knee or you put your knee in an awkward position, and if there’s pain and then a ‘block’ in the joint, so that you’re not then able to fully straighten your knee – then that means that you’ve got a locked knee!

If a knee joint is beginning to develop arthritis (wear and tear / degeneration), then if often becomes increasingly difficult to straighten the knee out fully, and with time a fixed bend might develop in the joint. This is called ‘a fixed flexion deformity’, and this is completely different from a locked knee. With a locked knee, a joint that used to straighten out fine suddenly becomes painful and there is a sudden block to extension (straightening).

 

Pain at the front of the knee

Pain at the front of the knee is very common. In medical terms, ‘front’ is referred to as ‘anterior knee pain’. The kneecap sits at the front of the knee, with the quads (thigh) muscles and tendon attaching at the top and with the patellar tendon going from the bottom and attaching to the front of the shin (the tibia). The back surface of the patella is V-shaped and it sits in a V-shaped groove at the front of the end of the femur (the bottom end of the thigh bone), and this groove is called the trochlea (or the trochlear groove). The surfaces of the kneecap and the trochlear groove are both covered with a layer of smooth white shiny articular cartilage, so that as the knee bends and straightens, the kneecap slides up and down in this groove.