Knee OA in Young Active Patients – Surgical Perspectives
This session included presentations on: The relationship of OA to knee injury; Early OA – radiological predictors; Neuromuscular optimisation to unload the lower limb; Arthroscopy – is there a role?; Meniscal transplant; Osteotomy; Implantable unloaders: current state of the art and future direction; and The role of partial replacements.
Joint injury is the biggest single risk factor for osteoarthritis (OA): 11% of OA is estimated to be post-traumatic. Post-traumatic OA is an active cellular process which requires protease activity and studies have identified a clinically meaningful biomarker response in the synovial fluid. Further study is needed to show if a prognostic model can be developed. Unlike traditional radiography, modern imaging techniques are now able to identify early OA, which is important in guiding research and emerging interventions. In the treatment hierarchy, the first stage is neuromuscular optimisation to unload the lower limb, strengthen muscles and re-establish movement quality through deliberate practice. Arthroscopy and osteotomy can be useful, but careful patient selection is critical for good outcomes. Meniscal allograft transplantation can improve symptoms, but better evidence is needed to see if it can prevent early OA. Implantable unloading devices now have an increasing life expectancy and can be useful for addressing joint overload in younger, more active patients. Partial knee replacement is a very versatile and useful technique with many advantages.