THE operation to repair a torn cartilage, or meniscus, in the Queen’s knee is a minor procedure. The general public first noticed that something was amiss when she did not walk to church as usual for the service on the Sunday before Christmas.

It is usual to postpone surgery when one of these cartilages is torn until the acutely injured knee has settled down. She walked to church last weekend showing that the worst of the symptoms had cleared.

In the meantime she will have had to suffer pain whenever the knee was straightened and may well have experienced locking of the knee joint, when it cannot be straightened completely; buckling of the knee, when it unexpectedly lets the patient down; or clicking, when the affected joint emits a click when used.

Younger people tend to damage their cartilage when exercising or playing sport and twist on a semi-bent knee while it is bearing their full weight.

Most older people tear them in the same way as the Queen, while negotiating uneven or frozen ground and slipping so that a twisting load is placed on a half-bent knee. This exerts an excessive strain on one of the four meniscal cartilages. The cartilages are half-moon in shape. The damage is variable, sometimes no more than a tear.

It is only rarely necessary to remove all of the cartilage and every effort is made to conserve those pieces which are left behind. The operation is usually performed through an arthroscope, leaving only the smallest of scars.

Patients are almost always kept in hospital for observation overnight but the operation is sometimes done as a day case. If there have been problems in removing the damaged cartilage through an arthroscope it may be necessary to make an incision and continue with an open operation.

In this case the patient will be required to stay in hospital slightly longer. Patients usually leave on crutches, need a couple of weeks of rest and should be using their joint again without trouble within a month.

Provided that there was no damage to the ligaments at the time of the injury, and no infection at operation, the Queen should have no further trouble. However, surgery to the knee could be a factor which would subsequently give rise to arthritis.

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