Knee joint preservation: a call for daily practice revival of realignment surgery and osteotomies around the knee


knee as an organ and consider the whole picture of treatment. Clearly, in cases in which leg realignment was not performed as a first step of treatment, experience painfully taught us a lesson that other well-intended joint preserving treatments like ligament reconstructions, meniscal repairs or replacement procedures as well as cartilage repair are often doomed to fail. Still many surgeons, experts in their own subspecialized field of knee surgery have not incorporated this algorithm in their daily practice causing well-intended treatments to fail. A reason for missing this important link may be the way we learn and incorporate knowledge into our daily practice. Bruce Reider [2] once wrote that physicians after their training enter into a lifelong career of learning and relearning. Keeping up with all new information, choose what is worthwhile for one’s own practice, and then incorporate this into daily practice, however, is not an easy task. Knowledge acquisition and implementation has become a scientific study by itself not in the last place because of the huge amount of information that can be obtained in our fields of specialization. To make life easier, one can follow widely available courses on information management, literature search strategies and health care statistics. Since childhood, knowledge has been presented to us by parents or peers, skills were developed by practicing and repetition, and skills were mastered by updating and further learning. Translated to our daily practice, this would mean: (a) remember what our teachers told us; (b) read textbooks and articles specific to the subject; (c) visit meetings, specialty sessions, practical teaching courses with hands-on practicing or visit expert centres and work with experienced colleagues, and then (d) incorporate the skills in your treatment armamentarium. The final step is (e) to update your knowledge by reading the literature and visit meetings where the latest knowledge is discussed. For joint preserving treatment of the degenerative knee, achieving a balanced mechanical leg axis is one of the most important goals. A previously published treatment algorithm has given osteotomies highest priority [1]. The hierarchy of treatment should be alignment, stability, meniscus and finally cartilage surgery. Having gained experience in centres with extensive knowledge on joint preserving therapy leads the authors to state that a re-focus on leg alignment is necessary. In a time in which medical education for knee surgeons becomes increasingly specialized, it is even more important to see the

DOI: 10.1007/s00167-017-4702-8

Cite this paper

@article{Heerwaarden2017KneeJP, title={Knee joint preservation: a call for daily practice revival of realignment surgery and osteotomies around the knee}, author={Ronald J. van Heerwaarden and Michael T. Hirschmann}, journal={Knee Surgery, Sports Traumatology, Arthroscopy}, year={2017}, pages={1-2} }