The knee joint is one of the most mechanically sophisticated and clinically demanding structures in the human musculoskeletal system. Despite the abundance of orthopedic literature available globally, there has long existed a significant gap in resources that speak directly to the realities of clinical practice in Nepal, addressing our unique patient populations, cultural contexts, and
healthcare delivery systems.

With immense pride, we present “Approach to Injured Knee”, a comprehensive 31-chapter textbook created specifically for orthopedic surgeons practicing in our region. This work emerges from recognition that while Western orthopedic texts provide invaluable foundational knowledge, they often fail to address the unique clinical scenarios, resource constraints, and epidemiological patterns that define practice in Nepal, India, and the broader South Asian region.

Our patients present with injury patterns influenced by occupational demands such as agricultural work requiring prolonged squatting, religious practices involving repetitive kneeling, and cultural habits of floor sitting that place unique biomechanical stresses on the knee. They often arrive after significant delays, sometimes having received initial care from traditional healers, and frequently
face financial constraints that profoundly influence treatment decisions.

The decision to prioritize Nepali authors and include invited contributors from India was deliberate and central to this book’s mission. Regional authorship brings irreplaceable authenticity. Our contributors understand intimately the challenges of practicing where advanced imaging may be limited, surgical implants must be cost-conscious, and rehabilitation protocols must account for patients returning to physically demanding livelihoods. Their collective wisdom, earned through years of managing knee injuries across tertiary centers, district hospitals, forms the foundation of this textbook.

This 31-chapter textbook systematically addresses the spectrum of knee pathology—from foundational anatomy and clinical examination to contemporary advances in ligament reconstruction, cartilage
restoration, and arthroscopy. The content is evidence-based yet contextually relevant, filtering international guidelines through the lens of regional applicability. Each chapter includes practical treatment algorithms with decision points relevant to South Asian practice, cultural and occupational considerations, and resource-appropriate alternatives when ideal equipment is unavailable. The book bridges fundamentals and frontiers, serving young surgeons learning basic principles while addressing recent advances, including biological augmentation strategies, minimally invasive techniques, and computer-assisted navigation. Importantly, it honestly addresses the healthcare realities of our regions—managing delayed presentations, triaging with limited resources, and counseling patients when financial constraints are paramount.

This publication symbolizes the maturation of orthopedic scholarship in Nepal. By documenting regional expertise in a comprehensive academic work, we validate the sophistication of orthopedic practice in our region and inspire future generations to contribute to global orthopedic literature from our unique perspective.

While primarily intended for arthroscopy surgeons and residents in Nepal, this textbook serves orthopedic surgeons and rehabilitation specialists throughout the region. The true measure of success will be its impact on patient care- if it helps navigate complex cases, provides evidence for patient counseling, or contributes to improved outcomes, we will have achieved our purpose.“Approach to Injured Knee” represents our collective expertise, commitment to excellence, and dedication to improving care for patients with knee injuries throughout South Asia. We are honored to present this work and hope it will serve as a valuable companion in your mission of healing.

Amit Joshi
Kathmandu, Nepal
October 2025

Approach to the Injured Knee

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