Joint preservation

Biological treatment of knee conditions is a way to cure or reduce symptoms with regenerative and reconstructive surgery instead of joint replacement operations.

Attention is paid to the overall leg alignment, the stability of the knee, the cartilage shock absorbers within the knee and the cartilage bearing surface of the knee itself. Often several of these need to be addressed at once and occasionally all four.

The rationale behind joint preservation surgery is to avoid removal of the natural knee tissues and bone to maintain a healthy knee for longer before a partial or total knee replacement is needed. This is because all knee replacements will eventually wear out and require revision surgery which can be technically demanding. Osteoarthritis and knee derangements are becoming more and more common and are presenting to surgeons in younger, higher demand patients. Often patients are unable/unwilling to simply wait to be old enough or bad enough for a "new knee" and quite rightly look for symptom relief and quality of life improvements to maintain an active lifestyle.

HTO surgical plan

ACL reconstruction

Intra operative image of osteochondral transfer

Joint preservation surgery is done in a stepwise manner addressing mechanical malalignment with osteotomy surgery, followed by ligament reconstruction if needed then meniscal repair/replacement and finally repair of the joint surface itself. Each of these facets can be addressed individually but if cartilage repair is performed in the presence of malalignment or instability the results are likely to be poor. This kind of surgery can be demanding for both the patient and surgeon. Mr Gallacher will help his patients plan their reconstructive surgery and decide between stepwise staged surgery or complex multiple operations all in one go. The rehabilitation can be prolonged taking up to 12-18 months for a full improvement in symptoms and quality of life.