Dr. Cabot is an orthopedic surgeon specialized in knee pathology. He has been president of the Spanish Knee and Arthroscopy Societies. He is director of the Knee Unit of COTA, develops his professional activity in the Hospital Quirón and in the medical center La Salud 78. In the last 20 years he has organized numerous courses on knee pathology.
Dr. Cabot, when should I have knee surgery?
The answer is very easy: when it is indicated, an accurate and complete diagnosis has been determined and surgery is the best remedy. Give an example, doctor. There are many: a meniscus tear will require an arthroscopy, an anterior cruciate ligament injury a ligamentoplasty, an advanced knee osteoarthritis will require a prosthesis and a patellar chondropathy should almost never be operated. But there are nuances in all of them.
Is the diagnosis easy?
Sometimes it is not. Fortunately, each person is different from the others and each case is unique. And although MRI is an excellent method, there are aspects that can only be detected by your physician’s clinical evaluation and examination. For example, a meniscal injury with osteoarthritis may have a poor outcome with arthroscopy and a prosthesis may be an excessive solution. When meniscal, arthrosis and ligament injuries are combined, the diagnosis becomes more complicated.
Are there special cases?
A 20-year-old professional athlete is different from a 60-year-old adult who plays paddle tennis, or a woman, who sometimes has to be treated differently?
Is a woman’s knee different?
Yes, even different prostheses are designed with the female anatomy in mind. There are also special physical preparations to prevent injuries to the female athlete.
So accurate diagnosis is key?
Yes. It must be customized for each person, taking into account his or her activity, profession, sex, etc. Often it is not enough to say “I have the same thing as you or I have had the same operation”.
Regarding this knee surgery, is there anything new, doctor?
The new is imposed when the traditional is surpassed, but this is difficult. There are surgical treatments such as osteotomies, recentrations of the patella and ligamentous-plasty combinations that have not been superseded and that have even been revalued in recent years. Not everything is arthroscopy and prostheses.
But something will have improved.
The quality and design of materials, such as plates, screws and prostheses, are much better, more compatible, more resistant and last longer. Surgical techniques have become more sophisticated and less invasive. Tissue banking is more widely used so as not to sacrifice patient structures and regenerative techniques are associated. Admission to the clinic is shorter and recovery is faster.
And if I do not want to have surgery, what can I do?
There are non-surgical treatments that offer good results and that can solve some pathologies or defer surgery, such as the so-called regenerative treatments, which range from the application of growth factors to the application of mesenchymal cells or stem cells.
Doctor, thank you very much. Excuse me, but I hope I do not have to have surgery.
The ideal is to be able to improve or cure it without surgery, I would only operate if this would be the best solution for your problem.