Choosing the Right Treatment for Knee Ligament and Meniscus Injuries

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• Common Knee Ligament Injuries
• Tailoring Treatment to the Patient
• Key Factors in Treatment Selection
• The Importance of a Holistic Knee Evaluation
• Benefits of Minimally Invasive Knee Surgery
• Surgical Goals and Patient Recovery

Common Knee Ligament Injuries

Knee ligament and meniscus injuries are among the most common sports-related and active lifestyle injuries. Dr. Pablo Gelber, MD, describes the knee as having four major ligaments: the medial collateral ligament (MCL), the lateral collateral ligament (LCL), and the two cruciate ligaments—the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL)—which cross inside the joint. The menisci are C-shaped pieces of cartilage that act as shock absorbers between the thigh bone (femur) and shin bone (tibia).

Dr. Pablo Gelber, MD, notes that a majority of complete ligament tears require surgical treatment to restore stability and function. However, the specific approach is never one-size-fits-all.

Tailoring Treatment to the Patient

The cornerstone of modern knee injury treatment is tailoring the approach to each individual patient. Dr. Pablo Gelber, MD, stresses that the same injury in ten different people could lead to ten different treatment choices. This personalized strategy is the key to achieving the best possible functional outcome and patient satisfaction.

Dr. Anton Titov, MD, and Dr. Gelber discuss how a surgeon's extensive experience is crucial in making these nuanced decisions. The goal is to move beyond a narrow focus on the torn structure and consider the entire clinical picture.

Key Factors in Treatment Selection

Selecting the correct treatment for a knee ligament or meniscus tear involves evaluating several critical patient-specific factors. Dr. Pablo Gelber, MD, highlights the patient's age, their desired level of knee function, and their involvement in sports or recreational activities as primary considerations.

A patient who is a competitive athlete will have different functional demands than someone who enjoys occasional running. Furthermore, the presence of concomitant injuries, which are common in knee trauma, dramatically influences the surgical plan and rehabilitation protocol.

The Importance of a Holistic Knee Evaluation

A successful outcome depends on a holistic evaluation of the knee joint and the patient. Dr. Pablo Gelber, MD, warns against focusing solely on the torn ligament or meniscus, a mistake he sometimes observes. He advises surgeons to "see the forest behind the trees."

This comprehensive assessment must include the condition of the articular cartilage, the overall alignment of the knee joint, and the health of all surrounding structures. Ignoring these concomitant issues can lead to suboptimal results and early joint degeneration.

Benefits of Minimally Invasive Knee Surgery

Whenever possible, Dr. Gelber advocates for a minimally invasive surgical approach to treat knee ligament and meniscus injuries. This philosophy aims to decrease the additional trauma caused by the surgery itself. The knee already suffers an injury from the initial trauma; the surgical procedure should not add significant further damage.

Techniques such as arthroscopy allow surgeons to operate through small incisions, minimizing injury to surrounding tissues, preserving cartilage, and protecting other vital elements of the knee joint.

Surgical Goals and Patient Recovery

The ultimate surgical goals are to provide the best possible treatment with confidence and to facilitate a faster recovery. By minimizing the aggression of the surgery, surgeons can significantly reduce post-operative pain and swelling.

Dr. Pablo Gelber, MD, explains that this leads to a quicker rehabilitation process and a more rapid return to normal activities and sports. This patient-centric approach, combining a holistic diagnosis with minimally invasive techniques, offers the highest chance for a full return to an active lifestyle after a serious knee injury.

Full Transcript

Dr. Anton Titov, MD: That's great. Let's start with this. You specialize in minimally invasive knee joint, meniscus, and knee ligament injury treatment. What are common knee ligament injuries?

Let's imagine a patient with a knee ligament or meniscus injury. He is choosing among several treatment options. What factors should this patient consider before selecting a treatment?

Dr. Pablo Gelber, MD: It's a huge universe of different approaches and treatments for each specific patient. We believe the most important thing is to tailor each treatment for each patient. So I cannot say specifically which is the best treatment for knee ligament and the best treatment for meniscus injury.

Ligament injuries of the knee and meniscus injuries are two of the most common injuries and diseases in sport. Sports injury is becoming more common. Also, not only sport-related injury but also knee injury in people happens because of aging and a more active way of living.

Let me give a background to knee injury treatment. The knees have four major ligaments: the lateral, the medial, and two cruciate ligaments, which are crossing inside the knee right here. Most knee ligaments, when they are torn, need to be surgically treated.

In those cases, we again have to specifically understand which ligament is torn or injured, but we also must understand the needs of the patients. How much function does a person require from their knees? What is the age of the patient? Are they involved in playing a sport, or do they just do running?

Do they also have concomitant injuries? This is very important! Concomitant issues that they have are important. Because when you injure your knee, it's not just about one ligament. It is not like someone with a knife cut a ligament, and everything else is perfect.

No, in most of the cases, in a majority of the cases, there are also concomitant injuries. And that's why we believe that we had to approach the knee, as you commented on before, in a holistic way. We have not only to think about one ligament or meniscus injury.

Because it is not only the meniscus, or the menisci, but also the cartilage, the knee joint alignment. We have to consider the whole patient situation. You have to see the forest behind the trees.

This is something that I sometimes see in the work of our surgical colleagues. They just focus on the specific knee injury. They don't consider so many other factors that are unique to each patient.

The same knee injury in ten different people may lead to a choice of ten different treatments. From our point of view, that is the key to a good outcome for each patient.

We, of course, try to perform the least aggressive incisions and as a minimally invasive surgical approach to knee joint injury treatment as possible. Of course, always the surgeon's goal is to be confident and to feel that you can provide the best treatment possible.

But of course, after many years of experience, we are trying to do knee trauma treatment in a minimally invasive approach. So the patient with knee ligament injury recovers faster.

Also, the knee suffers less injury because you have an injury because of the trauma itself. Also, there is an injury to the knee because of the surgery. So if we decrease and minimize the aggression of the surgery, we are minimizing the risk of injury inside the knee.

We minimize the injury to the cartilage during the surgery and preserve other elements of the knee joint.