The decision is made with you after the assessment. Alternatives, expected benefits, risks, and the recovery program are explained before the procedure.
ACL reconstruction
Ligamentoplasty reconstructs the anterior cruciate ligament using a tendon graft. It aims to limit instability in an unstable knee. The indication takes into account your activities, the instability, and any associated injuries; a rupture does not always require surgery.
The procedure is usually performed arthroscopically. The graft is fixed in bone tunnels; the choice of tendon and fixation method is explained during the consultation. Rehabilitation prepares for and then supports recovery. Resumption of pivoting sports depends on functional criteria and graft maturation, not just a specific date. Stiffness or a new rupture remains possible.
PCL reconstruction
Posterior cruciate ligament reconstruction uses a tendon graft to control posterior tibial displacement. It may be considered in cases of persistent symptomatic instability or multiple ligament injuries. Some isolated lesions can be treated non-operatively.
The assessment looks for associated ligament injuries and guides the procedure. The brace, weight-bearing, and rehabilitation follow a PCL-specific protocol to protect the reconstruction. Recovery is gradual; residual pain or laxity may persist.
Partial Meniscectomy
Meniscectomy involves removing a damaged portion of the meniscus, preserving as much functional tissue as possible. It may be recommended when a symptomatic fragment cannot be repaired. Complete removal of the meniscus is not the goal.
The procedure is usually arthroscopic. A degenerative lesion visible on MRI is not sufficient to justify surgery. The outcome also depends on the condition of the cartilage. Loss of meniscal tissue increases joint stress and the risk of osteoarthritis in the long term.
Meniscal Sutures
Suturing brings together and stabilizes the edges of a tear to allow healing. Preservation of the meniscus is prioritized when the location, tissue quality, and type of injury permit.
Sutures or repair devices are inserted, most often arthroscopically. Weight-bearing and flexion restrictions depend on the repair. Return to sports is gradual. Healing is not guaranteed: further surgery may be necessary if the initial repair is unsuccessful.
Meniscoplasty
Meniscoplasty reshapes the meniscus while preserving its function. For a symptomatic discoid meniscus, it involves reducing the overly large central portion while maintaining a functional periphery: this is also known as meniscal reduction.
A suture may be used to repair a tear or stabilize the peripheral edge. Recovery guidelines depend on these associated procedures. A discoid meniscus discovered without symptoms does not systematically require meniscoplasty.
Corrective osteotomy
Osteotomy modifies the limb's axis by making a bone cut and then fixing the bone in a corrected position. It aims to redistribute stresses, for example, when varus or valgum overloads one compartment of the knee.
Treatment planning is based on X-rays of the lower limbs taken while standing. Correction may involve the tibia, the femur, or both, depending on the origin of the deformity. It can preserve the joint and postpone a prosthesis in certain cases, but this is not guaranteed. Weight-bearing is adapted to the fixation and consolidation. Delayed consolidation or discomfort from the hardware is possible.
Unicompartmental knee replacement
Unicompartmental knee replacement, or partial knee replacement, replaces the surfaces of a single compartment affected by osteoarthritis, either internal or external. The other compartments and functional ligamentous structures are preserved.
It requires precise selection: location of the osteoarthritis, condition of the ligaments, mobility, and knee deformity. The decision is made after failure of appropriate treatment and according to the disability. Osteoarthritis can progress in the preserved compartments and subsequently lead to a total knee replacement.
Total or tricompartmental knee replacement
Total knee replacement is considered when the extent and impact do not allow for a suitable partial solution. It replaces the femoral and tibial articular surfaces; treatment of the patellar surface is decided on a case-by-case basis. The term "tricompartmental" describes the comprehensive management of the knee compartments.
The goal is to reduce pain and improve function. Preparation and rehabilitation contribute to the outcome. A prosthesis does not exactly replicate all the sensations of a natural knee. Infection, thrombosis, stiffness, persistent pain, and wear or loosening of the implant are among the risks discussed.
Custom-made Symbios ORIGIN® CR total knee replacement
For total knee replacements, Dr. Alexandre Journé uses custom-made Symbios ORIGIN® CR implants when this solution is suitable based on the assessment. Using a CT scan, three-dimensional modeling allows for surgical planning and the design of implants adapted to the patient's anatomy.
The CR (cruciate-retaining) version is designed to preserve the posterior cruciate ligament, which contributes to knee stability and movement. This preservation requires a functional ligament and appropriate balancing; it is confirmed during the procedure. It does not mean that the anterior cruciate ligament is preserved. Customization alone does not guarantee a superior result for every patient.
MPFL Reconstruction
The MPFL, or medial patellofemoral ligament, prevents the patella from moving outward. Its reconstruction uses a tendon graft to restore this stabilization, particularly in cases of recurrent patellar instability.
The assessment looks for associated bone factors: isolated tibial reconstruction does not correct all alignment abnormalities. It may be combined with tibial tuberosity transposition. In children, the technique must respect the growth plates. Rehabilitation aims to restore mobility, strength, and control of the knee; stiffness, pain, or recurrence remain possible.
Elmslie-Trillat Tibial Tuberosity Transposition
The anterior tibial tuberosity is the attachment point of the patellar tendon. The Elmslie-Trillat technique displaces this insertion medially, via an osteotomy, to correct excessive lateral traction of the patella. The bone fragment is fixed, usually with screws.
The procedure is planned after assessing the extensor mechanism and alignment. MPFL reconstruction may be combined with it. Distalisation of the tibial tubercle for a high-riding patella (patella alta) is a separate additional procedure, considered according to the measurements. This bony surgery takes skeletal maturity into account. Weight-bearing and knee-flexion instructions protect bone healing; screw irritation or failure of bone union may occur.