Circle Nottingham’s knee surgery department provides the very best clinical care for our patients by combining the expertise and experience of leading orthopaedic consultants with the availability of the latest diagnostic technology.
Our orthopaedic knee consultants are able to request a range of diagnostic techniques to complement their expert clinical assessment to help ensure the best options are taken at every stage of your treatment and recovery process. Our diagnostic imaging department is supported by our radiology consultants who provide additional expertise where more specialist diagnostics are needed or when more detailed radiology reporting is required.
Our holistic approach to knee surgery means that our patients are fully supported pre- and post-operatively by our dedicated orthopaedic team, including physiotherapy, occupational therapy and an orthopaedic nurse specialist. The close working relationship between our orthopaedic department, as well as the detailed protocols our department has developed for knee operations, ensures a rapid return to the activities of daily living.
The knee is a complex joint, allowing significant amounts of movement in a straight line (termed flexion and extension) to enable walking, stair climbing and squatting, amongst other tasks.
While allowing this free movement, the knee also needs to maintain stability which is provided by reinforcement from strong ligaments and by the powerful quadriceps muscles. The quadriceps muscles rely on the knee cap (patella) to provide a mechanical advantage over the joint to produce powerful contractions.
With a combination of huge forces being applied to the knee joint, it often suffers from degenerative changes known as osteoarthritis or from syndromes which give rise to pain in the patellofemoral joint of the tendon of the quadriceps muscles.
Degenerative joint changes can often be helped significantly by knee replacement operations (total knee arthroplasty), or in some cases by replacing one part of the knee (unicondylar knee arthroplasty).
In early cases of knee osteoarthritis, this process may be associated with tears to a fibrous cartilage known as the menisci. In cases where the menisci have torn due to degeneration or from a twisting injury, orthopaedic surgeons may address this with a keyhole repair or removal of the damaged meniscus. Menisci can also occasionally be replaced using innovative surgical techniques.
Due to their significance in providing stability in the knee, surgery to repair torn or ruptured ligaments forms a large part of a knee surgery unit’s work.
Some low-grade ligament injuries can be managed with knee bracing and careful monitoring by expert orthopaedic surgeons.
Higher grade ligament injuries tend to require surgical ligament repair which involves grafting new tissue, often from a tendon, and constructing the ligament with this graft.
Our orthopaedic knee consultants will initially spend time to get a full understanding of your individual symptoms. Factors such as the timeline of your condition, any contributing traumas or any repetitive occupational or sports-related positions or movement that causes the pain will be taken in to account.
Some knee conditions may have associated symptoms such as swelling, giving way or instability, locking or an inability to weight-bear through the leg. These symptoms are often helpful in formulating possible diagnoses.
A thorough physical examination will be conducted of the lower limbs. As well as a detailed examination of the hips, knees and ankles/ feet, your consultant will also carry out an assessment of some of the soft tissue structures and muscles. Specialist assessment techniques may include:
- Assessing posture of the pelvis and lower limb
- Range of motion tests, which may give an indication of degenerative changes or knee cartilage problems
- Assessing hip range of motion, to ensure there is no underlying hip condition (which can cause referred pain to the knee)
- Palpation (feeling the tissues under the skin to assess for pain)
- Resistance tests to check the integrity of the muscles around the knee (quadriceps and hamstrings)
State-of-the-art diagnostics available for you
To reach the most accurate diagnosis prior to offering treatment your knee consultant may request several types of imaging, including:
- X-rays of the knee joint: these can be very useful when assessing the degree of any degenerative changes to the knees. X-rays taken at specialist angles may also be useful in determining whether there are any signs of abnormal alignment to the knees, or any evidence of a loose body within the joint that may cause symptoms such as pain, instability or locking.
- MRI scan: may be considered for inspecting the soft tissue of the knee, including when a meniscal tear, ligament tear or rupture is suspected. MRI scans may also be requested when there is a need to investigate the bony cartilage (joint surfaces) in more detail than a plain X-ray may provide.
- Ultrasound: in instances of pain around the lower knee cap (patella), or where a muscle tear is suspected, an ultrasound scan can be useful to image the relevant structures.
The right treatment for you, always
You will always be given the space and time to talk about how your symptoms have affected you. Your individual goals, whether sporting or non-sporting will also be thoroughly discussed to determine the best possible management plan for you.
As well as offering the best possible surgical outcomes, when required our orthopaedic knee surgeons are able to administer or refer on for image-guided knee injections or rehabilitation with our specialist physiotherapists.
Research indicates that when the right treatment is delivered by experienced orthopaedic surgeons, with support from other services including radiology and physiotherapy in a specialist environment, outcomes for patients improve.
Our knee service includes:
- Expert assessment from an experienced consultant
- Diagnostic imaging, with no waits
- Latest imaging techniques
- Leading surgical techniques available
- Leading musculoskeletal physiotherapists and advanced rehabilitation equipment
- Communicative working environment to ensure all of our specialists work towards your goals
Following your knee surgery, we offer immediate treatment solutions through our ward-based physiotherapists.
These include demonstration of exercise technique as well as tutorials on how to use walking aids safely.
Once discharged, patients can still benefit from our outpatient musculoskeletal physiotherapy service, which offers regular and convenient appointments, scheduled for our patient’s convenience.
Strengthening is an important part of the rehabilitation process following any orthopaedic knee surgery.
Following surgical ligament repair procedures, there may be a period of time when the grafted ligament loses strength as it has lost its normal blood supply and has yet to develop a new network of capillaries. Due to this fact, it is essential that the operated knee is not exposed to rehabilitative regimes which place the ligament under too much stress.
At Circle, our expert post-operative knee protocols have been developed by leading orthopaedic surgeons and are designed for optimal recovery while providing a safe rehabilitation regime.
Our surgeons carefully monitor our patients’ progress and have a very close working relationship with our musculoskeletal physiotherapy department, who supervise our patients’ rehabilitation throughout.