Knee surgery: a philosophy

Functional disability should be proven before surgery is performed. If the knee demonstrates disability and simultaneously demonstrates muscle atonia and atrophy or contracture and imbalance, this dynamic support of the knee should be corrected preoperatively as far as possible and then the disability reevaluated before proceeding with surgery. A complete, documented knee examination must precede ancillary diagnostic procedures. Too often I see patients still in trouble with knees previously operated upon, who relate they had a cursory knee examination or no knee examination and were told that now there are modern diagnostic procedures such as arthrography and arthroscopy so they can be admitted to the hospital for these procedures with a resultant accurate diagnosis. This concept is not true! No ancillary procedure supercedes a knowledgeable history and clinical examination. The surgeon should operate only on the basis of objective demonstration of the need for operation, not on the basis of the history alone. In my estimation, rehabilitation accounts for 50 percent of a successful result following injury or operation. Remember, anatomy is the key to the knee.