Arthroscopy & Sports Medicine

Arthroscopy & Sports Medicine

Arthroscopic Surgery is often performed in an outpatient surgery center, which means no overnight hospital stay is required. Patients report to the surgical center in the morning, undergo the procedure and following a recovery period under the care of medical professionals-return home later in the day.

Commonly Performed PROCEDURES

  • Diagnostic and Therapeutic procedures of Knee.
  • Arthroscopic ACL/PCL Reconstruction of repair
  • Arthroscopic Meniscus repair of Resection
  • Patellofemoral Pathology
  • Cartilage repair | Reconstrucion
  • Sports injuries | PRP | BMAC
  • Multiligament Repair | Rotaor cuff repair
  • Diagnostic & Therapeutic procedures of Shoulder
  • Labral tear | SLAP tear Repair
  • Adhesive Capsulitis | Hydrodilatation
  • Diagnostic & Therapeutic procedures Ankle Wrist & Elbow joint

Arthroscopic surgery became popular in the late 1970s as fiber-optic technology enabled surgeons to see inside the body using a small telescope, called an “arthroscope”, which projects an image to a television monitor. Today, active patients all over the world experience its benefits.

Through an incision the width of a straw tip, your surgeon is able to insert an arthroscope, which allows him or her to inspect your joint and locate the source of your pain. He or she will then make one or more small incisions to accommodate the instruments that will repair the knee. These instruments can shave, trim, cut, stitch, or smooth the damaged areas.

  • Approximately 500,000 ACL injuries occur each year in the United States, much more in India but going unrecognized.
  • Female athletes are 4 times more prone and growing number of ACL tears in children and adolescents due highly competitive nature of youth sports.
  • In our country fall from two wheelers, RTA and twisting injuries are more common mode of injuries.

What is the Anterior Cruciate Ligament (ACL)?

  • The ACL is one of the four main ligaments of the knee.
  • It stabilizes the knee joint and protects the tibia (shin bone) from sliding forward and rotating on the femur (thigh bone).

What happens when the ACL is torn?

  • When the ACL is torn, the knee is unstable and prone to recurrent injury.
  • If an athlete returns to sport without ACL reconstruction, the knee may “give out” and injures the bearing surface (cartilage) and shock absorber (meniscus) inside the knee joint and can cause early degeneration.

How do I know when the ACL is torn?

  • The patient feels the sensation of a “pop” at the time of the injury following which have immediate swelling and pain in the knee joint.
  • An ACL tear is then diagnosed by physical examination. A special maneuver called the Lachman’s exam and anterior drawers test.
  • Magnetic Resonance Imaging (MRI) is used to confirm the diagnosis and is helpful in determining concurrent meniscal and cartilage injury.

Treatment Options

  • Functional bracing and non-operative management may lead to episodes of knee instability if the athlete returns to sport.
  • Episodes of instability inevitably lead to cumulative damage in the knee joint.
  • Arthroscopic ACL reconstruction using hamstring tendons or BPTB graft stabilizes the knee joint to allow participation in sports and prevent further meniscal or cartilage damage.

What is the Posterior Cruciate Ligament (PCL)?

  • The PCL is Extra-synovial, intra-capsular ligament, Stronger of both the cruciates.
  • Two bundles – anterolateral (stretches in flexion) and posteromedial (stretches in extension)
  • The PCL is the primary restraint to posteriortibial translation

How can it get injured?

  • A direct blow to the proximal anterior tibia in a flexed knee Eg: Dashboard injuries and falls on a hyperflexed knee
  • Hyperextension injuries
  • Patients with PCL insufficiency are at increased risk for meniscal tears, articular cartilage injury, and patellofemoral/medial compartment arthritis

How to diagnose it?

  • Always difficult in acute situation
  • High index of Suspicion
  • Anterior knee injury
  • Abrasion, Ecchymosis, effusion. Swelling in the proximal calf region as blood seeps into the posterior compartment muscles.(Unlike ACL injuries Knee effusion is slow to develop)
  • Classic clinical test for PCL injury
    • Posterior Drawer
    • Tibial Sag sign or Godfrey’s test
    • step off sign
    • Quadriceps Active Test
    • Dial Test and Reverse Pivot shift test (PLC injuries)
    • Magnetic Resonance Imaging (MRI) is used to confirm the diagnosis and is helpful in determining concurrent meniscal and cartilage injury.
     

Arthoscopic surgery became popular in the late 1970s as fiber-optic technology enabled surgeons to see inside the body using a small telescope, called an “arthoscope”, which projects an image to a television monitor. Today, active patients all over the world experience its benefits.

Through an incision the width of a straw tip, your surgeon is able to insert an arthroscope, which allows him or her to inspect your joint and locate the source of your pain. He or she will then make one or more small incisions to accommodate the instruments that may be used to repair the shoulder. These instruments can shave, trim, cut, stitch, or smooth the damaged areas.

Meniscal injuries can be addressed arthroscopically either repair or resection can be done depending on the type and duration of the tear.

Arthoscopic shoulder surgery is often performed in an outpatient surgery center, which means no overnight hospital stay is required. Patients report to the surgical center in the morning, undergo the procedure and following a recovery period under the care of medical professionals – return home later in the day.

Rotator cuff is a group of four tendons that join together and facilitate rotation of the arm bone, or humerus, at the shoulder. The most commonly injured tendons of the rotator cuff are the supraspinatus and infraspinatus tendons. These two tendons lie just beneath the acromion, bony arch of the shoulder Degenerative tears in middle age after years of wear and tear, or they can occur in younger athletes.

Rotator Cuff Tears

Rotator cuff injuries have a spectrum of severity, Inflammation of the rotator cuff and bursa.

Partial tearing of the rotator cuff. A partial rotator cuff tear occurs when the tendon starts to break down or tear, but has not actually torn completely through the tendon. Two types Bursal tear and Articular tear.
A partial rotator cuff tear may gradually worsen over time and eventually become a full thickness tear, or it may suddenly “snap” and become a full thickness tear as a result of trauma, or from trying to lift a heavy object.
A full thickness rotator cuff tear usually starts out as a small tear, which can progress over time to a medium or large tear, or even a massive tear.

Symptoms of a Rotator Cuff Tear

Rotator cuff tears may be asymptomatic, or they may cause pain and weakness of the shoulder.
Rotator cuff tears usually cause pain with shoulder motion, and shoulder motion may actually become limited due to pain.
Sometimes the pain is not in the shoulder itself, but refers to the affected arm. It is also very common to have night pain.
Because a painful shoulder becomes inefficient in its motions, muscles in the upper back, neck and arm may become painful as they try to compensate for the abnormal shoulder motion.
With a full thickness rotator cuff tear, the arm may become weak when trying to lift things in certain positions.

Diagnosis

  • Rotator cuff tears can usually be diagnosed with a history and physical examination.
  • X-rays are useful in determining acromion morphology, which may and superior migration of humeral head.
  • MRI (Magnetic Resonance Imaging) scans are very good at showing the extent and severity of a rotator cuff tear.

Treatment

A partial thickness rotator cuff has a good chance of healing without surgery.
Physiotherapy is an important treatment option as it will help regain any lost motion, and it will condition the other muscles of the shoulder – allowing more efficient use of the arm, giving a chance for the torn tendon to heal.
Icing the shoulder twenty minutes twice daily will also help reduce inflammation and relieve pain – it is especially helpful to ice the shoulder before bed if sleeping is difficult.
An arthroscopy of the shoulder (see below) may be a treatment option if pain continues despite physical therapy and a corticosteroid injection. During arthroscopy, the torn portion of the tendon is removed, leaving the healthy, intact fibers of the tendon. The inflamed bursa is removed, and the “hooked” portion of the acromion which pinches the tendons is shaved away, alleviating pain and allowing more space to prevent further tearing of the rotator cuff.

A partial thickness rotator cuff tear as seen from inside the joint, before shaving torn tissue (left) and after (right)

A large, full thickness rotator cuff tear as seen from above, before repair (left) and after repair (right)

A full thickness rotator cuff tear in most cases is best treated with an arthroscopy. During the surgery anchors are placed in the bone at the location where the tendon should be attached; these anchors have stitches in them, which are passed through the torn tendon and tied. When these stitches are tied, the tendon is pulled back down to the bone, allowing the tendon to heal in place.

The hooked portion of the acromion is also shaved away, allowing more space and preventing pinching of the repaired rotator cuff. After a rotator cuff repair, the tendon must be able to heal in place. While it is important to move the shoulder to prevent scar tissue, or a frozen shoulder, from developing, there should only be passive motion of the shoulder.

Passive motion is when a physical therapist moves the shoulder for the patient – the patient should not make any active effort to move the shoulder by himself. Usually, these passive motion only restrictions apply for four weeks. After the tissues have had time to heal, the physical therapist will advance your activities, and you will start strengthening exercises. While recovery is different for every patient, you should expect about four months of physical therapy, two to three times weekly, with additional exercises at home after you are done with therapy.

Shoulder Dislocation/Instability

The shoulder is a ball and socket joint, surrounded by rim of soft tissue called labrum. It is shallow when compared to hip joint which predisposes to instability. A dislocated shoulder is when the head of the humerus is out of the shoulder joint.

TYPES

  • Anterior
  • Posterior
  • Inferior
  • Multidirectional

SYMPTOMS

  • Significant pain
  • Sensation of slipping out of the joint during abduction and external rotation.
  • Resistance of all movement.
  • Numbness of the arm.
  • Recurrent dislocations, the apprehension test (anterior instability) and sulcus sign (inferior instability) are useful methods for determining predisposition to future dislocation.

DIAGNOSIS

  • Patient history and physical examination.
  • Radiographs to shows incongruence of the glenohumeral joint.
  • After reduction, radiographs are usually repeated to confirm successful reduction and to detect bony damage.

MRI scan may be used to assess soft tissue damage

  • Bankart Lesion
  • Hill-Sachs Lesion
  • Rotator Cuff Tear
  • Axillary Nerve Injury
  • Labral Tears

TREATMENT OPTIONS

First time Dislocator: Close reduction of acute dislocation and rehabilitation.
Recurrent dislocations: Arthroscopic Labral repair/ Bankart repair.
Open Laterjet Procedure

Bankart lesions

Bankart lesions are disruptions of the glenoid labrum with or without an avulsion of bonefragment. During an arthroscopy repair, the torn labrum is reattached to the glenoid using some anchors with stitches in them, recreating the “bumper” that prevents the humeral head from slipping out. This is known as a Bankart repair

Latarjet procedure

Latarjet procedure involves the removal and transfer of a section of the coracoid process and its attached muscles to the front of the glenoid. This placement of the coracoid acts as a bone block which, combined with the transferred muscles acting as a strut, prevents further dislocation of the joint.

Consultants

Dr.M.Chidambaram
Dr.M.Chidambaram
M.S.Ortho.,D.Ortho
Dr.M.Chidambaram
Dr.Prahalad Kumar Singhi
D. Ortho., DNB, Ortho
Dr.M.Chidambaram
Dr.T.Vinoth
M. S. Ortho
Dr.M.Chidambaram
Dr.G.Prasanth
M. S. Ortho.,