The Problem Knee PDF

Preface

The knee is a complex and crucial joint, vulnerable in the daily round as well as during sports and in transport or industrial accidents. While the causes of acute or chronic knee symptoms are not always apparent, it is to be hoped that, at very least, an informed questioning and examination of the patient or injured athlete will ensure that needless morbidity is avoided. Whether the sometimes inextricable mix of reactive synovitis, soft tissue and osteochondral damage can be teased apart may eventually depend on the experience and investigative skills of the surgeon; but assuredly a lack of cooperation and free communication with colleagues in other disciplines will retard both the speed and success of treatment.

This monograph emphasizes the basic principles in managing a ‘problem knee' in the younger patient. The interrelationship between skeletal and soft tissues injuries is acknowledged, but in the interests of a simplifi ed and rational approach, separate chapters deal with the different components of the joint, albeit with some repetition. Details about most surgical approaches have been kept to a minimum because these can be learnt effectively only in the operating theatre. Scanning the knee with magnetic resonance imaging, ultrasound or computed tomography has augmented the clinical value of history taking, careful and standardized physical examination, and conventional radiography. However, the unconditional and excessive use of investigations of this sort cannot be condoned. Clinical assessment is still the bedrock of management.

Operative intervention for patellar pain, with or without maltracking, is less frequently advised than in the past. The subtleties of patellar instability make surgical procedures prone to patient disappointment. Cruciate ligament reconstruction, on the other hand, is now a relatively safe and satisfactory procedure, particularly for the acute anterior cruciate rupture. The benefits of this intervention are now convincing, not least the protection of other structures in the knee that has been stabilized. Meniscal repair and (osteo)chondral grafting are appropriate in selected cases, and after all forms of surgery a more rapid rehabilitation is espoused.

The text now incorporates recent advances in surgical management and newer concepts in conservative treatment. As before, systemic conditions are described as they relate to the knee in younger patients but degenerative disease is excluded. An overview of fracture care is presented without elaboration.

The fi rst edition of The Problem Knee appealed especially to physiotherapists, family doctors and casualty officers. The second edition broadened its appeal to surgical trainees and those in orthopaedic practice. With the welcome assistance of Professor Franky Steenbrugge, who has extensively revised Chapters 5 and 6, it is hoped that this third edition will prove of further value. Chapter 4 on paediatric conditions has also been modernized.