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Centres: Centre for Orthopaedics & Joint Replacement >
Mimimally Invasive Surgery
ARTHROSCOPY
(MINIMAL INsVASIVE SURGICAL SERVICES)
Arthroscopy is a surgical procedure orthopaedic surgeons use to visualize, diagnose, and repairs your injured or diseased joint with the help of an optical instrument called an arthroscope . The word arthroscopy comes from two Greek words, "arthro" (joint) and "skopein" (to look). The term literally means "to look within the joint." A video camera attached to the arthroscope relays the view from within your joint to a video monitor. Because the arthroscope is so narrow, your surgeon needs only a small incision to place it in your joint. Doctors use arthroscopy to help diagnose and treat a variety of joint conditions — most commonly those affecting the knee, shoulder, elbow, ankle, hip and wrist — in people of all ages.
You'll receive general, regional or local anesthesia. General anesthesia is sometimes the best option for repairing acute injuries, or for procedures in which the surgeon has to reposition the arthroscope repeatedly. Regional anesthesia leaves you awake while blocking sensation in a large part of your body. The most common form of regional anesthesia is delivered through a small tube placed between two of your vertebrae, or spine bones. Local anesthesia involves injecting numbing agents below the skin to block sensation in a limited area, such as your knee. With local anesthesia, you'll be awake during your arthroscopy, but the most you'll feel is pressure or a sensation of movement within the joint.
Arthroscopic surgery usually takes between half an hour to two hours, depending on the procedure performed.
Your doctor may give you medication to relieve pain and inflammation. You may need to temporarily use splints, slings or crutches for comfort and protection. Your will be prescribed physical therapy and rehabilitation to help strengthen your muscles and improve the function of your joint.
In general, you should be able to resume desk work and light activity in two days and more strenuous activity in two weeks.
HIP ARTHROSCOPYis performed through small incisions using a camera to visualize the inside of a joint. Through several small incisions (about 1 centimeter each) your surgeon will insert a camera into one incision, and small instruments through the other incisions.
it is much less invasive than traditional hip surgery which means early and accelerated rehabilitation , Smaller incisions and early return to sport . The conditions that can be treated with Hip arthroscopy include Labral tear; loose pieces of cartilage; Snapping hip syndrome and cartilage damage
Most patients can begin light activities (cycling, swimming) within a few weeks. Athletes most often take about 12 weeks for recovery.
KNEE Meniscal TearsYour knee is the largest joint in your body and one of the most complex. Three bones meet to form your knee joint: - your thighbone (femur), shinbone (tibia), and kneecap (patella).Because you use it so much, it is vulnerable to injury. Because it is made up of so many parts, many different things can go wrong.
Two wedge-shaped pieces of cartilage act as "shock absorbers" between your thighbone and shinbone. These are called meniscus. They are tough and rubbery to help cushion the joint and keep it stable. Meniscal tears are among the most common knee injuries. Athletes, particularly those who play contact sports, are at risk for meniscal tears. However, anyone at any age can tear a meniscus. When people talk about torn cartilage in the knee, they are usually referring to a torn meniscus.
You might feel a "pop" when you tear a meniscus. Most people can still walk on their injured knee. Many athletes keep playing with a tear. Over 2 to 3 days, your knee will gradually become more stiff and swollen.
The most common symptoms of meniscal tear are: Pain , Stiffness and swelling , Catching or locking of your knee , The sensation of your knee "giving way" , You are not able to move your knee through its full range of motion .
Without treatment, a piece of meniscus may come loose and drift into the joint. This can cause your knee to slip, pop or lock.
Knee arthroscopy is one of the most commonly performed surgical procedures. In it, a miniature camera is inserted through a small incision. This provides a clear view of the inside of the knee. Your orthopaedic surgeon inserts miniature surgical instruments through other small incisions to trim or repair the tear.
Arthroscopic Treatment of Meniscal Tears After surgery, your doctor may put your knee or brace to keep it from moving.
Once the initial healing is complete, your doctor will prescribe rehabilitation exercises. Regular exercise to restore your knee mobility and strength is necessary. You will start with exercises to improve your range of motion. Strengthening exercises will gradually be added to your rehabilitation plan.
For the most part, rehabilitation can be carried out at home, although your doctor may recommend physical therapy.
Anterior Cruciate Ligament (Acl) Reconstruction The anterior cruciate ligament (ACL) keeps your shin bone (tibia) in place. A tear of this ligament can cause your knee to give way during physical activity. ACL reconstruction is surgery to replace the ligament in the center of your knee with a new ligament. The tissue that will replace your damaged ACL will come from your own body or from a donor. Tissue taken from your own body is called an autograft. The two most common places to take tissue from are a tendon in your knee or your hamstring. Your hamstring is a tendon behind your knee. We use bioabsorbable implants to fix tendons as these will not be required to be removed at the procedure is usually done by Arthroscopy wherein a tiny camera is inserted into the knee through a small incision (cut). The camera is connected to a video monitor in the operating room. Your surgeon will use the camera to check the ligaments and other tissues of your knee.
At the end of the surgery, your surgeon will close your incisions with sutures (stitches) and put a dressing on them. We take pictures during the procedure from the video monitor so that afterward you can see what was found and what was done.
You will probably go home the day of your surgery. You may have to wear a knee brace for the first 1 to 4 weeks. You also may need crutches for 1 to 4 weeks. You may need medicine to manage your pain.
Physical therapy can help many people regain motion and strength in their knee. Therapy can last 2 to 6 months.
How soon you return to work will depend on the kind of work you do. It can be anywhere from a few days to a few months. A full return to activities and sports usually takes 4 to 6 months. ACL reconstruction is usually very successful.
CARTILAGE TRANSPLANT: A meniscus transplant is a procedure that replaces the wedge shaped cartilage of the knee joint. The meniscus transplant procedure uses donor tissue to replace tissue that was removed at a prior surgery. Meniscus transplantation, or placing cartilage from a cadaver donor into a patient, has become a possible treatment for patients with a specific pattern of knee pain. The ideal patient is someone who had their meniscus removed, and subsequently begins to develop knee pain.
Who is a good candidate for a meniscus transplant?
As described previously, patients must fit specific criteria in order to be considered a good candidate for meniscus transplant surgery. The goal of a meniscus transplant surgery is to reduce pain associated with normal activities. It is possible that patients may not be able to resume competitive athletics despite a successful meniscus transplant. Patients who expect more than reduction of pain may want to consider other options as they may find disappointment with their results.
Most surgeons have patients protect the knee with crutches for four to six weeks. Patients will not be able to squat, run, or perform athletic activities for at least several months. Most patients who have a successful outcome return to their usual activities by about six months from surgery.
SHOULDER
ROTATOR CUFF TEAR TREATMENT The rotator cuff helps to lift and rotate the arm and to stabilize the ball of the shoulder within the joint. The rotator cuff is made up of four muscles and their tendons. These combine to form a " cuff " over the upper end of the arm (head of the humerus).
Cause The rotator cuff can be torn from a single traumatic injury. Patients often report recurrent shoulder pain for several months and a specific injury that triggered the onset of the pain. A cuff tear may also happen at the same time as another injury to the shoulder, such as a fracture or dislocation.
Most tears, however, are the result of overuse of these muscles and tendons over a period of years. People who are especially at risk for overuse are those who engage in repetitive overhead motions. These include participants in sports such as baseball, tennis, weight lifting, and rowing.
Rotator cuff tears are most common in people who are over the age of 40. Younger people tend to have rotator cuff tears following acute trauma or repetitive overhead work or sports activity.
Rotator cuff tear may often happen as a result of wear and tear.
Some of the signs of a rotator cuff tear include:
Over time the pain may become noticeable at rest or with no activity at all. There may be pain when lying on the affected side and at night.
Diagnosis Diagnosis of a rotator cuff tear is based on the symptoms and physical examination. X-rays, and imaging studies, such as MRI (magnetic resonance imaging) or ultrasound, are also helpful. An MRI can sometimes tell how large the tear is, as well as its location within the tendon itself or where the tendon attaches to bone
Your doctor will examine the shoulder to see whether it is tender in any area or whether there is a deformity. He or she will measure the range of motion of the shoulder in several different directions and will test the strength of the arm. The doctor will also check for instability or other problems with the shoulder joint.
Surgical Treatment
Your orthopaedic surgeon may recommend surgery if
In general, three approaches are available for surgical repair. These include:
You'll receive general, regional or local anesthesia. General anesthesia is sometimes the best option for repairing acute injuries, or for procedures in which the surgeon has to reposition the arthroscope repeatedly. Regional anesthesia leaves you awake while blocking sensation in a large part of your body. The most common form of regional anesthesia is delivered through a small tube placed between two of your vertebrae, or spine bones. Local anesthesia involves injecting numbing agents below the skin to block sensation in a limited area, such as your knee. With local anesthesia, you'll be awake during your arthroscopy, but the most you'll feel is pressure or a sensation of movement within the joint.
Arthroscopic surgery usually takes between half an hour to two hours, depending on the procedure performed.
Your doctor may give you medication to relieve pain and inflammation. You may need to temporarily use splints, slings or crutches for comfort and protection. Your will be prescribed physical therapy and rehabilitation to help strengthen your muscles and improve the function of your joint.
In general, you should be able to resume desk work and light activity in two days and more strenuous activity in two weeks.
HIP ARTHROSCOPYis performed through small incisions using a camera to visualize the inside of a joint. Through several small incisions (about 1 centimeter each) your surgeon will insert a camera into one incision, and small instruments through the other incisions.
it is much less invasive than traditional hip surgery which means early and accelerated rehabilitation , Smaller incisions and early return to sport . The conditions that can be treated with Hip arthroscopy include Labral tear; loose pieces of cartilage; Snapping hip syndrome and cartilage damage
Most patients can begin light activities (cycling, swimming) within a few weeks. Athletes most often take about 12 weeks for recovery.
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KNEE Meniscal TearsYour knee is the largest joint in your body and one of the most complex. Three bones meet to form your knee joint: - your thighbone (femur), shinbone (tibia), and kneecap (patella).Because you use it so much, it is vulnerable to injury. Because it is made up of so many parts, many different things can go wrong.
Two wedge-shaped pieces of cartilage act as "shock absorbers" between your thighbone and shinbone. These are called meniscus. They are tough and rubbery to help cushion the joint and keep it stable. Meniscal tears are among the most common knee injuries. Athletes, particularly those who play contact sports, are at risk for meniscal tears. However, anyone at any age can tear a meniscus. When people talk about torn cartilage in the knee, they are usually referring to a torn meniscus.
You might feel a "pop" when you tear a meniscus. Most people can still walk on their injured knee. Many athletes keep playing with a tear. Over 2 to 3 days, your knee will gradually become more stiff and swollen.
The most common symptoms of meniscal tear are: Pain , Stiffness and swelling , Catching or locking of your knee , The sensation of your knee "giving way" , You are not able to move your knee through its full range of motion .
Without treatment, a piece of meniscus may come loose and drift into the joint. This can cause your knee to slip, pop or lock.
Knee arthroscopy is one of the most commonly performed surgical procedures. In it, a miniature camera is inserted through a small incision. This provides a clear view of the inside of the knee. Your orthopaedic surgeon inserts miniature surgical instruments through other small incisions to trim or repair the tear.
Arthroscopic Treatment of Meniscal Tears After surgery, your doctor may put your knee or brace to keep it from moving.
Once the initial healing is complete, your doctor will prescribe rehabilitation exercises. Regular exercise to restore your knee mobility and strength is necessary. You will start with exercises to improve your range of motion. Strengthening exercises will gradually be added to your rehabilitation plan.
For the most part, rehabilitation can be carried out at home, although your doctor may recommend physical therapy.
Anterior Cruciate Ligament (Acl) Reconstruction The anterior cruciate ligament (ACL) keeps your shin bone (tibia) in place. A tear of this ligament can cause your knee to give way during physical activity. ACL reconstruction is surgery to replace the ligament in the center of your knee with a new ligament. The tissue that will replace your damaged ACL will come from your own body or from a donor. Tissue taken from your own body is called an autograft. The two most common places to take tissue from are a tendon in your knee or your hamstring. Your hamstring is a tendon behind your knee. We use bioabsorbable implants to fix tendons as these will not be required to be removed at the procedure is usually done by Arthroscopy wherein a tiny camera is inserted into the knee through a small incision (cut). The camera is connected to a video monitor in the operating room. Your surgeon will use the camera to check the ligaments and other tissues of your knee.
At the end of the surgery, your surgeon will close your incisions with sutures (stitches) and put a dressing on them. We take pictures during the procedure from the video monitor so that afterward you can see what was found and what was done.
You will probably go home the day of your surgery. You may have to wear a knee brace for the first 1 to 4 weeks. You also may need crutches for 1 to 4 weeks. You may need medicine to manage your pain.
Physical therapy can help many people regain motion and strength in their knee. Therapy can last 2 to 6 months.
How soon you return to work will depend on the kind of work you do. It can be anywhere from a few days to a few months. A full return to activities and sports usually takes 4 to 6 months. ACL reconstruction is usually very successful.
CARTILAGE TRANSPLANT: A meniscus transplant is a procedure that replaces the wedge shaped cartilage of the knee joint. The meniscus transplant procedure uses donor tissue to replace tissue that was removed at a prior surgery. Meniscus transplantation, or placing cartilage from a cadaver donor into a patient, has become a possible treatment for patients with a specific pattern of knee pain. The ideal patient is someone who had their meniscus removed, and subsequently begins to develop knee pain.
Who is a good candidate for a meniscus transplant?
- A young to middle-age patient (20-50 years old)
- Underwent prior meniscectomy (removal of meniscus)
- Normal or limited damage to the articular cartilage (bone lining) of the joint
- Symptoms consistent with the absence of a meniscus
As described previously, patients must fit specific criteria in order to be considered a good candidate for meniscus transplant surgery. The goal of a meniscus transplant surgery is to reduce pain associated with normal activities. It is possible that patients may not be able to resume competitive athletics despite a successful meniscus transplant. Patients who expect more than reduction of pain may want to consider other options as they may find disappointment with their results.
Most surgeons have patients protect the knee with crutches for four to six weeks. Patients will not be able to squat, run, or perform athletic activities for at least several months. Most patients who have a successful outcome return to their usual activities by about six months from surgery.
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SHOULDER
ROTATOR CUFF TEAR TREATMENT The rotator cuff helps to lift and rotate the arm and to stabilize the ball of the shoulder within the joint. The rotator cuff is made up of four muscles and their tendons. These combine to form a " cuff " over the upper end of the arm (head of the humerus).
Cause The rotator cuff can be torn from a single traumatic injury. Patients often report recurrent shoulder pain for several months and a specific injury that triggered the onset of the pain. A cuff tear may also happen at the same time as another injury to the shoulder, such as a fracture or dislocation.
Most tears, however, are the result of overuse of these muscles and tendons over a period of years. People who are especially at risk for overuse are those who engage in repetitive overhead motions. These include participants in sports such as baseball, tennis, weight lifting, and rowing.
Rotator cuff tears are most common in people who are over the age of 40. Younger people tend to have rotator cuff tears following acute trauma or repetitive overhead work or sports activity.
Rotator cuff tear may often happen as a result of wear and tear.
Some of the signs of a rotator cuff tear include:
- Atrophy or thinning of the muscles about the shoulder
- Pain when lifting the arm
- Pain when lowering the arm from a fully raised position
- Weakness when lifting or rotating the arm
- Crepitus or crackling sensation when moving the shoulder in certain positions
Over time the pain may become noticeable at rest or with no activity at all. There may be pain when lying on the affected side and at night.
Diagnosis Diagnosis of a rotator cuff tear is based on the symptoms and physical examination. X-rays, and imaging studies, such as MRI (magnetic resonance imaging) or ultrasound, are also helpful. An MRI can sometimes tell how large the tear is, as well as its location within the tendon itself or where the tendon attaches to bone
Your doctor will examine the shoulder to see whether it is tender in any area or whether there is a deformity. He or she will measure the range of motion of the shoulder in several different directions and will test the strength of the arm. The doctor will also check for instability or other problems with the shoulder joint.
Surgical Treatment
Your orthopaedic surgeon may recommend surgery if
- Nonsurgical treatment does not relieve symptoms
- The tear has just occurred and is very painful
- The tear is in the shoulder of the dominant arm of an active person
- If maximum strength in the arm is needed for overhead work or sports
In general, three approaches are available for surgical repair. These include:
- Arthroscopic Repair. A fiberoptic scope and small, pencil-sized instruments are inserted through small incisions instead of a large incision. The arthroscope is connected to a television monitor and the surgeon can perform the repair under video control.
- Mini-Open Repair. Newer techniques and instruments allow surgeons to perform a complete rotator cuff repair through a small incision, typically 4 cm to 6 cm.
- Open Surgical Repair. A traditional open surgical incision is often required if the tear is large or complex or if additional reconstruction, such as a tendon transfer, has to be done. In some severe cases, where arthritis has developed, one option is to replace the shoulder joint.
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