What is Knee Preservation Surgery?

Knee preservation surgery refers to a group of surgical procedures designed to preserve the natural knee joint and delay or prevent the need for total knee replacement, particularly in younger, active patients with early arthritis, deformity, or focal cartilage damage.

When is Knee Preservation Surgery Recommended?

Knee preservation surgery is typically recommended when:

• There is early or moderate arthritis with some healthy cartilage remaining.
• The patient is young or active and wants to delay total knee replacement.
• There is localized cartilage damage or meniscus injury rather than widespread arthritis.
• The knee shows malalignment (bowleg or knock-knee deformity), causing uneven joint wear.
• The ligaments are stable, and joint motion is well-preserved.
• Pain and function are not adequately managed with non-surgical treatments like physiotherapy, medications, or injections.

What are the Common Types of Knee Preservation Surgery?

Some of the common types of knee preservation surgery include the following:

• Arthroscopic Cartilage Repair or Regeneration – to restore damaged cartilage using techniques like microfracture, autologous chondrocyte implantation (ACI), or osteochondral grafting.
• Meniscus Repair or Transplantation – to preserve or replace the meniscus for shock absorption and joint protection.
• Osteotomy (e.g., High Tibial Osteotomy) – to realign bones and offload stress from the damaged part of the knee.
• Ligament Reconstruction – such as ACL or PCL reconstruction to restore knee stability.
• Biologic Treatments – using PRP, stem cells, or MFAT (Microfragmented Adipose Tissue) to promote healing and slow degeneration.

What Does the Procedure for Knee Preservation Surgery Involve?

The procedure for knee preservation surgery varies depending on the specific technique used, but generally involves the following steps:

• Detailed clinical examination and imaging (X-rays, MRI, or CT scans) are done to assess the extent of joint damage and alignment.
• The surgeon determines the best preservation technique (e.g., osteotomy, cartilage repair, or meniscus surgery).
• The patient is given spinal or general anesthesia, and the knee is sterilized for surgery.
• Depending on the condition, one or more of the following may be done:
  • Cartilage Restoration: Damaged cartilage is cleaned, and new cartilage cells or grafts are implanted to regenerate the surface.
  • Meniscus Repair or Transplant: Torn meniscus is sutured, or a donor meniscus is transplanted.
  • Ligament Reconstruction: A graft (from the patient or donor) replaces the damaged ligament for joint stability.
  • Osteotomy (Realignment): Bone is precisely cut and repositioned to shift weight away from the damaged joint area.
  • Biologic Injections: PRP or stem cells may be added to enhance healing and reduce inflammation.
• Plates, screws, or pins may be used to stabilize the bone if realignment is done.
• The incisions are closed using sutures or surgical glue.
• A brace or splint may be applied for protection.

What Happens After Knee Preservation Surgery?

After knee preservation surgery, the patient typically stays in the hospital for one to two days, depending on the procedure performed. Pain and swelling are managed with medication, ice, and elevation. A physical therapy program begins early to restore knee motion, prevent stiffness, and strengthen muscles. Weight-bearing is usually restricted initially, with gradual progression as healing occurs—often guided by X-rays or follow-up assessments. Over the next few weeks to months, patients regain mobility and function, returning to normal or athletic activities once the joint has healed and stability is restored. Regular follow-up visits ensure proper recovery and long-term joint preservation.

What are the Risks and Complications of Knee Preservation Surgery?

Risks and complications of knee preservation surgery may include the following:

• Infection at the surgical site
• Bleeding or blood clots (DVT)
• Joint stiffness or reduced range of motion
• Incomplete pain relief or recurrence of symptoms
• Failure of bone or cartilage healing
• Nerve or blood vessel injury
• Need for revision surgery or later knee replacement

What are the Benefits of Knee Preservation Surgery?

Benefits of knee preservation surgery may include the following:

• Retains the natural knee joint structure and function
• Delays or prevents the need for total knee replacement
• Reduces pain and improves mobility
• Restores alignment and joint stability
• Promotes cartilage healing and joint regeneration
• Allows a return to sports or an active lifestyle
• Helps maintain long-term joint health and flexibility