Choosing the right treatment for your knee depends on your symptoms, goals, activity level, and the underlying problem within the joint. There is no single solution for every patient. The aim is to identify the root cause of your symptoms and tailor treatment specifically to you.
What can cause knee pain or instability?
Knee symptoms are commonly caused by one or more of the following:
- Ligament injuries (such as ACL or multi-ligament injuries)
- Meniscal tears or meniscus deficiency
- Cartilage damage or arthritis
- Malalignment (the way the leg is aligned)
- Patellar (kneecap) instability
A detailed assessment, including examination and imaging, is essential to determine the most appropriate treatment.
What are the treatment options for ACL and ligament injuries?
If your knee feels unstable, gives way, or you have suffered a sporting injury, treatment may include:
- Rehabilitation and physiotherapy
- ACL reconstruction
- Multi-ligament reconstruction in more complex injuries
Not all ACL injuries require surgery, but reconstruction is often recommended in active patients or those with persistent instability.
What is the best treatment for a meniscal tear?
Treatment depends on the type, location, and severity of the tear.
Options may include:
- Physiotherapy
- Meniscal repair
- Meniscal root repair
- Arthroscopic trimming (debridement)
Where possible, preserving and repairing the meniscus is preferred, as this helps protect the knee joint long term.
What is a meniscal root tear?
A meniscal root tear occurs when the meniscus detaches from its attachment within the knee.
This type of injury can behave similarly to having the meniscus removed entirely and may rapidly increase joint loading and arthritis risk.
Early repair is often recommended to restore function and protect the joint.
What happens if I have previously had part of my meniscus removed?
Some patients develop ongoing pain after previous meniscus surgery due to meniscus deficiency.
In selected patients, meniscal transplantation may be considered to help improve symptoms and restore load distribution within the knee.
Do all degenerative meniscal tears need surgery?
No. Physiotherapy is the first-line treatment for degenerative meniscal tears, in line with national guidelines.
Many patients improve without surgery. However, a proportion of patients may continue to experience pain, locking, or mechanical symptoms and may ultimately benefit from surgery.
How is cartilage damage treated?
Cartilage damage may be treated with cartilage restoration procedures designed to:
- Reduce pain
- Improve function
- Protect the joint surface
Cartilage procedures are often combined with other surgery such as osteotomy, ligament reconstruction, or meniscal surgery.
What is an osteotomy?
An osteotomy is a realignment procedure used to redistribute load within the knee.
It is commonly considered in younger or active patients with:
- Malalignment
- Early arthritis
- Cartilage overload
- Meniscus deficiency
The aim is to reduce pressure on damaged areas of the joint and help preserve the knee.
How is kneecap (patellar) instability treated?
Treatment depends on the severity and frequency of dislocation.
Options may include:
- Rehabilitation and physiotherapy
- Bracing
- Patellar stabilisation surgery
Surgery is typically considered for recurrent instability or in patients with underlying anatomical risk factors.
When is knee replacement recommended?
Knee replacement is generally considered when arthritis causes significant pain, stiffness, and limitation despite non-operative treatment.
Initial treatment usually includes:
- Exercise and physiotherapy
- Weight management
- Pain relief medication
- Injections
Surgical options include:
- Partial knee replacement
- Total knee replacement
The most appropriate option depends on the pattern and severity of arthritis.
How do I know which treatment is right for my symptoms?
Instability or the knee giving way
Possible cause:
- ACL or ligament injury
Potential treatment:
- Rehabilitation
- Ligament reconstruction
Pain after previous meniscus surgery
Possible cause:
- Meniscus deficiency
Potential treatment:
- Meniscal transplantation
Locking, catching, or sudden sharp pain
Possible cause:
- Meniscal tear
Potential treatment:
- Meniscal repair
- Root repair
- Arthroscopic trimming if not repairable
Gradual worsening pain over time
Possible cause:
- Degenerative meniscal tear or early arthritis
Potential treatment:
- Physiotherapy first
- Surgery only if symptoms persist
Pain mainly on one side of the knee
Possible cause:
- Malalignment or cartilage overload
Potential treatment:
- Osteotomy
- Cartilage restoration procedures
Severe pain and stiffness affecting daily life
Possible cause:
- Advanced arthritis
Potential treatment:
- Partial or total knee replacement
Kneecap dislocation or instability
Possible cause:
- Patellar instability
Potential treatment:
- Rehabilitation
- Stabilisation surgery
Can multiple knee problems occur together?
Yes. Many patients have a combination of issues, for example:
- ACL injury with a meniscal tear
- Meniscus deficiency with cartilage damage
- Malalignment with early arthritis
In these situations, treatment is often combined and tailored specifically to the individual patient.
What happens during a specialist consultation?
A specialist consultation helps determine:
- The exact cause of your symptoms
- Which treatment options are most appropriate
- Whether surgery is necessary
- What outcome you can realistically expect
Every patient and every knee problem is different, so treatment should always be individualised.