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Complex Knee
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Complex knee conditions encompass a diverse range of treatments, such as ACL reconstruction, meniscus repair or transplantation, osteochondral defect repair, ligamentous reconstructions (e.g., MCL, PCL), realignment procedures (e.g., osteotomy), patellar stabilization, articular cartilage restoration techniques (e.g., microfracture, autologous chondrocyte implantation), and total or partial knee replacement. These complex knee issues often require a multidisciplinary approach involving orthopedic surgeons, physical therapists, and other specialists to tailor a comprehensive treatment plan that addresses the specific anatomical and functional challenges for optimal patient outcomes.
Knee Arthroscopy:
Knee arthroscopy is a minimally invasive surgical procedure that is commonly used to diagnose and treat a variety of knee conditions. It involves the insertion of a small camera, called an arthroscope, into the knee joint through a small incision. The arthroscope allows Dr. Jildeh to visualize the inside of the knee joint on a video screen and identify any areas of damage or abnormalities.
• Anterior Cruciate Ligament Reconstruction (ACL)
• Physeal-Sparing Reconstruction of the ACL
• Revision ACL Reconstruction
• BTB, Quadricep, Hamstring, Allografts
Anterior Cruciate Ligament Reconstruction (ACL):
• Anterior cruciate ligament (ACL) reconstruction is a surgical procedure that is performed to repair a torn ACL, which is a ligament located in the knee joint. The ACL is responsible for providing stability and support to the knee during movements such as running, jumping, and twisting.
Multiligament Reconstruction of the Knee:
• Multiligament reconstruction of the knee is a complex surgical procedure that is typically performed to repair multiple ligaments in the knee that have been injured or torn. The ligaments in the knee that may require reconstruction include the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), posterolateral corner (PLC), and lateral collateral ligament (LCL).
During the procedure, Dr. Jildeh will make several small incisions around the knee and insert a camera, called an arthroscope, to visualize the joint. Dr. Jildeh will then assess the extent of the ligament damage and determine the appropriate course of action. In cases where more than one ligament is injured or torn, Dr. Jildeh may use a combination of autografts (grafts taken from the patient's own body) or allografts (grafts taken from a donor) to reconstruct the damaged ligaments. The grafts are typically secured in place using screws or other devices. After the surgery, the patient will need to wear a knee brace and use crutches for several weeks to protect the surgical site and allow for proper healing. Physical therapy exercises will also be prescribed by Dr. Jildeh to help the patient regain strength, range of motion, and flexibility in the knee.
Cartilage Restoration Procedures
• Chondroplasty: This is a minimally invasive procedure that involves smoothing or removing damaged cartilage in the knee joint. This procedure is typically used for smaller areas of cartilage damage. MACI (matrix-induced autologous chondrocyte implantation): This procedure involves taking a small sample of healthy cartilage cells from the patient's own knee, which are then grown in a laboratory and seeded onto a scaffold. The scaffold is then implanted into the damaged area of the knee joint, where it encourages new cartilage growth.
• Mosaicplasty: This procedure involves taking small plugs of healthy cartilage and bone from another part of the patient's own knee and transplanting them into the damaged area of the knee joint. This is typically used for larger areas of cartilage damage.
Osteochondral allografts: This procedure involves using donor tissue to replace damaged cartilage in the knee joint. The donor tissue is carefully matched to the patient's own tissue to minimize the risk of rejection.
• Cartilage Repair:
All these procedures involve a similar process. Dr. Jildeh will first assess the extent of the cartilage damage and determine which procedure is best suited for the patient's needs. During the surgery, Dr. Jildeh will make several small incisions around the knee and insert a camera, called an arthroscope, to visualize the joint. Dr. Jildeh will then perform the selected procedure, either by implanting the scaffold, removing or smoothing the damaged cartilage, or transplanting healthy tissue into the damaged area.
Meniscal Procedures (repair/meniscectomy)
Revision Meniscal procedures
Meniscal procedures are a common type of knee surgery that Dr. Jildeh may recommend if a patient has a torn meniscus. The meniscus is a piece of cartilage in the knee that helps cushion and stabilize the joint. A torn meniscus can cause pain, swelling, and limited range of motion.
There are two main types of meniscal procedures that Dr. Jildeh may recommend:
• Meniscal repair: In this procedure, Dr. Jildeh will try to sew the torn meniscus back together using sutures or other techniques. Meniscal repair is often preferred for younger patients with a healthy meniscus who are able to avoid weight bearing activities for several weeks after surgery. This approach may provide the best long-term outcomes by preserving as much of the meniscus as possible.
• Meniscectomy: In this procedure, Dr. Jildeh will remove the torn portion of the meniscus. Meniscectomy may be recommended for older patients or those with extensive damage to the meniscus who are not good candidates for repair. While this approach provides immediate relief, it may increase the risk of future knee problems.
Both meniscal repair and meniscectomy are typically performed using an arthroscope, a small camera that allows Dr. Jildeh to see inside the knee joint. The procedure is minimally invasive and often done on an outpatient basis, meaning the patient can go home the same day.
Meniscal transplantation
• Meniscal transplantation is a surgical procedure that may be recommended by Dr. Jildeh for patients who have had their meniscus removed in a previous surgery and are experiencing ongoing pain and instability in the knee joint.
During the procedure, Dr. Jildeh will replace the missing meniscus with a donor meniscus, which is obtained from a donor. The donor meniscus is matched to the patient based on size and shape, and may be either a partial or full meniscus transplant. Meniscal transplantation is typically performed as an outpatient procedure using arthroscopic techniques.
Extensor tendon procedures
• Extensor tendon procedures refer to surgeries that are used to repair injuries or damage to the tendons that help straighten the knee joint. Two common extensor tendon procedures are quadriceps tendon repair and patellar tendon repair.
Quadriceps tendon repair: The quadriceps tendon is a thick band of tissue that connects the quadriceps muscle to the patella (kneecap). A tear or rupture of this tendon can make it difficult to extend the knee or put weight on the leg. During a quadriceps tendon repair, Dr. Jildeh will make an incision above the kneecap and reattach the torn tendon to the patella using sutures or other techniques. The surgery is typically performed under general anesthesia and may require a short hospital stay. Rehabilitation typically includes exercises to improve range of motion and strengthen the muscles around the knee joint.
Patellar tendon repair: The patellar tendon is a band of tissue that connects the patella to the shinbone. A tear or rupture of this tendon can cause pain, swelling, and instability in the knee joint. During a patellar tendon repair, Dr. Jildeh will make an incision below the kneecap and reattach the torn tendon to the shinbone using sutures or other techniques.
Tibial eminence fracture
• A tibial eminence fracture is a type of knee injury that occurs when a small piece of bone, called the tibial eminence, breaks off from the top of the shinbone (tibia). This injury is commonly seen in children and adolescents, but can also occur in adults.
A tibial eminence fracture can be caused by a sudden force or impact to the knee joint, such as a fall or a direct blow to the knee. Symptoms of this injury include pain, swelling, and difficulty bearing weight on the affected leg.
If Dr. Jildeh suspects a tibial eminence fracture, he will perform a physical exam and may order imaging tests, such as an X-ray or MRI, to confirm the diagnosis. Treatment for a tibial eminence fracture typically depends on the severity of the injury.
For some minor fractures, non-surgical treatment such as immobilization with a brace or cast and physical therapy may be sufficient to allow the bone to heal. However, for more severe fractures, Dr. Jildeh may recommend surgery.
Deformity and Osteotomies around the knee
• Distal femoral osteotomies
• High tibial osteotomies
Osteotomies around the knee are surgical procedures that involve cutting and repositioning the bones in the knee joint to improve alignment and reduce pain. Two common types of osteotomies around the knee are distal femoral osteotomy (DFO) and high tibial osteotomy (HTO).
A distal femoral osteotomy involves cutting the lower end of the thigh bone (femur) and repositioning it to change the angle at which it meets the shin bone (tibia). This can be done to shift weight bearing to the unaffected part of the knee joint, relieve pressure on damaged or arthritic cartilage, and reduce pain. DFO is typically used to treat knee conditions such as patellofemoral arthritis, lateral compartment arthritis, and chronic ligament injuries.
A high tibial osteotomy involves cutting and repositioning the upper end of the shin bone (tibia) to improve alignment and reduce pressure on damaged or arthritic cartilage. This procedure is typically used to treat knee conditions such as medial compartment arthritis, where the cartilage on the inner side of the knee joint is damaged. HTO can help shift weight bearing to the unaffected part of the knee joint, relieve pain, and delay or avoid the need for a knee replacement surgery.
Both DFO and HTO are complex surgical procedures that require careful planning and precision. Dr. Jildeh will perform a thorough evaluation of the patient's knee joint, including imaging studies such as X-rays and MRI, to determine the appropriate type of osteotomy and the optimal surgical technique. Dr. Jildeh approaches these surgeries with patient-specific custom-tailored guides.
Patellofemoral procedures
• Patellofemoral procedures are surgical treatments that aim to address problems with the alignment and stability of the kneecap (patella) and the thigh bone (femur) where they meet. Two common types of patellofemoral procedures are medial patellofemoral ligament (MPFL) reconstruction and tibial tubercle osteotomy.
Medial patellofemoral ligament (MPFL) reconstruction involves reconstructing the ligament that helps keep the patella properly aligned with the femur. This may be necessary if the ligament is damaged or torn, which can lead to recurrent dislocation of the patella. During the surgery, Dr. Jildeh will use a graft, often taken from the patient's own hamstring or quadriceps tendon, to reconstruct the MPFL. The graft is attached to the femur and the patella to provide stability and help keep the patella in its proper position.
Tibial tubercle osteotomy is a procedure that involves cutting and repositioning the bone at the top of the shin bone (tibia) where the patellar tendon attaches. This can be done to correct the alignment of the patella and improve stability. Tibial tubercle osteotomy is often used to treat patellar instability or patellofemoral pain syndrome. During the surgery, Dr. Jildeh will carefully cut and move the tibial tubercle to a new position, where it will be secured with metal plates, screws, or other devices. This helps realign the patella and reduce pressure on the cartilage, improving stability and reducing pain.
Both MPFL reconstruction and tibial tubercle osteotomy are complex surgical procedures that require careful planning and precision. Dr. Jildeh will perform a thorough evaluation of the patient's knee joint, including imaging studies such as X-rays and MRI, to determine the appropriate type of procedure and the optimal surgical technique.
Arthroplasty
• Patellofemoral Arthroplasty
• Robotic unicondylar knee arthroplasty
Knee arthroplasty is a surgical procedure that involves replacing all or part of the knee joint with an artificial joint. This is typically done to relieve severe pain and restore function in patients with advanced arthritis or other degenerative conditions that have not responded to non-surgical treatments.
There are several types of knee arthroplasty, including total knee arthroplasty (TKA), partial unicompartmental knee arthroplasty (UKA), and patellofemoral arthroplasty (PFA). TKA involves replacing all three compartments of the knee joint with an artificial joint, while UKA involves replacing only one or two compartments. PFA involves replacing the surface of the patella and the groove in the femur where it articulates.
In recent years, robotic-assisted surgery has become increasingly popular for knee arthroplasty, particularly for unicompartmental knee arthroplasty (UKA). During robotic UKA, Dr. Jildeh uses a computer-guided system to precisely plan and execute the surgery, ensuring accurate placement of the implant and optimal alignment of the joint.
Posterior Cruciate Ligament Reconstruction
• The posterior cruciate ligament (PCL) is a strong band of tissue that connects the thighbone (femur) to the shinbone (tibia) at the back of the knee joint. The PCL works together with the anterior cruciate ligament (ACL) to provide stability and control movement of the knee joint.
A PCL injury can occur when there is a direct blow to the front of the knee, or when the knee is hyperextended or twisted. A PCL injury may cause pain, swelling, stiffness, and difficulty walking or bearing weight on the affected leg.
Posterior cruciate ligament (PCL) reconstruction is a surgical procedure that is performed to repair or replace a torn or ruptured PCL. The procedure is typically recommended for patients who experience persistent knee instability, pain, and functional limitations despite conservative treatments such as physical therapy and bracing.
During PCL reconstruction, Dr. Jildeh makes several small incisions around the knee joint and inserts an arthroscope, a small camera that allows him to visualize the inside of the knee. He then removes the damaged ligament and replaces it with a graft, which may be taken from the patient's own body (autograft) or from a donor (allograft).
LCL/Posterolateral Corner Reconstruction
• The lateral collateral ligament (LCL) and posterolateral corner (PLC) are important structures that provide stability to the outside (lateral) part of the knee joint. The LCL is a strong band of tissue that runs along the outside of the knee, connecting the thighbone (femur) to the fibula bone in the lower leg. The PLC is a complex network of ligaments and other soft tissue structures that work together to control movement and stability of the knee joint.
Injuries to the LCL and PLC can occur as a result of a direct blow to the inside (medial) part of the knee, or from twisting or hyperextension of the knee joint. Symptoms of an LCL or PLC injury may include pain, swelling, bruising, and instability of the knee joint.
LCL and PLC reconstruction is a surgical procedure that is performed to repair or replace a torn or ruptured LCL or PLC. The procedure is typically recommended for patients who experience persistent knee instability, pain, and functional limitations despite conservative treatments such as physical therapy and bracing.
MCL Repair/Reconstruction
• The medial collateral ligament (MCL) is a ligament on the inside of the knee joint that helps to stabilize the knee. Injuries to the MCL can occur from a direct blow to the outside of the knee or from twisting forces applied to the knee.
If the MCL is torn, it may be possible to repair it by stitching the torn ends together. However, in some cases, the MCL may be too damaged to be repaired and instead, a reconstruction may be necessary.
During an MCL reconstruction, Dr. Jildeh will replace the torn ligament with a graft from another part of your body or from a donor. This graft is secured to the bones of the knee with screws or other fixation devices. Over time, the graft will heal and integrate into the knee, providing stability to the joint.
