Knee joint arthrosis | Meniscus | Ligament injuries
Knee specialist Vienna: Dr. Philipp Heuberer is your reliable specialist for orthopedics
You have pain in the knee and do not know what to do? Your kneecap is giving you problems? Have you torn your cruciate ligament?
That’s when you need a true specialist who knows the ins and outs of knee problems, cartilage injuries, meniscus injuries, collateral ligament injuries, anterior cruciate ligament injuries and other such ailments.
As an experienced knee specialist, I can certainly help you.
Competence and experience: This is how I would like to improve your quality of life as a knee specialist in Vienna
During a detailed examination in my private clinic in Vienna, I, as a specialist with a focus on orthopedics, make an initial diagnosis and design a tailored therapy plan together with you. In doing so, the best possible care for my patients is my priority.
The treatment methods depend on the cause of your knee problems. Depending on your needs, I treat your injuries using regenerative or conservative methods. In particularly delicate cases, an intervention in the form of knee surgery is necessary. As a specialist in knee surgery for many years, I naturally perform this operation myself. However, surgery is always only the last step of the treatments.
This is why the knee joint is particularly vulnerable
The knee joint is the largest joint in the body. It consists of two joints, namely the patellofemoral joint and the tibiofemoral joint, which is found between the femur and the tibial plateau. This is referred to as a compound joint. The knee joint contains highly sensitive ligaments and tendons, such as the anterior cruciate ligament, posterior cruciate ligament, internal ligaments and external ligaments.
This complex and weight-bore joint is exposed to constant stress and is strongly affected by wear and tear. Even minor knee injuries and damage can result in pain and limited range of motion.
It is therefore all the more important that you consult a knee specialist at the very first appearance of problems in the knee joint area.
Knee pain and its causes
The causes of knee pain can be quite different. The most common causes of knee pain in patients are wear and tear diseases such as osteoarthritis or rheumatoid arthritis and, of course, sports injuries.
Sport is healthy, but many sporting activities must be assumed to place a particularly high strain on the knee joint. Very often there is damage to the ligaments and tendons, such as the cruciate ligaments.
Only the timely visit, the correct diagnosis and the therapy precisely tailored to the patient can relieve pain and save you from chronic diseases.
What I can do for you as a knee specialist in Vienna
In my work as a specialist for orthopedics in Vienna, I find the best possible solution for your individual knee problems. I take care of all kinds of knee injuries and complaints and restore pain-free mobility of the knee joint.
For an accurate diagnosis, my first step is to perform some manual tests on your knee. I check the load capacity and mobility, which are possible without knee pain. As an experienced orthopedist, I take enough time for this initial examination. Based on this thorough analysis, a decision is made as to whether further investigation is necessary.
To give me – literally – a better picture of your symptoms, an ultrasound, X-ray and in some cases an MRI (magnetic resonance imaging) might help.
After the necessary examinations of the knee joint are completed, I will discuss with you the possible forms of therapies in my center in Vienna. For me as a knee specialist, the focus is always on gentle but equally effective treatment.
What I can offer you as a knee specialist:
Pain therapy
Pain therapy uses a high-energy laser to stimulate blood flow in the patient’s treated tissue. The laser has an anti-inflammatory and analgesic effect. In addition, bio-stimulation causes rapid tissue regeneration and resolution of hematomas. Other treatment options for pain include extracorporeal shock wave therapy and trigger puncture therapy.
Regenerative therapy
The goal of regenerative therapy is not to replace damaged tissue, such as tendons and ligaments, but to stimulate the production of the body’s own cells and growth factors, thereby restoring the damaged tissue. Examples include PRP (platelet rich plasma) therapy and stem cell therapy.
Operative therapy
If the mechanical damage is too great and neither regenerative therapy nor pain therapy promise a noticeable improvement in your symptoms, I recommend knee surgery to my patients. The goal of such knee surgeries is to restore necessary body functions and permanently take away pain.
The right treatment option
If you are currently suffering from pain, you may find our small encyclopedia of the most common knee injuries, helpful.
I have summarized some of the most common causes of pain and discomfort in the knee joint. Specifically, these are the injuries of the ligaments (cruciate ligament tear, internal ligament tear, external ligament tear), meniscus tear and knee joint arthritis. In addition, I have summarized information about meniscus transplantation for you.
First and foremost, I would like to answer the three most important questions:
Which area in the knee is affected?
How is the cause determined?
What treatment options can be used to treat both cause and symptoms?
Of course, this small encyclopedia can only provide a first insight into the broad spectrum of knee orthopedics. If you want to know what the problem is in your specific case and what treatment promises the greatest success, I recommend a visit to our medical center in Vienna.
The little encyclopedia of knee complaints
(cruciate ligament tear, inner ligament tear, outer ligament tear)
What is affected?
In addition to the muscles, the knee joint is stabilized to a large extent by its ligament structures. The most important stabilizers are the medial and lateral collateral ligaments, which stabilize the knee on the side, and the anterior and posterior cruciate ligaments, which prevent the lower leg from sliding forward or backward.
Ligament injuries to the knee joint are usually caused by trauma and occur primarily in sports injuries such as soccer, skiing, or in-line skating. By far the most common ligament injury is a tear of the anterior cruciate ligament.
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A torn ligament in the knee joint usually causes severe pain immediately, usually with swelling of the knee joint. Loading of the knee is hardly possible. After the acute symptoms have subsided, many patients complain of unsteadiness, a “giving way” of the knee joint.
How is it determined?
The exact determination of the diagnosis is mainly done clinically by a detailed examination of the knee joint and is confirmed by an MRI.
In addition to the affected structure, the cardinal symptom, instability, and the severity of the finding dictate the choice of therapy.
How to treat the discomfort?
In general, all types of ligament injuries are first and foremost treated conservatively with fasciatherapy and physiotherapy to release the muscles and get back the function and stability of the joint.
In the case of complex ligament injuries with bony avulsion or joint instability, surgery should be sought. It is well known that permanent knee joint instability due to anterior cruciate ligament tear leads to meniscal injury and cartilage damage, which promotes early wear and tear.
Therefore, it is strongly recommended to consult a specialist in case of knee joint injuries, as untreated ligament tears carry a high risk of premature osteoarthritis.
Bony ligament tears are reattached and torn collateral ligaments can be refixed.
Nowadays, cruciate ligament replacement surgery is performed arthroscopically and the torn ligament is replaced by the patient’s own body material.
In selected cases the torn anterior cruciate ligament can be directly refixed to the insertion preserving the native ligament.
Postoperatively, the knee joint can be loaded again from the first day with the help of 2 forearm support crutches. Everyday activities can be performed again after about 4-6 weeks. Crucial for an optimal surgical result is the implementation of physiotherapy with muscle strengthening and coordinative training. The rehabilitation phase lasts about 4-6 months. When patients can return to sports varies from individual to individual; the result of a coordination test is crucial.
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What is affected?
The meniscus is an important component of the human knee joint as a shock absorber and stability provider. Meniscus injury is one of the most common pathologies occurring in the knee. Despite the fact that nowadays the main goal is to preserve the meniscus and to suture it whenever possible, it may not always be possible to achieve. In some cases after previous surgery, the meniscus may has been partially removed. Partial meniscal loss can result in significant functional loss in the knee joint, leading to accelerated joint wear with early osteoarthritis due to altered biomechanics and instability. A pronounced, functional meniscal loss can lead to what is known as postmeniscectomy syndrome, with typical load-dependent pain in the region where the meniscus was previously located.
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How is it determined?
In order to correctly diagnose functional meniscal loss and plan for possible replacement, X-rays of the knee joint and a whole-leg radiograph under stress, as well as a current MRI scan, are necessary in addition to a clinical examination.
How to treat the discomfort?
The most promising method of restoring the meniscus is transplantation with a so-called allograft. An allograft is donor tissue from an organ donator that is removed under sterile conditions in surgery and tested and processed by a certified tissue bank. The decisive factor is that a certain biocompatibility is still maintained. Based on MRI, the required meniscus size is measured and ordered from the tissue bank according to these parameters. In general, transplantation of bone, cartilage and soft tissue such as tendons or meniscus is not expected to cause any rejection reactions and therefore no medication as known from organ transplantation is necessary.
The procedure is now performed completely arthroscopically due to the constant advancement of technology. The graft is inserted into the knee through 2 small holes in the knee joint and the two ends of the meniscus are anchored to the former roots through 2 small holes in the tibial plateau via a third hole. The rest of the meniscus is sutured to the joint capsule.
Meniscal transplantation should therefore lead to restoration of proper joint function and help delay knee joint wear due to the regained stability and shock absorbing function.
Decisive for the success of a meniscus transplant are stable knee joint conditions and a straight leg axis. Instabilities such as those caused by cruciate ligament tears or axial deviations must be corrected. The higher the degree of wear already present in the knee joint, the greater the risk of early failure.
The aftercare is similar to a meniscus suture and should be performed very carefully with gradual increase of loading. Initially, the range of motion is severely limited by a knee brace and after 6-8 weeks, the implementation of active physiotherapy is highly recommended.
From medical literature 80% very good results are known after 10 years. Good results over 4 years have also been reported in pre-existing knee joint osteoarthritis, so meniscus transplantation can be considered instead of knee arthroplasty in selected cases to postpone joint replacement.
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What is affected?
The meniscus is a crescent-shaped cartilage-like structure between the thigh and tibia; one on the outside (lateral) and one on the inside (medial) of each knee joint.
Its function is to
- act as a shock absorber in the knee joint
- increase the articular surface in the knee
- provide better distribution of synovial fluid for friction reduction and cartilage nourishment
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Injuries to the meniscus happen frequently
- on the one hand, due to a rapid rotation of the knee joint or rapid bending or stretching, or due to an accident during sports activities (stop-and-go sports, skiing, snowboarding, athletics, martial arts, cycling, etc.)
- on the other hand, by wear and tear over time due to overload and micro-instability of the knee joint.
How is it determined?
Patients sometimes feel a twinge in the knee joint often with no restrictions on walking and are only affected during exercise.
Symptoms include temporary swelling of the knee joint, inability to bend or extend the knee joint. The pain is typically localized internally or externally over the joint space.
How to treat the discomfort?
Initial treatment should include rest, ice, anti-inflammatory medications (NSAIDs), and bandaging.
A torn meniscus rarely heals on its own due to the poor blood perfusion.
Physiotherapy and continuous strengthening of the thigh muscles are further measures to avoid surgery.
If the quality of life is significantly impaired or the knee is unable to move (bucket-handle meniscus tear), a knee specialist should be consulted immediately.
Together with the physician, the further surgical procedure can then be decided. By means of a knee arthroscopy (arthroscopy of the joint, keyhole surgery), the torn meniscus is usually repaired, partially removed or trimmed. The decision to suture (repair) the torn part of the meniscus depends, on the one hand, on the patient’s age, occupation, activity level and sporting activity and, on the other hand, on the type, localization and tissue quality of the tear. Therefore, a final decision can only be made during surgery after precise visualization of the tear.
The operation can be performed in day surgery. If the meniscus can no longer be sutured, full weight-bearing of the knee joint is possible immediately after surgery. Normally, no crutches are needed and athletic activity can be resumed 6-8 weeks after appropriate muscle strengthening. Generally, an intra-articular injections of hyaluronic acid to lubrificate the cartilage are recommended after arthroscopy.
If the meniscus can be sutured, the protective function of the meniscus on the knee joint is preserved and the risk of arthritis is reduced. However, a longer rehabilitation phase (2 crutches for 6 weeks, then physiotherapy) is necessary afterwards, contact or stop-and-go sports are to be avoided for 6 months.
Up to 20% of all meniscal sutures fail due to its poor blood supply, possibly leading to a repeat knee arthroscopy to remove the unhealed portion of the meniscus.
Loss of the meniscus -with or without surgery- inevitably leads to premature osteoarthritis of the knee joint.
As a result, on the one hand, the meniscus should be repaired whenever possible, and if it is not possible, only as much as necessary and as little as possible should be removed from the meniscus during the surgery. On the other hand, the patient should continuously strengthen the anterior and posterior thigh muscles through training as a preventive measure.
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The right treatment options
What is affected?
Wear and tear of the knee joint is the most common reason for pain in the knee joint. There are different types of knee joint arthritis depending on which part of the knee joint is affected. Knee joint arthritis is characterized by progressive wear of the articular cartilage. The loss of articular cartilage leads to a loss of gliding ability of the knee joint. The overloading of the bone causes recurrent joint inflammation with swelling and pain of the knee joint.
Typically, knee osteoarthritis affects patients over 50 years of age and is more prevalent in overweight individuals. Weight reduction can contribute significantly to pain relief. A genetic component is also known. Other factors that can lead to knee joint osteoarthritis include trauma, especially in younger patients, meniscal tears and ligament injuries.
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How is it determined?
Typical symptoms of knee joint arthritis are load-dependent pain accompanied by night pain, restricted movement, as well as swelling and pressure pain of the knee joint. Often the pain begins only slightly and is hardly noticed to end up in rather violent pain inhibiting walking.
The diagnosis is typically made with a clinical examination and x-rays. MRI usually provides information if a bone marrow edema is present.
How to treat the discomfort?
Treatment always begins conservatively with the goal of maintaining quality of life and improving mobility. Muscle strengthening, physiotherapy and weight reduction make an important contribution. Since the loss of articular cartilage cannot be reversed, therapy is based on the symptoms. Occasional cortisone injections may be helpful to control inflammation. Improvement in lubrication and pain relief can be achieved by hyaluronic acid injections. It has been shown that regenerative therapies such as platelet rich plasma therapy (PRP or ACS) or stem cell concentrates are the best way to effectively relieve pain and restore mobility, without side effects.
If conservative therapy can no longer improve the quality of life, a surgical procedure is necessary. In the early stages of knee osteoarthritis, joint-preserving surgical techniques can also be used. In the advanced stage of wear and tear, only a partial or usually complete knee joint replacement can then be performed. Due to today’s possibilities with computer-assisted planning, where the knee joint replacement is individually tailored to the patient (MyKnee), very good results can be achieved with knee joint replacements. Patients can resume full weight bearing on the operated knee joint from the first day of surgery and usually leave the hospital after 5-7 days with good mobility and climbing stairs. Crutches should be used to relieve soft tissue pressure for 4 weeks, and rehabilitation under physical therapy guidance with muscle strengthening and movement coordination is strongly recommended.
In addition to the use of state-of-the-art techniques, optimal cooperation between the physician, patient and physiotherapist is essential for a successful surgical result.
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