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The Knee

View profile for Kimmo Boote
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The Knee – it’s a complex bit of kit.

 

The knee, as you will know, is a hinge joint. This means that it can either be flexed (folded ‘backwards’) or extended.

It is a complex joint, as the femur (thigh bone) joins with the tibia (shin bone) but there is also some involvement with the fibula (the thinner bone that runs parallel with the tibia) the bottom of which forms the bony prominence on the ‘outside’ of the ankle, known as the lateral malleolus. The bottom of the tibia forms the bony prominence on the inner side, which is known as the medial malleolus.

Between the femur and the tibia lies the joint itself which comprises the cartilage structures inside the knee. Fluid within the knee joint helps to lubricate the motion of the femur moving over the cartilages, one on the outer aspect of the knee, the lateral cartilage, and one on the inner aspect, the medial cartilage – this latter one is commonly damaged in activities with sudden twisting actions such as is seen in football and tennis. Cartilage acts as a shock absorber, though it can become damaged should there be excessive forces placed up on it. The cartilages lie on top of the tibia, over an area known as the tibial plateau. Fractures can occur through the tibial plateau which can cause damage to cartilage and ligament function and be awkward to repair. 

The knee joint is kept together by 2 fibrous bands, known as ligaments. One starts from the lower part of the femur towards the back of the knee, going to the front of the upper part of the tibia. Another goes from the front of the femur towards the back of the tibia, ie.  the posterior of the tibia. These two ligaments are known as the anterior cruciate and posterior ligaments respectively, with the anterior one being commonly damaged in skiing accidents.

Surrounding the knee on either side are the medial and lateral collateral ligaments, which help keep the knee movements limited to flexing or extending the knee, as there should be no/very little sideways movement.

The knee cap (patella) is a bone that lies within a fibrous band and is not connected to the knee joint. The fibrous band is found at the end of the thigh muscles (the quadriceps muscle) and it’s attached to the knobbly part of the upper front part of the tibia, called the tibial tuberosity.

In young people, particularly those who exercise or take part in vigorous sports, the fibrous band may break off from the tibial tuberosity, causing some pain and discomfort at the site (known as Osgood-Schlatter’s disease), though it repairs itself over time with rest.

With age, wear and tear occurs to most joints, especially to weight bearing ones such as the hip and knees. Osteoarthritis is common in the knees as they bear much of transmitted forces involved in walking and generally getting around ! There may be cartilage damage, degenerative bone (such as bone thinning and weakening, osteoporosis) and even ligamentous laxity. Falls are more common in the elderly and can have significant effects on the joints including the knee amongst others (such as the bones in the wrist and forearm from impact with a hard surface for example).

Knee replacements can be carried out in patients and restore mobility and confidence in being able to ambulate and return to a better quality of living, with the removal of discomfort of an osteoarthritic knee and an improved level of functional activity.

Clinical Negligence

Unfortunately there are instances when knee surgery does not go quite according to plan, and here at Dutton Gregory we have assisted clients to seek redress for the resultant pain, suffering, loss of amenity and financial loss.

Examples have included:

  • A case involving partial knee replacement in which the tibial component (this is a metal component that is fixed to the top of the tibia with a type of cement) was too big, causing it to overhang. This resulted in painful symptoms for the patient, and eventually the requirement for total knee replacement. We were able to secure damages of just over £19,000 for our client.
  • A case in which a section of a stent (a small plastic drainage tube) was left in the knee following surgery – causing the claimant to suffer nagging pain for a couple of years until the cause of the pain was diagnosed, with the stent being surgically removed.  We were able to secure damages of £10,000 for our client.

If you want further information about this particular topic, or wish to discuss the possibility of bringing a claim for Clinical Negligence – perhaps as a result of substandard knee surgery - or indeed any other type of injury, please contact the Dutton Gregory Clinical Negligence Team on (01202) 315005, or email c.hayter@duttongregory.co.uk

NB This article does not constitute legal advice and should not be relied on as such. No responsibility for the accuracy and/or correctness of the information and commentary set out in the article, or for any consequences of relying on it, is assumed or accepted by any member of Dutton Gregory LLP.