Many patients come with knee pain who are in the age group of 40 – 60 years.
On examination the primary component of pain is in the medial compartment of the knee along with pain in the back part of the knee.
The pain in the medial part of the knee is associated with medial meniscal tears most commonly in the posterior horn of the meniscus.
The same can be confirmed on MRI.
Plus on MRI we check the cartilage condition of the medial compartment of the knee and secondly on the feet bearing x-ray of the knee we check for gap scene in the medial compartment of the knee. Any gap scene in the middle compartment of the KNEE if its 50% of the gap seen on the lateral part of the knee it indicates a good cartilage condition and a functioning meniscus and in these patients we can take an option of arthroscopy meniscus repair after checking the cartilage condition on MRI of the knee…
If in the same patients the medial compartment is severely osteoarthritic and the lateral compartment is relatively good with the primary varus deformity of up to 10 degrees and on MRI the meniscus tear is reparable along with bad condition of the medial knee cartilage then the option of mobile bearing Unicondylar half knee replacement must be considered.
Pain in the back part of the knee along with heaviness while walking and standing is associated in most cases with the mucoid ACL . mucoid ACL is an abnormal swelling of ACLÂ in the intercondylar area of the knee.
Since it occupies a large portion of the intercondylar area it can lead to ffd that is fixed flection reformity and increase pain on activities like walking and standing.
If the joint is relatively healthy as seen on X-Ray then arthroscopic primary debridement of the mucoid ACL with radio frequency vand must be considered and if in the process of decompression the strength of ACL goes away then the patients can be Counselled for a reconstructive surgery after 6 to 9 months if they have problem of instability in the knee.
In much selected cases primary reconstruction of the ACL can also be considered in the same sitting as debridement of the mucoid ACL.
It offers the advantage of only a single sitting but with disadvantage of acute pain for next 3 weeks.
