Conditions and Treatments

Mr Nick Hancock offers expert opinion, advice and surgical expertise on all knee conditions. His specialist training means that he has focused on the lower limb and knee joint to offer the full range and latest evidence based treatments.

The knee is a complicated joint that relies on the supporting muscles, ligaments and cartilage for is function. The knee is affected by the alignment and biomechanics of the whole musculoskeletal system. It is important to understand the mechanism of injury and disease so the surgeon can ensure a holistic and complete treatment.

Knee Problems

  • Knee arthritis
  • Knee ligament injury
  • Knee cartilage problems
  • Knee cap (patella) instability
  • Anterior knee pain
  • Leg alignment problems
  • Joint replacement problems

Trauma and Sports Injuries

  • Fractures of the hip
  • Fractures of the tibia and femur
  • Fractures of the foot and ankle
  • Tendon ruptures
  • Sports injuries

Elective Surgery

  • Knee replacement
  • Partial knee replacements
  • Revision knee replacement
  • Ligament reconstruction
  • Keyhole surgery (knee arthroscopy)
  • Knee cap alignment surgery
  • Minimally invasive surgery
  • Osteotomy

Trauma and Fractures

  • Treatment of fractures
  • Hip fracture surgery
  • Knee (tibial plateau) fracture surgery
  • Tibial fracture surgery
  • Ankle fracture surgery
  • Foot fractures
  • Treatment of ligament and tendon injuries
  • Achilles Tendon Repair

Knee Anatomy

The knee is a weight bearing joint and is classified as a modified hinge joint.

Figure 1. The knee bones shown in motion, note the knee cap (patella) glides on the front of the thigh bone (femur)

The femur (thigh bone) joins and articulates with the tibia (shin bone). The patella (knee cap) is in the front of the knee and articulates with the groove on the front of the end of the femur known as the trochlea groove.

Tendons join muscles to bones and ligaments join bones to bones. Tendons and ligaments are strong cable like soft tissue structures composed of very strong fibres.

Figure 2. The quadriceps muscle joins onto the quadriceps tendon which in turn envelopes the one cap (patella). The knee cap is joined onto the shin bone by the patella tendon. The pull of the quadriceps mechanism straightens (extends) the knee.

The quadriceps muscle is part of the extensor mechanism of the knee. It is a strong muscle that extends or straightens the knee. The quadriceps muscle blends with the quadriceps tendon and then with the patella tendon, which incorporates the patella.

Figure 3. The quadriceps muscle, in red, has fibres which insert at an angle onto the extensor mechanism, guiding the patella into place on the front of the thighbone (femur).

When viewed from the side (or outside) of the knee the semicircular “shock absorbing” cartilages called the menisci are wedge shaped in profile, depicted in blue below in figure 4. There is a lateral (outer) meniscus and a medial (inner) meniscus. These cartilages are commonly torn during sports injuries.

Figure 4. View from the side (or lateral view) shows the extensor mechanism on the front (anterior) of the knee and flexors (bending) of the knee behind (posterior).

Meniscus cartilage is different from articular cartilage. Articular cartilage is depicted in white below and has a specialized microscopic layered structure. It is between 3 and 7 millimeters thick in the knee. This articular cartilage is thickest behind the kneecap and these surfaces will experience between 3 and 7 times body weight during normal daily activities.

The 4 main ligaments in the knee are:

  • Anterior Cruciate Ligament (ACL)
  • Posterior Cruciate Ligament (PCL)
  • Lateral Collateral Ligament (LCL)
  • Medial Collateral Ligament (MCL)

Figure 5. This is a right knee viewed from the front (anterior view). It shows the large long MCL on the inside of the knee and the smaller pencil like LCL on the outside. In the middle (notch) the two crossing ligaments are seen, The ACL in front and the PCL behind.

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