Choosing the right treatment for your knee depends on your symptoms, goals, and the underlying problem within the joint.
There is no single solution for all patients. The aim is to identify the root cause of your symptoms and tailor treatment accordingly.
Understanding your knee problem
Knee symptoms are often caused by one or more of the following:
- Ligament injury (e.g. ACL or multi-ligament injuries)
- Meniscal damage or deficiency
- Cartilage wear or arthritis
- Malalignment (the way your leg is aligned)
- Patellar (kneecap) instability
A detailed assessment, including examination and imaging, is essential.
Treatment pathways
Ligament injuries (ACL and multi-ligament)
If your knee feels unstable or gives way:
- Rehabilitation may be appropriate in some cases
- ACL reconstruction is often recommended for active patients
- Multi-ligament reconstruction is required in more complex injuries
Meniscal injury and meniscus deficiency
If you have pain, locking, or a history of previous meniscus surgery:
- Physiotherapy is often the first step
- Meniscal repair is preferred where possible to preserve the meniscus
Meniscal root tears
- A specific type of tear where the meniscus detaches from its attachment
- This can behave like the meniscus has been removed
- Early repair is usually recommended to restore function and reduce the risk of arthritis
Meniscus deficiency (previous removal)
- Meniscal transplantation may be considered in selected patients with ongoing symptoms
Non-repairable tears
- Debridement (trimming) may be appropriate in selected cases
The overall aim is to preserve or restore the meniscus wherever possible.
Degenerative meniscal tears
- Physiotherapy is first-line treatment, in line with national guidelines
- Many patients improve without surgery
- A proportion (approximately 35–50%) may go on to require surgery if symptoms persist
Cartilage damage
- May be treated with cartilage restoration procedures
- Often combined with other surgery
- Aims to reduce pain and protect the joint
Malalignment (osteotomy)
- Osteotomy (realignment surgery) may be recommended
- Redistributes load away from damaged areas
- Often used in younger, active patients
Kneecap (patellar) instability
- Rehabilitation after a first dislocation
- Stabilisation surgery for recurrent instability
Arthritis and knee replacement
- Non-operative treatment initially (exercise, weight loss, injections)
- Partial knee replacement for isolated arthritis
- Total knee replacement for more advanced disease
Decision guide
What is your main symptom?
🟢 Instability (knee giving way)
➡️ ACL injury or ligament problem
→ Rehabilitation or ligament reconstruction
🔵 Pain after previous meniscus surgery
➡️ Meniscus deficiency
→ Consider meniscal transplantation
🟡 Locking, catching, or acute pain
➡️ Meniscal tear
→ Repair if possible
→ Root repair if root tear
→ Trimming if not repairable
🟠 Gradual progressive pain over time
➡️ Degenerative meniscus or early arthritis
→ Physiotherapy first
→ Surgery if symptoms persist
🟣 Pain on one side of the knee
➡️ Malalignment or cartilage overload
→ Consider osteotomy ± cartilage treatment
🔴 Severe pain and stiffness affecting daily life
➡️ Advanced arthritis
→ Partial or total knee replacement
⚫ Kneecap instability / dislocation
➡️ Patellar instability
→ Rehabilitation or stabilisation surgery
A personalised approach
Many patients have a combination of problems, for example:
- ACL + meniscus injury
- Meniscus deficiency + cartilage damage
- Malalignment + early arthritis
In these cases, treatment is often combined and tailored specifically to you.
Not sure what you need?
A specialist consultation will help determine:
- The exact cause of your symptoms
- Which treatment is most appropriate
- What outcome you can expect