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KNOW YOUR KNEE

The knee is a hinge joint analogous to the hinges of the door allowing one way bending only. However it also allows some degree of twisting from side to side. It allows weight bearing and movement.

The knee is basically a construct of the thigh bone (called femur) and the shin bone (called tibia) and the knee cap (called patella).the bones are lined by a smooth layer called articular cartilage to allow smooth low-friction movement of the bearing surfaces. Between the femur and tibia are two floating cartilages called medial and lateral menisci which act as stabilisers, shock absorbers and increase the surface area of contact for stress distribution. There is a inner membrane layer called Synovium which produces fluid for lubrication and also nutrition for cartilage.

The knee is stabilised by two ligaments outside the joint called the medial and lateral collateral ligaments to support the knee and avoid side-to-side abnormal movement.

The knee is stabilised by two ligaments inside the joint called the ACL (anterior cruciate ligament) and PCL (posterior cruciate ligament) to prevent instability/buckling and avoid abnormal anterior/posterior transalation of the bones on each other.

The muscles around the knee are secondary stabilisers.

knee pain treatment in coimbatore
knee pain treatment in coimbatore

General

The ligaments/menisci/cartilage can get injured by a wide spectrum of injuries from simple twisting injuries or severe injuries like Sports,fall from height and Road Traffic Accidents.

Almost all conditions of the knee can be treated by arthroscopy of the knee. Meniscus tears Anterior cruciate ligament tear Recurrent dislocation of patella Posterior cruciate ligament tear Multiligament injury knee Osteoarthritis knee Rheumatoid arthritis knee Gouty arthritis Tuberculosis knee Septic arthritis knee Knee swelling of unknown causes

1-2 days(patients prefer weekend surgery)

No. Besides white-collar job professionals return to work the same week

Two small stitches are only needed. Hence scars are small and cosmetically appealing. In males, the presence of hair, obscures the scar completely.

In case of meniscal resections, the patient can go back to work in a couple of days itself once they are comfortable, especially for deskjobs and IT professionals. In case of meniscal repairs, the patient can go back to work with some restrictions in day-to-day activities.

Patients usually start driving cars in a week or two, based on their comfort.

Spinal anaesthesia or short general anaesthesia is sufficient usually

If the patient is fit and there are no other comorbid medical illnesses, he/she can get discharged on the same day or next day morning.

Definetely yes. Surgery is only half the battle. Adequate exercising with preplanned protocols under the guidance of your surgeon and physiotherapist is mandatory and ensures good successful results. A brace maybe needed for some time to protect the reconstructed ligament.

I meniscal repair has been performed, you may need crutches for some time.

the patient can usually return to sports in 4-8 weeks

Meniscus tears (kaleeshwaran and dr meera testimonial)

The menisci are two “C” shape elastic structures inside the knee joint which separate the bones forming the knee joint. This ensures that there is smooth movement of the knee joint

The menisci are analogous to the shock-absorbers of a vehicle. They aid in distributing the various stresses across the knee joint in day-to-day activities. These menisci also increase the surface area of loading in general and avoids future arthritis due to wear and tear.

This crucial meniscus can get torn due to a multitude of reasons leading to pain, swelling, limping, locking in a fixed position and difficulty in squatting, walking and climbing stairs

The menisci can get torn following Road Traffic Accidents, sports injuries and any form of twisting injury of the knee. Sometimes even a trivial twist like slipping in the bathroom, getting down stairs or climbing down the pavement on the road can cause a meniscal tear. Repeated short insults to the knee like jogging, running on uneven surfaces etc can cause overuse meniscal tear of the knee

Unfortunately meniscal tears do not heal with medications, since most of the meniscus does not have blood supply. Only small peripheral tears of the meniscus may heal with adequate rest, bracing, medications.

Meniscal tears need arthroscopic intervention. Usually two or maximum of three small 3 mm entry points and hence two or three stitches are enough to visualise the joint and tackle meniscus problems.

Meniscus resection -If it is a small tear, that small part can be resected. This prevents the small tear from extending into the rest of the meniscus and getting converted into a bigger tear and causing more damage.

Meniscus repair – young patients with recently diagnosed tears may not need resection always. When the tear is fresh, the meniscus can be repaired 100% and this ensures good healing.

Anterior cruciate ligament (ACL)

see knee anatomy

The ACL avoids abnormal anterior transalation between the tibia and femur. This prevents damage to the cartilage and meniscus.

The ACL can get torn usually following sports or after Road traffic accidents etc.. This leads to instability and a sense of buckling

Unfortunately no,ACL does not heal with medicines

the patient can usually return to sports in 4-8 weeks

The torn ACL can be reconstructed by arthroscopy with hamstrings or bone patellar-tendon-bone graft (add scar image too) and the patient can start walking the next day itself.

Rarely yes. If it is an ACL avulsion injury with a small bone piece, it is treated as a fracture and the native ACL can be reattached (attach my research publication)

1-3 days(patients prefer weekend surgery)

No. Besides white-collar job professionals return to work the same weekp>

Two small stitches are only needed. Hence scars are small and cosmetically appealing. In males, the presence of hair, obscures the scar completely. For hamstrings graft harvesting, another separate incision of around an inch size is needed.

The patient can go back to work in 3-10 days itself once they are comfortable (deskjobs and IT professionals). In case of meniscal repairs, the patient can go back to work with some restrictions in day-to-day activities.

Patients usually start driving cars at around 6-8 weeks based on their comfort and also recovery.

Spinal anaesthesia or short general anaesthesia is sufficient usually.

Definetely yes. Surgery is only half the battle. Adequate exercising with preplanned protocols under the guidance of your surgeon and physiotherapist is mandatory and ensures good successful results. A brace maybe needed for some time to protect the reconstructed ligament.

I meniscal repair has been performed, you may need crutches for some time. When can I return to sports? – the patient can usually return to sports in 12 weeks

The patella commonly also known as the knee cap which is located in front of the knee can get dislocated/slip out of position from position due to tear of the MPFL (medio patella-femoral ligament) which is a ligament in the inner side of the knee cap. At this time, a small bone chunk (osteochondral fragment) may get broken off and may lie loose in the knee which needs removal by arthroscopy. In some individuals, the patella may dislocate repeatedly due to unhealed MPFL ligament.

This is more common in females. There is usually a background history of dancing/sports, when the young girl hears a POP sound accompanied by excruciating pain and a feel of giving away of the knee

In few cases, the MPFL maybe opened up and the fibres maybe double breasted also. However in recurrent cases, it is better to reconstruct instead of repair.

Unfortunately not always do the MPFL tears heal with rest, bracing and medications. Then they need reconstruction.

Arthroscopy aids in diagnosis, loose body removal and also assists in ensuring that the patella is in central position while tightening the reconstructed MPFL and avoids overtightening/laxity of the new ligament.

No, not all arthroscopy surgeons can comfortably perform MPFL reconstruction, just as they do ACL reconstruction/ meniscal tears. This is technically a difficult procedure.

1-3 days(patients prefer weekend surgery)

No. Besides white-collar job professionals return to work the same week

No, not all arthroscopy surgeons can comfortably perform MPFL reconstruction, just as they do ACL reconstruction/ meniscal tears. This is technically a difficult procedure.

– Two small stitches are only needed. Hence scars are small and cosmetically appealing. In males, the presence of hair, obscures the scar completely. For hamstrings graft harvesting, another separate incision of around an inch size is needed.

The patient can go back to work in 3-10 days itself once they are comfortable (deskjobs and IT professionals). In case of meniscal repairs, the patient can go back to work with some restrictions in day-to-day activities.

Patients usually start driving cars at around 6-8 weeks based on their comfort and also recovery.

Spinal anaesthesia or short general anaesthesia is sufficient usually

Definetely yes. Surgery is only half the battle. Adequate exercising with preplanned protocols under the guidance of your surgeon and physiotherapist is mandatory and ensures good successful results. A brace maybe needed for some time to protect the reconstructed ligament.

I meniscal repair has been performed, you may need crutches for some time.

– the patient can usually return to sports in 12 weeks

Posterior cruciate ligament (PCL)

see knee anatomy

The PCL avoid abnormal posterior transalation between the tibia and femur. This prevents damage to the cartilage and meniscus.– the patient can usually return to sports in 12 weeks

The PCL can get torn usually following sports or after Road traffic accidents etc.. This leads to instability and a sense of buckling.

Unfortunately no, PCL does not heal with medicines.

1-3 days(patients prefer weekend surgery)

No. Besides white-collar job professionals return to work the same week– the patient can usually return to sports in 12 weeks

Two small stitches are only needed. Hence scars are small and cosmetically appealing. In males, the presence of hair, obscures the scar completely. For hamstrings graft harvesting, another separate incision of around an inch size is needed.

The patient can go back to work in 3-10 days itself once they are comfortable (deskjobs and IT professionals). In case of meniscal repairs, the patient can go back to work with some restrictions in day-to-day activities.

Patients usually start driving cars at around 6-8 weeks based on their comfort and also recovery.

Spinal anaesthesia or short general anaesthesia is sufficient usually.

Definetely yes. Surgery is only half the battle. Adequate exercising with preplanned protocols under the guidance of your surgeon and physiotherapist is mandatory and ensures good successful results. A brace maybe needed for some time to protect the reconstructed ligament

I meniscal repair has been performed, you may need crutches for some time.

the patient can usually return to sports in 12 weeks.

There are six ligaments in the knee. In high velocity injuries like road traffic accidents or contact sports like football,rugby etc. the knee is subjected to different directions of stresses leading to injury to multiple ligaments.

Patients may need one or two surgeries to repair the ligaments in different sequences to ensure good results. For individual ligaments, read under those sections separately..

Osteoarthritis knee (meera madam testimonial)

Osteoarthritis is a degenerative disease of the joint characterised by wear and tear leading to damage to the cartilage, damage to the meniscus, breakdown of small pieces of cartilage into joint called loose bodies and also inflammation.

there is selective role of arthroscopy in (a) early cases of Osteoarthritis (b) traumatic component of meniscal tears in a n arthritic knee (c) localised cartilage damage only

No Osteoarthritis cannot be cured definitely. It can only be controlled.

Yes. Although rheumatoid arthritis is a disease of the small joints, the knee is a common joint to get affected by rheumatoid arthritis.

DMARD’s (Disease modifying Anti-Rheumatoid Drugs) are usually sufficient to treat Rheumatoid Arthritis of all joints. These drugs have good anti-inflammatory action and controls the disease process. However, the drug combination needs dose-adjustment on a regular basis by an Orthopaedician/rheumatologist/physician to ensure that the disease stays well under control.

In acute active state of inflammation, the knee joint is very painful and does not respond to high doses of DMARD’s also. In such cases, the inflamed synovial tissue of the knee is debrided, shaved off and arthroscopic lavage also washes away the inflammatory mediators and gives good pain relief.

The proliferative inflamed synovium tends to eat off the cartilage (smooth layer lining the knee joint on either sides) and leads to early onset of secondary Osteoarthritis. Hence it needs to be removed when medical management does not seem to control the disease.

Yes. Although gout is a disease of the joints of the feet especially the joint of the great toe , the knee can also be involved.

Drugs like colchicine, Febuxostat and Analgesics are usually sufficient. These drugs have good anti-inflammatory action and controls the disease process. However, the drug combination needs dose-adjustment on a regular basis by an Orthopaedician/physician to ensure that the disease stays well under control.

In acute active state of inflammation, the knee joint is very painful and does not respond to high doses of medications also. In such cases, the inflamed synovial tissue of the knee is debrided, shaved off and arthroscopic lavage also washes away the inflammatory mediators and gives good pain relief. There are also some situations where the diagnosis cannot be confirmed even after an MRI scan and arthroscopy aids in diagnosis by performing synovial biopsy. In this procedure, the joint is completely visualised and suitable samples of tissue are taken for microscopic examination.

The proliferative inflamed synovium tends to eat off the cartilage (smooth layer lining the knee joint on either sides) and leads to early onset of secondary Osteoarthritis. Hence it needs to be removed when medical management does not seem to control the disease.

Yes, especially in a country like India. Although Tuberculosis is a disease of the Lungs, it can affect anywhere in the body from head to toe. The knee is the third most common skeletal region after the spine and the hip joint.

ATT (Anti Tuberculosis Therapy) are a group of drugs for treating Tuberculosis anywhere in the body. These drugs have good anti-inflammatory action and controls the disease process. However, the drug combination needs monitoring and dose-adjustment on a regular basis by an Orthopaedician/physician to ensure that the disease stays well under control.

In acute active state of inflammation, the knee joint is very painful and does not respond to high doses of ATT also. In such cases, the inflamed synovial tissue of the knee is debrided, shaved off and arthroscopic lavage also washes away the inflammatory mediators and gives good pain relief.

There are also some situations where the diagnosis cannot be confirmed even after an MRI scan and arthroscopy aids in diagnosis by performing synovial biopsy. In this procedure, the joint is completely visualised and suitable samples of tissue are taken for microscopic examination.

The proliferative inflamed synovium tends to eat off the cartilage (smooth layer lining the knee joint on either sides) and leads to early onset of secondary Osteoarthritis. Hence it needs to be removed when medical management does not seem to control the disease.

This is an acute knee emergency. As the name suggests, the knee is filled with lot of pus. This warrants urgent surgical drainage.

Elderly and children are the common age groups. The hip is another common joint for similar infection to occur. Immunocompromised individuals (Ex.Diabetes, HIV positive patients, asthmatics on steroid usage etc) are more prone for this condition.

“Pus anywhere in the body should be let out” is a common surgical adage. This pus has the tendency to eat away your cartilage (the smooth layer on either sides of your joint) leading to early onset Osteoarthritis, bony ankylosis (pathological fusion of the bony ends of the joint leading to stiff joint) or in the worst of cases, the pus can spread throughout the body and lead to generalised sepsis, multiorgan dysfunction syndrome and ultimately DEATH.

Traditionally the knee was opened by a 12 – 15 cm incision and the pus was cleared along with debridement of the dead muck of tissue called synovium. This procedure was morbid with wound healing problems, knee stiffness, severe pain postoperatively and difficult physiotherapy. On the other hand, Arthroscopic lavage and shaving of the infected synovial tissue by just two 3 mm holes ensures adequate clearance of the same with much lesser mortality.

Yes antibiotics play a role to clear the infection fully, but after surgical debridement only, either by open/arthroscopic surgery. Initially antibiotics are given Intravenously and later orally.