MENISCUS LESIONS AND ARTHROSCOPIC SURGERY
MENISCUS LESIONS AND ARTHROSCOPIC SURGERY
Meniscus and its function
Meniscus is an elastic cartilage situated in the knee joint. With the help of meniscus knee joint stays in contact throughout the range of motion. Their triangular shape increases the contact surface between thigh bone and shin bone. Meniscus transfers load in the knee joint and to absorbs the excess of it. In the absence of menisci increased loads will cause cartilage wear in that compartment of knee in the following 10 years after injury. Therefore, the presence and function of meniscus in a knee joint is crucial to preserve normal knee function.
Meniscus lesion and its the treatment
Meniscus laceration is one of the most frequent sports related knee lesions. Tears cause a discontinuity in the meniscal tissue and interferes with its function. Up to date treatment of meniscus lesions is via arthroscopy and the aim is to preserve as much meniscal tissue as possible. Arthroscopic surgery is safe and less traumatic.
Meniscus lacerations may be repaired with sutures and may heal. Young patients and early intervention are upmost importance for meniscal preservation. If a resection is required a limited resection is done.
Signs meniscus lesion
The most important signs of meniscus lesions are pain at the joint line, blocking of knee or an audible click.
The postoperative follow-up
Postoperative measures after meniscus surgery depends on the type of surgery. Sutured meniscus is preserved from loading with a knee brace and a gradual recuperation of range of motion is allowed in 6 weeks. Either after resection or preservation patient may walk the day after surgery and return to work in 4 weeks. Return to preinjury level of sport is expected.
ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION
ACL and its function
Stability of knee joint is supplied by ligaments of which the anterior cruciate ligament (ACL) is the upmost importance. ACL while limiting the anterior translation of tibia it also limits the internal rotation which renders ACL the key ligament for pivot contact sports. Thus, ACL rupture is to be treated in sportive patients to return to pivot contact or pivot- non contact sports (football, basketball, tennis, etc…)
Treatment of ACL rupture
ACL rupture is treated with ligament reconstruction. This is the replacement of ligament arthroscopically with a graft resembling ACL. The source of the new ligament is mostly the tendons harvested from the same knee. There are different techniques each of which has different good and weak sides. Common philosophy of all techniques is the anatomical replacement of the ligament. The mostly known techniques use hamstring tendons, bone-patellar tendon-bone graft and iliotibial band and quadriceps tendon with or without anterolateral ligament reconstruction.
With the new pain management strategies, ACL surgery may be a day surgery.
Postoperative period
Usually, it is possible to walk on the next day of surgery. Crutches are carried for 10 to 15 days to prevent further injuries.
After operation there is an intense rehabilitation protocol in the first 6 months which requires patient participation. It begins with preserving extension in the first days, continues with the isometric and closed chain exercises followed by flexion and open chain exercises. These exercises may be assisted or personal but always be supervised by a physical therapist. Return to sport is not advised before 6 months and is a joint decision of the patient, surgeon and the rehabilitation team.
Re-rupture possibiliity
Rupture of the reconstructed ligament or the ACL of contralateral knee is not impossible. Prevention measures are taken by some of the teams and might help avoiding further ACL injuries.
Advantages of ACL surgery
The real advantage of the surgery is a higher rate of return to sport and prevention of further meniscal and cartilage injuries. However, operation itself can`t prevent development of arthritis. Presence of cartilage, meniscus or other ligament injuries besides ACL injury may exacerbate the grade of knee injury, require additive surgeries or diminish the clinical scores and percentage of return to sport in the sportive population.
Ligament injuries in the knee is to be thoroughly evaluated and treated by an expert of sport surgery in order to get the optimal result. Patient participation is a must after ACL reconstruction operation.
KNEE ALIGNMENT SURGERY
Deformations of lower extremity bones and knee pain
Knee pain may result from axial deformations of lower extremity bones. Bone deformities around the knee may cause meniscus and cartilage lesions in the knee joint. The most frequent knee deformities are bow legs (genu varum) and knock knees (genu valgum).
Correction of bone deformities
Correction of bone deformities require special bone cuts and fixation with plates and screws to restabilize the bone (osteotomy operation). Surgeon decides correction osteotomies according to the placement of deformity. The most frequent correction osteotomy around the knee is high tibial osteotomy (HTO) for a bow-leg. Knee osteotomy operations unload the damaged cartilage and offers the patients to return to their daily life and habitual sport and may relieve pain and delay prosthesis surgery.
Good candidates for osteotomy operation
Under optimum conditions, the patient is less than 60 years old and the knee damage is localized.
Return to work
Walking without loading is allowed in the day after surgery with crutches. Generally, in 6 to 8 weeks there will be a consolidation and in 6 months to 1 year the plates and screws may be removed.
KNEE OSTEOARTHROSIS
Criterias for surgery
People who need knee replacement surgery usually have problems walking and severe pain sometimes at rest. These difficulties may be very difficult to compensate especially if the patient is willing to participate daily activities.
Knee replacement
Prosthetic replacement of a joint or arthroplasty is the mostly reliable surgical treatment to relieve pain and restore function in severely worn knee joints. The procedure involves cleaning of damaged bone and cartilage from your joint and replacing it with an artificial prosthesis. There exists variety of surgical techniques and different prosthetic types (partial or total). In determining whether a knee replacement is right for you, an orthopedic surgeon assesses your knee's condition with clinical examination and radiological tests help determine the extent of damage.
Benefits of a knee replacement
The benefits of knee replacement are pain relief, improved mobility and a better quality of life.
The postoperative period
In the operating day there is an intense pain control and patient stays at the hospital. Patients are allowed to walk the day after surgery. Wound care will end and there will be less and less need to pain relieving medications in 10 days. Three to six weeks after surgery, patients may regain most daily activities like going out and driving.
Durability of prosthetic knee
Most versions of knee prosthesis are durable more than 15 years. Due to the fact that the prosthetic implants tend to wear in time, after knee replacement surgery return to high impact sports or activities is not advised although the patients are free to mobilize.
Presence of any infection in the body, previous implants, scars of previous surgeries and medications are important to be known by the surgical team and taken into consideration to prevent complications.
- Ankle ligament lesions and osteochondral injuries
What is chronic ankle ligament insufficiency?
Ankle instability and osteochondral lesions are one of the most important causes of ankle surgery. Most of the ankle ligament injuries heal after an orthopedic or functional treatment, however, some patients experience recurrent instability episodes and require ligament reconstruction. Recurrent episodes of ankle sprains may cause osteochondral lesions especially in the dome of talus bone. Painful ankle instability has to be evaluated for the presence of osteochondral lesions, as well.
Which imaging studies are done?
X-rays and MRI are the two main examinations to be studied before the surgery.
What is the treatment of ankle instability and related chondral damage?
Arthroscopic treatment of ankle osteochondral lesions is the gold standard. This approach gives the chance to treat some other conditions like inflammation of synovial membrane and removal of free osteochondral fragments with precision. If there is a concurrent instability it has to be treated at the same time to optimize the results.
How is the postoperative follow-up?
After the surgery, walking is allowed with crutches and an ankle brace for 6 weeks. Return to sports is allowed after 6 months from the surgery.