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ARTHROSCOPIC SURGERY

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Arthroscopy – Knee

ACL TEAR
1. What is an ACL tear?
Ans: ACL is thick with fibro-collagenous tissue connecting the lower end of the thigh bone and the upper end of the leg bone. It is one of the important ligaments inside our knee joint which gives stability. It is the most common ligament injury in sports or RTA in our region.

2. How does an ACL tear?
Ans: It is the most common ligament injury in the knee. Any contact sports involving twisting of the knee joint can cause an ACL tear. Eg. Football, volleyball, rugby, etc.

3. What is the treatment?
Ans: Acute injury is treated is conservative 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 ( semi tendinosis or gracilis ) muscle This graft is fixed by various methods like titanium screws, bioabsorbable screws, endo button, and 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 are that it is very strong, a single semitendinosus graft is enough, and NO screw or threads prominence over the tibial insertion site. Leg bone outer side is not tunneled, so less painful and hence early recovery. Only very few surgeons are doing this all-in technique.

POSTERIOR CRUCIATE LIGAMENT(PCL)
1. What is PCL?
Ans: Posterior Cruciate ligament(PCL) is another ligament inside the knee joint which is 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 a 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 a meniscus?
Ans: Meniscus is a thick fibrocartilaginous tissue inside the knee joint. There are two menisci in the knee joint. They function as shock absorbers and get 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 the 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 a broad outer edge and thin inner edge. Tears towards the outer edge have a 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 meniscectomy i.e torn part of the meniscus is removed and the remaining part is trimmed smoothly to prevent a further tear.

4. How is the meniscus repaired?
Ans: There are various kinds of techniques available and are dependent on the area of a tear over the meniscus. The repair technique is based on the 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 is preserved to the maximum with the latest techniques of repair or partial meniscectomy to prevent secondary arthritis.

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 pain-free walking.

2. Who would require knee replacement?
Ans: Any person who is suffering from severe arthritis of their knee joint.

Difficulty in walking and climbing stairs.
No relief with medication, feeling the necessity to take pain killers daily for a long time
The deformity is noticed at the knee joint – bowed legs or knock knees
Rest pain – having disturbed sleep due to pain.
3. Which age group should undergo knee replacement?
Ans: Knee replacement is usually advised for persons over 60 years with severe arthritis, but Rheumatoid arthritis patients can present at a much younger age or even in their twenties presenting themselves with severe arthritis. These patients also undergo knee replacement to have a good quality of life. we even see patients in their 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 has to undergo tests to assess fitness for surgery in which tests are conducted to evaluate heart & kidney function along with sugar, thyroid, blood hemoglobin, and 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 % of people do well by 15 years, 90% do well by 20 years. With the latest implants now, the 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 surgeries. 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 an infection that is affected by the surgeon, theatre conditions, and patient factors.

We take utmost care from our side in preventing infection, our operating theatres are laminar airflow 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 to them to 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 the proper judgment of bone stock and the 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 a walker on that day, but it is individualized based on the patient’s recovery and strength. Thin-built and strong patients are able to walk on the same day and obese and weak patients walk on the 1st or 2nd-day post-surgery. Every patient is able to walk with a walker to the restroom while in a hospital so that further rehabilitation is easy at home under the supervision of a physiotherapist. Patients would discard their walkers 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, cycle, and drive vehicles – two-wheeler or cars. They can sit on the ground with the high flex design implants but are not allowed to squat or use an Indian toilet.

9. What is the 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, and Attune is known to last a lifetime.

10. What is your specialty in total knee replacement?
Ans: We perform with minimally invasive technique, less tissue trauma, no blood loss during surgery, dissolvable sutures, less post-op pain, and early ambulation with fast track anesthesia.