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Conditions & Treatments

Knee Conditions

Ligament Injuries (Knee Instability)

Ligaments are strong bands of tissue that help keep your knee stable. If one of these ligaments tears, your knee may feel unstable, buckle, or give way, especially when walking or playing sports. Over time, this instability may also damage other tissue in your knee such as your cartilage or meniscus. The anterior cruciate ligament (ACL) is commonly injured, often due to a sudden twisting motion or landing awkwardly, while the posterior cruciate ligament (PCL) is usually torn from a direct impact, such as a fall or car accident. Injuries to the medial collateral ligament (MCL) and lateral collateral ligament (LCL) occur when there is force applied to the inner or outer knee. More severe cases involve multiple ligament tears, often due to high-impact trauma, or in patients with high BMI taking a wrong step. While minor injuries may heal with rest and rehabilitation, complete ligament tears often require surgery to restore stability and function.

X-Ray of a dislocated knee.

Meniscus Tears

The meniscus is a piece of cartilage in the knee that acts as a shock absorber, protecting the bones from wear and tear. A meniscus tear can happen suddenly from twisting or bending the knee, or it can develop gradually over time due to degeneration. Symptoms of a meniscus tear include knee pain, swelling, a clicking or locking sensation, and difficulty bending or straightening the knee. Some small tears may heal on their own with rest and physical therapy, but larger or more complex tears may require surgery to either remove or repair the damaged tissue to restore normal knee function.

Arthroscopic image of a large bucket handle meniscus tear which is probed with an arthroscopic instrument.

Cartilage Damage (Chondral or Osteochondral Injuries)

Cartilage is the smooth, protective surface covering the bones in your knee, allowing for pain-free movement. Damage to this cartilage can cause pain, swelling, stiffness, and mechanical symptoms such as locking or catching in the joint. Focal chondral defects are small areas of damaged cartilage, often caused by injury, while osteochondritis dissecans (OCD) is a condition where a piece of bone and cartilage separates from the joint, sometimes leading to loose fragments that can interfere with movement. Because cartilage does not heal well on its own, treatment may involve surgical techniques such as microfracture, cartilage grafting, or cell-based therapies to repair or replace the damaged area.

MRI scan and arthroscopic image of a patient with a large 22mm cartilage damage of the femoral condyle.

Patellofemoral Disorders (Kneecap Problems)

The kneecap (patella) moves in a groove in the thigh bone, allowing the knee to bend and straighten smoothly. However, if the patella does not track properly, it can lead to pain and instability. Patellar instability occurs when the kneecap shifts out of place, sometimes completely dislocating, often due to weak ligaments or a shallow trochlear groove. Another common condition, chondromalacia patellae, involves softening or damage to the cartilage under the kneecap, leading to pain when climbing stairs, squatting, or sitting for long periods. Some individuals have an abnormally positioned kneecap, such as patella alta (where the kneecap sits too high) or patella baja (where it sits too low), which can contribute to pain and dysfunction. Many cases can be managed with rehabilitation, but surgery may be needed for recurrent dislocations or severe pain.

MRI scan of a patient with lateralized patella and flat trochlea groove.

Knee Arthritis and Degeneration

Arthritis is a condition that causes the knee joint to wear down over time, leading to pain, swelling, stiffness, and difficulty with movement. The most common type, osteoarthritis (OA), results from gradual wear and tear on the joint, while post-traumatic arthritis develops after an injury such as a fracture or ligament tear. Some people suffer from inflammatory arthritis, such as rheumatoid arthritis, in which the immune system mistakenly attacks the joint lining, causing progressive damage. In the early stages, arthritis can be managed with medication, physical therapy, lifestyle changes, and injections. However, as the condition worsens and pain becomes disabling, surgical options such as knee replacement may be necessary to restore mobility and quality of life.

X-Rays showing medial bone-on-bone contact in a patient with osteoarthritis.

Knee Fractures and Trauma

A broken bone in or around the knee can cause severe pain, swelling, and difficulty moving the leg. Distal femur fractures occur when the lower part of the thigh bone breaks, while proximal tibia fractures (also known as Schatzker fractures) affect the upper part of the shin bone. The kneecap itself can also fracture, which may require surgery if the bone fragments are displaced. Severe fractures often need surgical intervention with metal plates, screws, or rods to realign and stabilize the bones while they heal. Without proper treatment, fractures can lead to long-term pain, stiffness, and an increased risk of arthritis.

CT scan and X-Ray of a patient with a tibial plateau fracture who was treated with open reduction internal fixation (ORIF).

Surgical Treatments

Surgical Techniques

Surgical intervention may be necessary when knee pain, instability, or limited function do not improve with conservative treatments. Procedures are designed to repair damaged structures, restore stability, and improve mobility.

Cartilage Restoration Procedures

Cartilage damage in the knee can cause pain, swelling, and stiffness. Since cartilage doesn’t heal well on its own, procedures like microfracture, cartilage grafting, or cell-based therapies (ACI) can help regenerate new cartilage and protect the joint. These treatments are usually recommended for younger patients with localized cartilage damage.

Osteochondral (bone and cartilage) autograft transplant for a large defect.

Ligament Reconstruction and Repair

If you have torn one of the major stabilizing ligaments in your knee (like the ACL or PCL), you may experience instability, making it difficult to walk or play sports. Ligaments can be repaired if they are damaged or they can be reconstructed with a tendon graft (usually from your own body or in some cases from a donor) to restore stability and function. Recovery usually includes physiotherapy to regain strength and movement.

Different graft options

Meniscus Surgery

The meniscus is a shock-absorbing cartilage in your knee. If it's torn, you might feel pain, swelling, and difficulty moving your knee. Depending on the type of tear, the damaged part may either be trimmed (partial meniscectomy) or repaired. If the entire meniscus is damaged, a meniscus transplant may be considered in young, healthy patients with stable knees and good leg alignment.

Meniscus sutures are placed via key-hole surgery with a specific instrument.

Patellofemoral Surgery

If you have frequent kneecap dislocations, pain, or alignment problems, surgery can help stabilize the kneecap. This may involve reconstructing a ligament (MPFL reconstruction), realigning the kneecap (TTO), addressing rotational malalignment in the limb with an osteotomy, or reshaping the knee joint (trochleoplasty). These surgeries improve knee function and reduce the risk of further dislocations.

Image of Medial Patellofemoral Ligament reconstruction for recurrent patella instability (image from Arthrex).

Arthroplasty (Joint Replacement Surgery)

If you have severe arthritis or joint damage that affects daily activities, a knee replacement may be the best option. In total knee replacement (TKA), the damaged joint surfaces are replaced with metal and plastic implants. In unicompartmental knee replacement (UKA), only the damaged part of the knee is replaced. These surgeries reduce pain and restore mobility. They are usually only indicated when there is bone-on-bone contact without cartilage left in the respective compartment.

Partial medial knee replacement for arthritis of the medial knee joint.

Fracture Fixation Surgery

A serious knee fracture can cause long-term pain and difficulty moving. Surgery may involve using metal plates, screws, or rods to hold the broken bones in place while they heal (ORIF). In some cases, external fixation is needed if the injury is severe or with extensive soft tissue or skin damage. The goal is to avoid fracture related infections, and restore the alignment of the knee with normal knee function as quickly as possible.

Open reduction internal fixation of a tibial plateau fracture. Preoperative CT scan and postoperative X-Rays.

Surgery for Stiff Knee and Other Conditions

If your knee has become too stiff due to scarring inside the joint (arthrofibrosis), a procedure called arthroscopic adhesiolysis can help remove the scar tissue and improve movement. If you have a condition like pigmented villonodular synovitis (PVNS), removing the inflamed tissue (synovectomy) can prevent joint damage. If you have a knee infection, it can cause pain, swelling, and joint damage. Surgery is usually necessary to determine the pathogen causing the infection and the suseptability to antibiotics will be tested. The joint will need to be clean out (debridement and washout) until the infection is under control.

Arthroscopic shaver debriding a ‘cyclopes lesion’ which resulted in knee stiffness.

Osteotomy and Realignment Procedures

If your knee is misaligned (such as being bow-legged or knock-kneed), it can put too much pressure on one side of the joint, leading to arthritis. A high tibial osteotomy (HTO) or distal femoral osteotomy (DFO) involves cutting and repositioning the bone to shift weight away from the damaged area, delaying the need for a knee replacement. There are also realignment procedures for the patellofemoral joint.

An X-Ray of a patient who underwent a simultaneous high tibial osteotomy (opening wedge) to correct mal-alignment and a ligament surgery for his ACL and LCL injuries.

Non Surgical Treatments

Conditions to consider non-surgical management:

Non-surgical options focus on reducing pain, improving mobility, and preventing further damage. These treatments are often the first line of management before considering surgery.

Early-Stage Arthritis and Degenerative Joint Disease

In the early stages of osteoarthritis or other degenerative knee conditions, non-surgical treatments focus on reducing pain, maintaining joint function, and slowing disease progression. Lifestyle modifications such as weight loss and low-impact exercise can help reduce stress on the knee. Physiotherapy plays a crucial role in strengthening the muscles around the joint to improve stability and mobility. Pain management includes the use of anti-inflammatory medications, such as NSAIDs, and intra-articular injections like corticosteroids or hyaluronic acid to provide temporary relief. Emerging treatments, such as platelet-rich plasma (PRP) and stem cell therapy, may offer additional benefits by promoting cartilage health and reducing inflammation.

Patellofemoral Pain Syndrome (Runner’s Knee) and Overuse Injuries

Patellofemoral pain syndrome, often caused by muscle imbalances, poor knee alignment, or repetitive stress, is managed through activity modification and targeted physiotherapy. Strengthening exercises for the quadriceps and hip muscles help to stabilize the kneecap, while stretching routines address tight structures such as the iliotibial band and hamstrings. Taping techniques and knee braces can provide additional support and improve patellar tracking. Ice therapy and NSAIDs help control pain and inflammation, while footwear modifications and orthotics may be recommended to correct biomechanical issues contributing to knee stress.

Tendonitis and Tendinopathies (Jumper’s Knee, IT Band Syndrome, Pes Anserine Bursitis)

Inflammation or degeneration of the knee's tendons, such as in patellar tendonitis (jumper’s knee) or iliotibial band syndrome, requires a combination of rest and structured rehabilitation. Eccentric strengthening exercises help to improve tendon resilience, while stretching programs reduce tension in the affected structures. Physical therapy modalities such as ultrasound, shockwave therapy, and deep tissue massage can facilitate healing. Anti-inflammatory medications, activity modification, and, in persistent cases, PRP injections may also be used to stimulate tissue repair.

Meniscus Degeneration and Small Meniscus Tears

Degenerative meniscus tears, mainly in middle-aged and older adults, can often be managed without surgery. Physiotherapy focuses on quadriceps and hamstring strengthening to provide better support to the knee joint. Pain relief may be achieved through NSAIDs, lifestyle modifications, and activity adjustments to avoid excessive knee loading. In some cases, corticosteroid or PRP injections can help reduce inflammation and improve symptoms. Patients without gross mechanical symptoms, such as locking or catching, may recover well with a structured rehabilitation program.

Ligament Sprains and Partial Tears

Mild to moderate ligament injuries of the ACL, MCL, or LCL, can heal without surgery. Management involves the RICE protocol (rest, ice, compression, and elevation) in the early stages to control swelling and pain. Physiotherapy is crucial for restoring strength, stability, and balance, with a focus on progressive strengthening and neuromuscular training. Hinged knee braces may be used to provide additional support during recovery. Athletes and active individuals may undergo sport-specific rehabilitation before returning to play. Reassessment of subjective instability and objective side-to-side difference in laxity is important before returning sport to see if surgery is necessary.

Mild to moderate Knee Effusions in older adults

Swelling within the knee joint, whether due to inflammation, injury, or an underlying inflmmatory condition such as rheumatoid arthritis, is best treated by addressing the underlying cause. If due to overuse or minor trauma, rest, ice, and NSAIDs can help reduce swelling. When associated with inflammatory arthritis, disease-modifying medications such as methotrexate may be required. In cases of significant effusion, fluid aspiration (arthrocentesis) can relieve pressure and confirm the diagnosis. Physiotherapy and movement-based therapies are often recommended to prevent stiffness and maintain joint mobility.

Chronic Pain Syndromes

Chronic knee pain that persists despite structural healing is managed through a combination of physical therapy, pain modulation strategies, and lifestyle adjustments. Low-impact exercises such as swimming and cycling can maintain joint mobility without excessive stress. Medications like NSAIDs, certain antidepressants, but also treatment targeting neuropathic pain may be required. It is best to involve a pain specialist here. Cognitive behavioural therapy and pain education can help patients manage long-term discomfort.

Conditions & Treatments

Knee Conditions

Ligament Injuries (Knee Instability)

Meniscus Tears

Cartilage Damage (Chondral or Osteochondral Injuries)

Patellofemoral Disorders (Kneecap Problems)

Knee Arthritis and Degeneration

Knee Fractures and Trauma

Surgical Techniques

Cartilage Restoration Procedures

Ligament Reconstruction and Repair

Meniscus Surgery

Patellofemoral Surgery

Arthroplasty (Joint Replacement Surgery)

Fracture Fixation Surgery

Surgery for Stiff Knee and Other Conditions

Osteotomy and Realignment Procedures

Conditions to consider non-surgical management:

Early-Stage Arthritis and Degenerative Joint Disease

Patellofemoral Pain Syndrome (Runner’s Knee) and Overuse Injuries

Tendonitis and Tendinopathies (Jumper’s Knee, IT Band Syndrome, Pes Anserine Bursitis)

Meniscus Degeneration and Small Meniscus Tears

Ligament Sprains and Partial Tears

Mild to moderate Knee Effusions in older adults

Chronic Pain Syndromes

Restoring your ability to move freely and embrace every moment.

Book a Consultation to Improve your Knee Function

Address

Contact

Phone +27 21 422 5636
Mobile +27 87 164 2442

Drheldreception@ctorth.com

Opening Hours

Mon - Fri

Saturday

Sunday

Conditions & Treatments

Knee Conditions

Ligament Injuries (Knee Instability)

Surgical Techniques

Cartilage Restoration Procedures

Conditions to consider non-surgical management:

Early-Stage Arthritis and Degenerative Joint Disease

Restoring your ability to move freely and embrace every moment.

Book a Consultation to Improve your Knee Function

Address

Contact

Phone +27 21 422 5636 Mobile +27 87 164 2442

Drheldreception@ctorth.com

Opening Hours

Mon - Fri

Saturday

​Sunday

Phone +27 21 422 5636
Mobile +27 87 164 2442

Sunday