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OPPORTUNITIES The potential impact of tissue engineering and regenerative therapies is so far-reaching that practising surgeons should be aware of the resulting opportunities to improve patient management. Several conditions that could benefit from this appro...

REFERENCES 1 Friedenstein AJ, Piatetzky-Shapiro II, Petrakova KV . Osteogenesis in transplants of bone marrow cells. J Embryol Exp Morphol 1966; 381–90. 2 Caplan AI. Mesenchymal stem cells. J Orthop Res 1991; 9 (5): 641–50. 3 Horwitz EM, Le Blanc K, Dominici ...

SAFETY CONCERNS β 3 was The major safety concerns of cell-based therapy and tissue β 3 engineering are listed in Table 4.3 . One of the most serious concerns is that of tumour formation and malignant transfor - mation. The risk of tumour formation varies a...

Somatic cells Fully di ff erentiated specialised cells (somatic cells) obtained from normal tissues have been used for tissue engineering and regenerative therapy with some degree of success. For example, skin has been engineered using cultured epithelial cel...

Stem cells Stem cells are undi ff erentiated or non-specialised cells that are able, through cell division, to renew themselves indefinitely (self-renewal). Crucially , they are also able, when provided with appropriate stimuli, to di ff erentiate into one or mor...

APPLIED ANATOMY The knee joint is a synovial hinge joint. It consists of two condyloid tibiofemoral joints and a sellar (or saddle shaped) patellofemoral joint. The shape makes the joint inherently unstable, but stability is achieved by a combination of stat...

BIOMECHANICS Axes of the lower limb The anatomical axes of the femur and tibia are defined by their medullary canal. The mechanical axis of the lower limb runs from the centre of the femoral head, through the inter condylar notch of the knee to the centre o...

CONDITIONS AFFECTING THE KNEE JOINT The commonest conditions a ff ecting the knee include injury to the soft-tissue structures and osteoarthritis (OA). CONDITIONS AFFECTING THE KNEE JOINT The commonest conditions a ff ecting the knee include injury to the so...

Cruciate reconstruction An isolated ACL injury is most commonly treated with an arthroscopic intra-articular reconstruction. The graft can be a bone–patellar tendon–bone or four-strand hamstring auto - graft. Screws or fixation devices hold the graft in bone tu...

FURTHER READING Bulstrode C, Wilson MacDonald J, Eastwood D et al . Oxford textbook of trauma and orthopaedics , 2nd edn. Oxford: Oxford University Press, 2017. Howells NR, Brunton LR, Robinson J et al . Acute knee dislocation: an evidence based approach to th...

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Kinematics and kinetics Knee motion is predominantly in the sagittal plane. A limited - degree of rotation also occurs and increases as knee flexion increases. The normal range of motion is between 5° of hyper - extension and 135° of flexion. Magnetic resona...

Knee arthrodesis Knee arthrodesis is rare and is largely a historic procedure that is seldom acceptable to modern patients. It is therefore used as a salvage option after failure of multiply-revised and infected joint replacements, particularly if there is d...

Knee joint replacement There are three compartments within the knee: medial and lateral tibiofemoral, and patellofemoral. In 20–50% of cases, OA a ff ects only one compartment and these patients may be suitable for a partial or unicompartmental knee replacemen...

Learning objectives To understand: The anatomy and biomechanics of the knee and their • clinical implications The clinical presentation, aetiology and management of • common knee pathologies Learning objectives To understand: The anatomy and biomechanics of th...

Meniscal surgery This is performed arthroscopically , commonly using two portals, usually as a day case under general anaesthetic. The meniscus is inspected to define the configuration of the tear and whether it is in a part of the meniscus with su ffi cient blo...

Osteoarthritis OA commonly a ff ects the knee joint. The prevalence of symptomatic knee OA in adults aged 60 years or older is approximately 10% in men and 13% in women. OA can be either primary (idiopathic) or secondary . Patients with primary OA tend to have ...

Osteotomy Varus or valgus alignment or deformity of the knee can abnormally load the medial or lateral compartment, resulting in premature degenerative change in that compartment. Osteotomy aims to divide the bone, correct the deformity and alter the load-bea...