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Meniscus and knee ligament trauma. Minimally invasive treatment options. 2
You see people with knee meniscus trauma, patella trauma, or knee ligament injury. You help patients to avoid knee replacements. What situations minimally invasive surgery methods offer an advantage over “metal solutions” in knee injury treatment? When might “metal solutions” actually be better for patients with knee trauma? Are there such situations?
Yeah, something that I considered very, very important from a doctor’s point of view is that you should not offer only one kind of specific treatment. Because, as I said before, each person requires different treatment. I’m not saying that I am not offering a “metal solution.” I perform all kinds of treatments that are being performed worldwide in the knee. But you may only, for example, perform treatment of meniscal injuries or knee ligament injuries. Then a patient comes to you and also has some concomitant knee joint injury that needs to be treated. Maybe a patient needs an osteotomy to realign the lower extremity. Or perhaps a patient has a very severe cartilage problem at the same time. You need to perform some kind of treatment for the knee cartilage, let’s say, cartilage transplantation. Or you even have to do a total knee replacement, which can also be performed concomitantly with ligament or meniscal injuries. So again, I think it is more correct to, again, as I was saying in the previous question, to tailor a specific treatment for each specific disease [condition]. It is not the same if you have a knee ligament torn when you’re 20 years old that when you are 50 years old—age difference in patients matters in the real world. For example, in a 20-year-old patient old, a surgeon could perform an autologous cartilage graft transplantation. It is a cartilage graft taken from the patient himself.
On the other hand, if you are 50 years old, perhaps you can get allogenic cartilage transplantation. That’s just, for example. This is an example of the differences that you have to take into consideration for each patient with knee trauma or ligament injury. There are thousands of different variables that you have to consider to offer this kind of treatment for a knee injury. We try, of course, have focused more on conservative treatments and biological treatments of the knee. We have to delay as much as we can a “metal solution” [knee replacement]. But that doesn’t mean that “metal solutions” do not have a role in knee trauma problems. There are also some patients with knee trauma; in some situations, patients cannot use different kinds of specific treatment methods. We cannot offer cartilage transplantation to some patients. That is a gap in the treatment algorithm of knee ligament, meniscus, and other knee joint injuries. Then perhaps you go from nothing to a “metal solution [knee replacement]. So the good thing is to have this kind of biological treatment with a fresh cartilage allograft. Osteochondral allograft transplantation fills a gap in those patients who are not old enough to go for “metal solutions” [knee replacements]. And you can offer this kind of treatment, fresh cartilage allograft. Again, I think this is just to sum up my philosophy. Each patient needs a specifically tailored and fine-tuned treatment for a knee injury.
When we say “metal solutions,” what do we mean apart from a total knee replacement? What are other kinds of common hardware-related treatments for knee injury?
We consider a total knee replacement in a young patient mainly when there is a failure of the different treatments. Because the least we want to do is to perform a total knee replacement in a young patient. By “young patient,” we are talking about age 40 – 50 – 55-year-olds. But the total knee replacement doesn’t mean that they are the only “metal solution.” There are also so-called partial knee replacements. And with partial knee replacement, we mean that not all the knee joint needs a metal resurfacing. Just to be a general idea about knee anatomy. The knee has three compartments: lateral, medial, and anterior. So if you have severe osteoarthritis in only one part of the three knee areas, you can perform a partial replacement. It could be a unicondylar knee arthroplasty. It could be lateral. Also, it can be medial or patellofemoral knee arthroplasty. Patellofemoral arthroplasty is performed for the kneecap, the patella, and the femur, which is down there. So those are the relatively less invasive treatments that can be offered in a localized knee injury.
You don’t have to be so concerned to provide this unicondylar knee arthroplasty in people who are around 50 or 55 years of age. Again, in younger patients than those ages, we still prefer not to do total or partial knee replacement. It is not only because we just don’t want it. There are two main reasons for not performing “metal solutions” in young patients. We all know that “metal solutions,” knee prostheses, need to be replaced after some years of use. That’s obvious. Some people say that 10 – 15 – 20 years is how long a knee replacement prosthesis lasts. But if we go to knee replacements in younger patients, the revision rate is much higher. Revision happens in a shorter and shorter time because that’s obvious. You use the knee joint more if you are 50 than if you are 70 years of age. If you have a car, you just drive it slowly on the street, in the city. But if you can have a nice car, a Ferrari or something like that, you go to the highway, and you speed up a lot, and you use it much more. So the risk of failure of replaced knee joint increases because of overuse. Use of knee joint is much higher in younger patients. That’s why we try to avoid knee replacements. It is not because total or partial knee replacement is not a good solution in the short term or medium term. But for younger patient, we are trying to offer not short-term solutions to their knee problems, but longer-term treatment options.
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