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The Anterior Cruciate Ligament (ACL) is a ligament that provides stability to the knee joint. 

An ACL tear commonly occurs when pivoting or landing badly from a jump. ACL injuries are common among people who engage in highly demanding physical activities, especially high-intensity sports.

ACL injuries can result in a loose knee that prevents them from participating in regular sports, even with an extended period of physiotherapy and rehabilitation.
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What Causes an ACL Tear?

ACL tears are associated with sporting or fitness activities that put too much strain on the knee joint. In most cases, the ligament stretches instead of twists to firmly ground the foot. 

Some causes include:

• A sudden change of direction while engaging in an intense physical activity
• Trying to pivot while a foot is planted-firmly
• Landing incorrectly while jumping or stopping abruptly while running
• The knee is being hit or injured in a collision
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ACL tears can also result from non-movement-related causes such as:

• Poor conditioning of the knee
• Wearing footwear that does not fit properly 
• Playing on artificial turf surfaces 
• Using poorly maintained sports equipment, causing the knee to sprain
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What are the Symptoms of an ACL Tear?

After the time of injury, you may experience some of these common symptoms of a torn ACL:

• A loud pop or popping sensation at the knee 
• Severe, abrupt pain to the knee while engaging in physical activity 
• Rapid swelling of the knee
• Being unable to stand, walk or move the knee
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After an ACL tear, you may experience a sensation of the knee giving way when playing or pivoting.
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ACL Tear Treatment

Non-surgical treatment is a preferred option for less severe cases. Patients who do not often participate in intense activities such as running, jumping, or pivoting can particularly benefit from non-surgical treatment.

Depending on the severity of the damage on the ACL, a patient can benefit from surgery to reconstruct or repair an injury. However, surgery remains beneficial for people who engage in intense physical activities often. 

Reconstruction involves using a tendon graft to replace the torn ACL. Most patients will receive nine months of physiotherapy after surgery before they can return to sports.

Non-Surgical Treatment of an ACL Tear

• Physiotherapy:
  Non-surgical treatment with physiotherapy is a preferred option for less active patients who do not participate in intense activities such as running, jumping, or pivoting.
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Surgical 

• Customised ACL Treatment:
  Every ACL injury is different. The benefit of such a tailored approach is that the Orthopaedic Surgeon can utilise the remaining ACL to improve the knee’s final function after surgery.
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• All-Inside ACL Reconstruction:
  In this procedure, the new ACL is secured into sockets that are drilled into the bones of the knee.
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• ACL Preservation Surgery:
  This surgery allows a patient to avoid a full ACL Reconstruction. The Orthopaedic Surgeon will repair part of the ACL and augment the irreparable component with a tendon graft.
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This is done to avoid removing the entire ACL and replacing it with a new one. ACL repair changes the treatment of ACL injuries by employing surgical devices and techniques to repair the original, torn ligament. 

Only an estimated 20-30% of ACL tears are repairable, but this means that 20-30% of patients with ACL tears can preserve their original ACL and avoid having to sacrifice their spare parts for an ACL reconstruction. 

ACL repair is technically more complex, and the repair may fail to heal in roughly 10% of cases. However, with successful healing, patients who have undergone ACL repairs rehabilitate much faster and potentially have better function than patients who have undergone the traditional ACL reconstruction surgery.

The meniscus is a shock absorber that cushions and provides stability in the knee. 

A meniscus tear refers to a tear of this shock-absorber. Any activity which causes a forceful strain on the joint to rotate or twist, especially adding the entire body weight onto the knee, can easily lead to a torn meniscus.

There are two types of meniscus tears:

1. Acute tears – these are common to children and young adults who are active.
2. Degenerative tears – These tears are due to cumulative stress and deterioration related to age.
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What Causes a Meniscus Tear?  

Meniscus tears are related to either trauma or age. These are the common causes:

• Athletic activities in contact sports
• A sudden stop or forceful twist of the knee 
• Stress caused by heavy bodyweight or malaligned bones
• Degeneration due to routine daily activities
• Degeneration due to age
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What Are the Symptoms of a Meniscus Tear? 

It is common for the symptoms of a meniscus tear to be similar to those for Anterior Cruciate Ligament (ACL) injury. 

Here are the symptoms you may experience:

• A popping sensation in the knee
• Acute onset of pain in the knee
• Swelling in the knee a few hours after the popping sensation
• Difficulty in straightening the knee (locking)
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After the injury, you may experience the following symptoms:

• Persistent pain in one side of the knee
• Inability to fully straighten the knee
• A sensation of the knee locking up (occasionally unable to fully straighten)
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Meniscus Tear Treatment

Pain from meniscal tears will often resolve with time. The tears usually do not heal and may give rise to recurrent symptoms or a progression of the tear’s severity.

Non-Surgical Treatment for a Meniscus Tear

• Physiotherapy
  Exercises performed during a physiotherapy session can help to decrease pain and improve knee function.
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• Painkillers
  Treatment for meniscus tears usually involves painkillers in the early painful phase to help patients manage the symptoms.
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Surgical Treatment for a Meniscus Tear

• Arthroscopic / Key-Hole Surgery
  As meniscal tears do not commonly heal independently, surgery may sometimes be required to restore its shock-absorption function. Without the meniscus, the knee is prone to developing osteoarthritis.
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Surgery is usually in the form of a keyhole meniscus repair where the meniscus’s torn edges are stitched together. In some severe or complex tear cases, the meniscus may not be repairable. In these instances, the tear would then be trimmed until a stable rim is reached to reduce the chances of the damage progressing in the future.

The kneecap, also known as the patella, is a tiny bone that sits in a groove in front of the knee located at the end of the thigh bone. When you bend or straighten your leg, the kneecap glides over the groove.

The kneecap is held in place by a group of ligaments and muscles. A dislocation occurs when these ligaments and muscles are overstretched or torn, allowing the kneecap to slide out of the groove. Typically, this movement happens suddenly. You are likely to experience sharp pain, and you might be unable to straighten your knee after that.
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What Causes a Patella (Kneecap) Dislocation? 

Here are some scenarios where a kneecap dislocation may occur:

• A sudden and abrupt direction change while the leg is anchored firmly on the ground will put pressure on the kneecap. Too much pressure will overstretch the support tissues causing dislocation. Likely scenarios for this situation is when playing sports like soccer or basketball.
• A fall or a direct blow to the knee will tear or overstretch the support tissues, leading to dislocation.
• In some people, dislocation could result from bony abnormalities in the hip, knee or shin bone.
• Loose ligaments make joints too flexible hence predisposing the individual to patella dislocation.
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What Are the Symptoms of a Patella (Kneecap) Dislocation?

• A visibly deformed knee
• Difficulty in straightening a bent knee 
• Tenderness and pain in the knee
• Swelling of the knee
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Subsequent symptoms after the kneecap has been put back in place include:

• Kneecap is sloppy and can move sideways excessively
• A sensation of instability and of the kneecap wanting to dislocate again
• Pain and locking in the knee if there are other accompanying injuries following the dislocation
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Patella (Kneecap) Dislocation Treatment

There is a range of options for treating kneecap dislocation based on the injury’s extent and severity. The typical treatment is non-surgical, where the kneecap is manipulated back into place, then followed by a period of splinting physiotherapy.

Non-Surgical Treatment of a Patella (Kneecap) Dislocation

• Patella manipulation:
  Patella manipulation involves relocating the kneecap back into its normal position.
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• Physiotherapy:
  Physiotherapy aims to strengthen the muscles that hold the kneecap in position to compensate for the torn ligaments that usually stabilise the kneecap. Physiotherapy can also help correct underlying functional abnormalities with knee and hip muscles, which may predispose one to dislocate their kneecap.
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Surgical Treatment of a Patella (Kneecap) Dislocation

• Knee Reconstruction Surgery:
  In recurrent cases of knee dislocations, surgery may be required to stabilise the kneecap. This usually involves reconstructing the torn ligament known as the Medial Patellofemoral Ligament (MPFL). In cases where there is a severe underlying bony deformity, our surgeon may have to cut and realign the bone or deepen the groove in which the kneecap sits typically.

Knee Osteoarthritis is a degenerative disease where the cartilage in the knee joint wears away. Eventually, bone spurs may begin to form, and the two bone ends start to rub directly against each other. As a result, patients experience pain in the knee.

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What Causes Knee Osteoarthritis?

Causes of Knee Osteoarthritis:

• Heavy body weight adds a lot of stress to the joint and predisposes one to osteoarthritis.
• Malalignment of the knee can overload certain parts of the knee, resulting in rapid wear and tear of the joint.
• Previous trauma such as fractures, meniscus tears or ligament tears to the knee can affect the bony alignment and stability of the knee, resulting in early wear and tear on the joint.
• Knee infections can damage the internal structures in the knee, giving rise to premature osteoarthritis.
• Inflammatory conditions of the knee, such as rheumatoid arthritis and gout, can cause damage to the cartilage and progress to osteoarthritis.
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What are the Symptoms of Knee Osteoarthritis?

The following are the symptoms of knee osteoarthritis:

• Pain with an activity that improves at rest
• The feeling of stiffness in the knee joint, especially in the morning or when trying to begin movement
• Swelling in the knee
• Loss of full flexibility in the knee.
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Knee Osteoarthritis Treatment

If you’re experiencing chronic knee pain, it’s best practice to consult a doctor to have it diagnosed and treated as early as possible. Treatment aims to reduce pain and to improve function in the knee.

Non-Surgical Treatment of Knee Osteoarthritis

• Weight loss:
  Activities like exercise to produce weight loss are encouraged to relieve pressure on the knee.
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• Physiotherapy:
  Physiotherapy can help to improve flexibility and pain in the knee.
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• Intra-Articular Injections:
  Corticosteroids and gel injections of hyaluronic acid are commonly injected into the joint to improve osteoarthritis symptoms.
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• Oral medication and supplements:
  Painkillers and oral anti-inflammatory medication can help with painful flares of osteoarthritis. Joint supplements can also help reduce the level of pain and inflammation in the joint. These include herbal anti-inflammatories or collagen supplementation.
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Surgical Treatment of Knee Osteoarthritis

In early cases of osteoarthritis, doctors usually try to preserve the joint. These procedures are largely termed ‘joint preserving surgery’. As doctors try to avoid replacing the knee with an artificial joint. Mild cases may be responsive to cartilage repair.

The most common procedure is microfracture, where small holes are drilled into the bone to stimulate the cartilage’s healing. This procedure is often augmented with the addition of collagen, hyaluronic acid or bone marrow aspirate concentrate (BMAC) over the repair site to improve the success rates. Where possible, a torn and non-functioning meniscus is repaired. Underlying bony malalignment may be necessary to protect the knee from further wear and tear.

• Subchondroplasty:
  In some painful joints that aren’t repairable, subchondroplasty may reduce the bone pain of osteoarthritis and improve knee function. Subchondroplasty involves injecting a bone substitute into the painful, damaged parts of the bone around an arthritic joint. With improvements in pain, this procedure can help some patients avoid a total knee replacement.
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• Partial (unicompartmental) knee replacement:
  A partial knee replacement may help if only one compartment of the knee is worn out. This is a more minor operation than a total knee replacement and has a shorter recovery period.
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• Total knee replacement:
  In severe osteoarthritis, a total knee replacement will remove all the damaged bone and cartilage in the joint and replace it with an artificial joint made out of metal and plastic.