What are the Most Common Types of Arthroscopies Surgeries Performed?
Best Arthroscopy Treatment Near Me - Some of the most common arthroscopic surgeries performed include knee, shoulder, hip, and ankle surgery. A brief description of Knee Arthroscopy and Shoulder Arthroscopy is described below -
Knee Arthroscopy Treatment in Delhi
Anatomy of the Knee Ligaments
The knee is the largest joint of the body consisting of tibiofemoral and patellofemoral articulations.The knee joint is inherently unstable and stability is largely dependent on the surrounding capsule-ligamentous complex.
Ligaments and menisci primarily stabilizing the knee joint are:
- Collateral ligaments (medial and lateral)
- Cruciate ligaments (anterior and posterior)
- Menisci (medial and lateral)
This group includes the medial and the lateral collateral ligaments that are extra-articular and extra-synovial.
Lateral Collateral Ligament (LCL)/Fibular Collateral Ligament: It extends from the lateral femoral epicondyle to the apex of the head of the fibula.
Medial Collateral Ligament (MCL)/Tibial Collateral Ligament: It begins from the medial epicondyle (exactly little proximal and posterior to the epicondyle) of the femur and runs down to attach on the medial condyle of the tibia approximately 6-7 cm distal to the joint line.
Functions of Collateral Ligaments
The collateral ligaments are present on either side of the knee joint. Their prime role is to provide stability against a varus or a valgus force as shown in the image above. If Valgus stress (distal to joint, limb moves outwards) is given to the knee, the MCL is stretched and torn and vice versa. So, collateral ligaments basically stabilize the knee joint in the coronal plane. Varus stability is maintained by LCL and valgus stability is maintained by MCL.
These include the anterior and the posterior cruciate ligaments that classically cross centrally in the joint in the shape of an “X” when viewed from the front.
Anterior cruciate ligament (ACL): It takes origin from the medial wall of the lateral femoral condyle (posteriorly in the area of the intercondylar notch) and courses anteriorly and medially to insert into the intercondylar area of the tibia.
Posterior cruciate ligament (PCL): This ligament (1.5 times thicker than ACL) has a course opposite to that of ACL. It takes origin from the lateral wall of the medial femoral condyle and courses posteriorly and laterally to insert on an area that is around 1.5 cm posterior and inferior to the posterior articular margin of the tibia.
Functions of Cruciate Ligaments
Since the ACL runs from the front on the tibia coursing back to attach to the femur, it will be stretched when the tibia moves forwards on femur while the PCL would stretch when the tibia is forced back on the femur. Hence, these ligaments function to provide knee stability in the anteroposterior direction. ACL prevents the tibia from displacing forwards on femur while the PCL prevents the tibia from displacing backwards on the femur. Thus, their prime role is to stabilize the knee in the sagittal plane of the body.
The menisci are the wedge-shaped semilunar fibrocartilaginous disks (made primarily of type I collagen) that are sandwiched between the opposing femoral and tibial condyles.
Functions of Menisci
The collateral ligaments are present on either side of the knee joint. Their prime role is to provide stability against a Varus or a Valgus force as shown in the image below. If valgus stress (distal to joint, limb moves outwards) is given to the knee, the MCL is stretched and torn and vice versa. So, collateral ligaments basically stabilize the knee joint in the coronal plane. Varus stability is maintained by LCL and valgus stability is maintained by MCL.
When do you Need a Knee Arthroscopy?
- The major symptoms are knee pain and swelling following a knee injury.
- Swelling is abrupt in the case of cruciate ligament tears and meniscal tears the swelling appears after a night.
- A clicking sound on flexion or extension of knee as in climbing up or down the stairs.
- Locking of the knee
Knee Arthroscopy is the common arthroscopy procedure performed by orthopedists. The frequently observed arthroscopic procedures to the knee include:
- ACL/PCL: Torn anterior or posterior cruciate ligament.
- Meniscus tear.
- Dislocated patella (knee cap).
Arthroscopic procedures allow your surgeon to repair issues related to the knee with surgical techniques like suturing, inserting pins or rivets, or repositioning bones. It also helps extract tissue or bone that causes pain, for example:
- Loose cartilage or its parts.
- Arthritis associated Baker's cyst.
- Swollen or inflamed synovium (the lining in the joint)
Post-Surgery Recovery & Rehabilitation
Post-surgery, you will be discharged with instructions to care for your incisions and to heal early. Pain medications will be given, and recommendations for exercises or physical therapy will be provided. Recovery time usually varies for patients; some patients can return to school or work within a week. At the same time, many others can return to everyday, active lifestyles within one or two months.
Shoulder Arthroscopy Treatment in Delhi
Most common arthroscopic shoulder surgery procedures are conducted due to the following:
Dislocation of Shoulder
Dislocation of the shoulder is the most common dislocation in orthopedics that comprises of almost 50% of all dislocations that are presented to an orthopedic clinic. Uncommon in children, it most commonly affects young, active males below 30 years of age. In most of the patients, the joint dislocates recurrently even with minimal trauma due to the failure of important stabilizing restraints to heal up. The younger the age at first dislocation, the higher the chances the patient may come back with recurrence. Dislocation of shoulder can be anterior, posterior or inferior (depending upon where the humeral head goes in relation to the glenoid).
When do you get a Shoulder Dislocation?
A traumatic anterior shoulder dislocation mostly results from a fall on an outstretched hand with an abducted and externally rotated shoulder (shoulder in throwing position). Convulsive disorders and electric shock are the common causes of a posterior dislocation as in such situations the shoulder at times gets forcefully adducted and internally rotated. Inferior dislocations result from hyper abduction injuries of the shoulder.
Most first time dislocations of the shoulder are traumatic in nature. Patients present with a history of trauma and severe pain in the shoulder with the inability to use the limb.
Bankart's repair is currently the mainstay of treatment. Here the torn labrum and the detached capsule are reattached back to the anteroinferior glenoid rim with suture anchors (anchors are special fixation devices capable of fixing soft tissue to bone). The procedure nowadays is done arthroscopically and arthroscopic Bankart's repair is the treatment of choice.
It is essential to understand that since the shoulder is a joint entirely stabilized by soft tissue, patients who tend to have lax ligaments from any cause can exhibit abnormal pathological motion in the joint. The reason for the ligament laxity can be multifold appropriately coated as torn loose (ligament laxity after trauma when the native ligaments fail to heal up), born loose (ligament laxity secondary to genetic defects) or micro-trauma (players involved in throwing sports who gradually stress their shoulder stabilizers due to repetitive external rotation and abduction). Lax ligaments or capsule from any cause makes these patients more prone to dislocation with minimal trauma and also predisposes them to more chances of recurrent dislocations. However, at times they may not experience a frank dislocation, but rather have a minimal extra motion that manifests as a subluxation. Such subluxations withhold them from participating in sporting activities or at times may even interfere with their daily routine.
Management & Treatment
The patients who tend to have recurrent instability secondary to generalized ligamentous laxity, i.e. born loose patients mostly present with multidirectional instability (inferior instability plus either anterior or posterior instability or both) while the patients who tend to be in the other two categories (torn loose or microtrauma) tend to present with unidirectional instability. The management in the latter group is similar to lines of managing a recurrent dislocation. Same surgical procedures are offered after identifying the direction of instability and the cause. The former ones, however, seldom benefit from surgery and are better managed with stringent physiotherapy to strengthen the shoulder stabilizers.
Rotator Cuff Tear
The rotator cuff comprises of four tendons that surround and stabilize the shoulder joint. These include subscapularis, supraspinatus, infraspinatus and teres minor.
Management & Treatment
MRI investigation is done for rotator cuff tears in detecting full thickness rotator cuff tears and partial thickness rotator cuff tears. This test can quantify the amount of fatty degeneration (replacement of muscle with fat) that may occur in a torn cuff if it is neglected for a long time. In this case, Arthroscopy is a diagnostic tool as well as a treatment modality. NSAIDs for pain relief along with stretching and cuff strengthening exercises are prescribed. If strength improvements are minimal or pain relief is not noticed by 6 weeks, one may proceed to surgery. While small tears may do well with a simple arthroscopic debridement procedure, full thickness tears and grade III partial thickness tears (i.e. involving more than 50% of cuff thickness), mostly need an arthroscopic repair.
Disabled Throwing Shoulder & Slap Lesions
An athlete with a disabled throwing shoulder (DTS) cannot throw overhead or hit a ball without discomfort and pain. This condition is commonly encountered in throwing athletes such as bowlers in cricket and those who are involved in hitting a ball as in lawn tennis, etc.
Repetitive throwing action involves forceful internal rotation at the shoulder as the ball is released. This stretches the capsule on the posterior side of shoulder repeatedly leading to micro-tears that eventually heal with fibrosis and posterior capsular contracture. This results in loss of internal rotation at the throwing shoulder.
SLAP (superior labral tear anterior to posterior) tear is a tear of the superior labrum that occurs at the attachment of the long head of biceps to the labrum. These labral tears are a common cause of DTS in throwing athletes. Patients with a SLAP tear are usually below 40 years of age and present with pain and often a popping and clicking sound while throwing that result in loss of throwing speed and control.
Management & Treatment
Treatment of a symptomatic SLAP tear generally requires an arthroscopic labral repair with suture anchors.