With the London Marathon taking place on Sunday 23rd April, both amateur and professional runners will be gearing up for their longest training runs before starting off their marathon taper to allow their body to recover for race day.

However, you may be experiencing a dull, aching pain around or behind the kneecap that worsens when going downstairs, bending, kneeling or even after sitting for extended periods. The knee joint can feel tender and swollen to the touch and there may be a popping or grinding sensation. The knee can feel unstable.

Runner’s knee, known medically as patellofemoral pain syndrome or PFPS, is estimated to affect between 15 and 40% of all runners training for marathons.

The kneecap is held in place by the quadriceps tendon and patella tendon, and when the leg extends, the kneecap should retract smoothly into the femoral groove on the thigh bone. If it fails to do so, then it can be excruciating.

Common risk factors are long runs, inward rotating or pointed knees, tight or weak hips and glutes, excessive pronation, and overuse.

Another painful knee condition is iliotibial band syndrome, which is thought to affect 14% of runners. Pain is usually felt down the side of the knee.

The iliotibial band or IT band is a long tendon that runs from the glutes to the knee and helps stabilise the knee joint. If the IT band repeatedly rubs against the lower end of the thigh bone where it meets the knee, this can cause inflammation and pain.

Is runner’s knee surgery necessary?

The first step is to explore non-surgical intervention. Initially, this will be to avoid activities that are causing pain and follow the RICE protocol of rest, ice, compression, and elevation. Exercises that improve the flexibility and strength of your thigh muscle will be advised. Knee taping, a knee brace or orthotics may be prescribed.

If conventional treatment fails, runner’s knee surgery may entail realignment of the knee joint or arthroscopy to remove any damaged fragments in the knee joint.

For more advice on treating runner’s knee, call 07724 909 414 to arrange a consultation at Mr Neil Hunt’s knee clinic. Consultation and surgery are available in London, Leeds and York.

Osteoarthritis, caused by wear and tear, is the most common type of arthritis worldwide, and it’s estimated that it affects 10% of men and 18% of women over 60 years of age. The knee is the most commonly affected joint and one in five adults in the UK over 45 has sought treatment for knee arthritis.

Over 100,000 knee replacements are performed either privately or on the NHS each year to alleviate the pain and improve function in those with advanced knee osteoarthritis. Although increasing numbers of younger men and women are undergoing knee replacement surgery, the prosthesis may not last a lifetime, particularly in more active patients. They may require a repeat replacement at a later stage.

How does a knee osteotomy improve arthritis?

In some cases, the degeneration of the cartilage that covers the knee joint over time is caused by misalignment of the knee that puts more pressure on the inside of the joint.

In a 2021 study, Canadian orthopaedic surgeons found that 95% of patients who underwent a high tibial osteotomy do not go on to have a total knee replacement within five years, and 79% do not have a TKA within ten years. The strongest predictor of conversion to a total knee replacement was the degree of osteoarthritis at the time of the initial operation.

Knee osteotomy surgery has been performed since the nineteenth century and fell out of favour as knee replacement surgery evolved and improved. It entails either removing a wedge of bone or grafting a small piece of bone or bone-like substance into the tibia, which is the top part of the lower leg bone. This realigns the joint and distributes body weight more evenly, preventing further deterioration of cartilage while leaving the joint largely intact.

A knee osteotomy can often delay the need for a knee replacement and, for many patients, make it unnecessary. This makes it very advantageous for younger and very active older patients. If arthritis continues to progress, as the Canadian study noted, knee osteotomy does not negatively affect future knee replacement surgery.

Neil is a very experienced osteotomy surgeon and not only have the osteotomies he performs on patients relieved their pain but most of his patients have been able to avoid having to have a knee replacement as a consequence.

To find out if you’re a suitable candidate for a knee osteotomy, call 07724 909 414 to arrange a consultation with Neil.