Philipp Schuster

Anterior cruciate ligament rupture is the most common ligament injury to the knee. Surgery is recommended in the majority of cases. The timing of the operation, the choice of the right procedure and the treatment of concomitant injuries are crucial for a good result.

In cases of repeated cruciate ligament ruptures, individual concomitant injuries and risk factors must be identified and treated in addition to the actual, usually more complex cruciate ligament surgery. Most revisions can be carried out in one surgical procedure – but there are also cases where two surgeries are necessary.

Posterior cruciate ligament injuries can occur either isolated or in combination with other ligament injuries. In cases of combined injuries, it is crucial to also treat the other injured structures – otherwise, there is a high risk of failure.

Knee dislocations should be treated surgically as soon as possible (within 2 weeks) – this offers the best prognosis for recovery. In cases of chronic instability involving multiple ligaments, a combined reconstruction is necessary.

In cases of unilateral osteoarthritis and malalignment of the axis (bow leg or knock knee deformity), correcting the axis can relieve the strain on the affected knee joint compartment – thus improving the symptoms and in many cases delaying a joint replacement for years or even decades. Depending on the malalignment, the correction is performed on the upper or lower leg, and in some cases on both.

In cases of recurrent cruciate ligament tears or complex patellar problems, bony deformities may be the underlying cause. In these cases, appropriate bone correction is indicated to achieve a good long-term outcome.

For lateral patellar dislocations stabilization is recommended depending on the individual risk of recurrent dislocation. In the majority of cases, this can be achieved with an isolated MPFL-reconstruction: The medial patello-femoral ligament is reinforced with a tendon (patient’s own tissue) and then acts like a safety belt.

Complicated cases of lateral patellar dislocation and/or knee pain around the patella often involve bony deformity of the thigh or lower leg or the trochlea of the patella. These can be corrected and normalized.

Knee injuries in children can vary widely, ranging from torn cruciate ligaments to congenital meniscus problems. It is crucial to take into account the unique characteristics of children: their specific anatomy, growth plates that are still open – and, of course, the specific circumstances of surgery and hospital care.

Meniscus injuries are very common and require an individualized approach: in the case of degenerative tears, partial removal is usually indicated; particularly in cases of traumatic injuries, an attempt should be made to suture or refix the meniscus – and thus preserve it.

Complete meniscus loss can lead to exercise-related, unilateral knee pain and early-onset osteoarthritis in many cases. In select cases, a meniscus transplant from a donor can be performed. Artificial menisci and other meniscus replacement procedures have not yet proven to be effective.

Cartilage damage can occur in all areas of the knee joint and can vary greatly in terms of extent, development and prognosis. The choice of the best individual procedure is crucial. Most cartilage interventions – including autologous cartilage cell implantation – can be treated using minimally invasive knee arthroscopy.

In the event of failed surgical interventions or new injuries, it is crucial to precisely analyze the causes and problems and find a tailored individual treatment concept. This requires a precise analysis of previous injuries, surgeries and current findings.

For dislocated bony cruciate ligament avulsions surgical treatment is recommended in the majority of cases, and also for special fractures of the tibial plateau. This can be carried out in a minimally invasive manner (usually as part of a knee arthroscopy) and with modern implants.