Arthroscopy

Arthroscopy - Knee

ACL Tear
1.What is ACL tear?

Ans:ACL is a thick of fibro collagenous tissue connecting the lower end of thigh bone and upper end of leg bone. It is one of the important ligament inside our knee joint which gives stability.It is the most common ligament injury in sports or RTA in our region.

2.How does ACL tear?

Ans: It is the most common ligament injury in the knee. Any contact sports involving twisting of the knee joint can cause ACL tear. Eg. Foot ball, volley ball, rugby etc.

3.What is the treatment?

Ans:Acute injury is treated is conservatively with Brace and analgesics. After 3-6 weeks of review if there is instability , then they need to undergo ACL reconstruction.

4. How is ACL reconstruction done?

Ans: ACL is reconstructed with a graft which is a PTB (Patellar tendon bone) or Hamstrings ( semitendinosis or gracilis) muscle This graft is fixed by various methods like titanium screws, bio absorbable screws, endo button, tight rope.

5.What is your preferred technique And how is it different?

Ans: We do an “all inside ACL reconstruction with graft link tightrope technique”. The advantages of this technique is that it is very strong, single semi tendinosus graft is enough, NO screw or threads prominence over the tibial insertion site. Leg bone outer side is not tunnelled, so less painful and hence early recovery. Only very few surgeons are doing this all inside technique.

Posterior Cruciate ligament(PCL)

1.What is PCL?

Ans: Posterior Cruciate ligament(PCL) is another ligament inside the knee joint which is more stronger than the ACL ligament and is less often torn. It is a very important structure for knee stability. It has to be reconstructed if it is torn completely

2.How is PCL tear treated?

Ans: A completely torn PCL is reconstructed with hamstring graft done arthroscopically . PCL is reconstructed in a similar fashion to ACL with special instruments but needs a lengthier graft.

Meniscus

1.What is meniscus?

Ans: Meniscus is a thick fibro cartilaginous tissue inside the knee joint. There are two menisci in the knee joint. They function as shock absorbers and getting a smooth knee movements in the knee joint.

2. What happens if one gets a meniscal tear?

Ans: Meniscal tear is the most common injury to the knee. A tear in meniscus presents as pain in the knee joint on weight bearing, locking of the knee joint while walking, or simply pain with swelling.

3. What is the treatment for Meniscal tear?

Ans: Meniscus is a semi-circular structure with broad outer edge and thin inner edge. Tears towards the outer edge have good blood supply and heal well with repair and tears towards the inner edge and irregular tears are not repairable and so they undergo partial menisectomy i.e torn part of the meniscus is removed and the remaining part is trimmed smoothly to prevent further tear.

4. How is meniscus repaired?

Ans: There are various kinds of techniques available and is dependent on the area of tear over the meniscus. Repair technique is based on tear pattern.

5. Do I get arthritis if my meniscus is removed?

Ans: Arthritis can occur after 10-15 years if the meniscus is removed completely but nowadays meniscus preserved to the maximum with the latest techniques of repair or partial menisectomy to prevent secondary arthritis.

ACL Reconstruction and Knee Arthroscopy
 

Arthroplasty - Knee

Total knee replacement

1.what is Total knee replacement?

Ans: In osteoarthritis of the knee, the worn out ends of the femur and tibial ends are replaced with metal implants and a plastic insert is put in between the metal implants. This surgery restores the normal alignment of the leg and allows the patient to have a pain free walking.

2. Who would require knee replacement?

Ans: Any person who is suffering from severe arthritis of their knee joint.

  1. Difficulty in walking and climbing stairs.
  2. No relief with medication, feeling necessity to take pain killers daily since a long time
  3. Deformity is noticed at the knee joint – bowed legs or knock knees
  4. Rest pain – having disturbed sleep due to pain.
3. Which age group should undergo knee replacement?

Ans: Knee replacement is usually advised to persons over 60 years with severe arthritis, but Rheumatoid arthritis patients can present at a much younger age of even in their twenties presenting themselves with severe arthritis. These patients also undergo knee replacement to have good quality of life. we even see patients in late forties and fifties presenting with degenerative arthritis who would require knee replacement

4. What are the prerequisites to undergo knee replacement?

Ans: A person once advised surgery have to undergo tests to assess fitness for surgery in which tests are conducted to evaluate heart & kidney function along with sugar, thyroid, blood Haemoglobin, urine examination.

Also the patient should have Blood pressure and sugar levels under normal levels if they are hypertensive or diabetic. There should not be any neurologic deficits.

5. How long does a knee replacement last?

Ans: With the follow up patients till now of the implants that have been used, 95 % people do well by 15 years, 90% do well by 20 years. With the latest implants now, knee can last over 30 years as claimed by the lab studies.

6. What is the success rate of the surgery?

Ans: Knee replacement is one of the most successful surgery. There are more benefits than complications. In our hands the success rate is 99.5%.The most important complication that I explain to all my patients is infection which is affected by surgeon, theatre conditions, and patient factors.

We take utmost care from our side in preventing infection, our operation theatres are laminar air flow theatres for infection control. Patient factors include uncontrolled sugars, dental caries, and urinary tract infection, in short any infection in the body can transmit to the knee joint and get infected. Most of the infections have been mainly due to patient factors. So I explain every one this so that they improve their personal hygiene and health.

Another complication is loosening of the implant which is again either due to poor bone quality or improper fixation. Loosening can be prevented by proper judgement of bone stock and use of special implants with stems and good surgical skills. Loosening has been very rare in our hands.

7. How long does it take to recover?

Ans: Patient can move their knee on the day of surgery and some can even walk with walker on that day but it is individualised based on the patient’s recovery and strength. Thin built and strong patients are able to walk on same day and obese and weak patients walk on 1st or 2nd day post-surgery. Every patient is able to walk with walker to rest room while in hospital so that further rehabilitation is easy at home under the supervision of a physiotherapist. Patients would discard their walker in 10 days to 3 weeks’ time.

8. What are the activities that can be done and what cannot be done after surgery?

Ans: Patients can walk normally without support, climb stairs, cycling, and drive vehicles – two wheelar or car. They can sit on ground with the high flex design implants but are not allowed to squat or use Indian toilet.

9. What is latest in knee replacement?

Ans: Newer implants have come with new designs and long lasting properties like Oxynium Verilast technology, Gender specific knees for male and female knees separately, Attune known to last a life time.

10. What is your speciality in total knee replacement?

Ans: We perform with minimal invasive technique, less tissue trauma, no blood loss during surgery, dissolvable sutures, less post op pain and early ambulation with fast track anesthesia.

Orthobiologics

BMAC

(BONE MARROW ASPIRATE CONCENTRATE – STEM CELLS

BONE MARROW ASPIRATED FROM THE ILIAC CREST

Preparation

BMAC

Collection of Bone Marrow aspirate containing stem cells

BMAC USES

CARTILAGE REPAIR

AVASCULAR NECROSIS OF HIP

Difficult and worst Non unions – BMAC injections will do the miracle – very promising results

For Detaisls contact

Dr Akhil Dadi - MS(Ortho)

Chief arthroscopic surgeon and joint surgery specialist

Srikara Hospital -Secunderabad