Knee trauma can involve bony or soft tissue structures. Fractures around the knee are serious events, as they can cause post traumatic arthritis if they are not reduced and stabilised. Often soft tissue injuries take longer to heal than bony injuries as the blood supply in soft tissue structures is not as good as bone.
When the knee joint is injured through a sporting injury, motorcycle accident or just when falling from a ladder, there is a complex interplay between the bony and soft tissue structures around the knee.
Bony Injuries to the knee
When the bone is injured around the knee, the most important thing to determine is if the joint has been affected or whether the injury is outside the joint (Extraarticular). The best method of determining whether or not a joint is involved is to start with an Xray. Sometimes subtle signs cannot be seen on Xray and a CT scan is performed. This gives a 3 dimensional interpretation of the bone and is valuable in planning complex surgery.
One of the more common bony knee injuries is one that involves the joint surface of the tibia. This is called a tibial plateau fracture. After an Xray is performed and the fracture identified, in most cases, a CT scan is useful for planning surgery. This is because an Xray may miss some features of the fracture that need to be determined prior to surgery. Surgery is performed via minimally invasive techniques which offer less tissue damage than open approaches. Sometimes multiple incisions around the skin are used to access different parts of the knee.
Soft tissue Injuries to the knee
One of the more common soft tissue injuries around the knee is to the collateral or cruciate ligaments. These are often damaged during sporting games and can cause serious disability, especially in fit and healthy sports people. In general, these need addressing surgically. One of the best ways to determine what soft tissue structures have been damaged is by performing an MRI prior to orthopaedic surgery. An anterior cruciate ligament injury is one of the most common injuries to the knee, and requires surgery in people wanting to return to pivoting sports. Dr Liew performs his anterior cruciate ligament surgery using a hamstring autograft and fixes it in place using a special device called an Endobutton. This has been shown in studies to be extremely strong, and is one of the most widely used methods worldwide.
After surgery, the knee can be progressed to range of motion immediately, or after a period of splinting, depending on the type of injury sustained. Once the knee has recovered, the aim of surgery is the return a person back to their pre-injury function.