Dr. Ravi Sauhta has got wide experience in limb salvage surgery for large bone tumors followed by Mega Prosthetic Reconstructions and lumbar Spinal stabilization procedures including the following.
- It presents as pain along the inner aspect of the knee, and limitation of knee flexion. It may sometimes produce locking episodes. MRI is the investigation of choice.
- In patients with multiple episodes of locking, and limitation in daily activities, arthroscopy is indicated. The torn piece of meniscus is excised during surgery. In early cases with large tears, repair of the meniscal tissue may be attempted, however success of such surgery depends on the location of tear, and extent of damage to meniscal tissue
- This procedure is performed by making a small ‘5 mm’ size cut on both sides of the knee joint. These portals are used to insert an arthro-scope with camera, and another is used for instruments to perform the required procedure.
- It is usually performed under spinal anaesthesia. Common procedures/ indications for knee arthroscopy include
- 1. Meniscal tear
2. Recurrent synovitis
3. Loose body removal
4. Osteochondral defects
5. Para-meniscal cysts excision
6. Synovial Chondromatosis
7. Synovial biopsy
10. Arthroscopic Chondroplasty
11. Arthroscopic Laser Chondroplasty
The patient may start walking from the next day of surgery, and over 90 % of them resume office within a week. Active sport activities should be avoided for approximately 3 weeks.
ACL Reconstruction Surgery
- Most patient after ACL reconstruction return to pre-injury status after 6- 8 weeks,and are allowed to pursue active sports after 6 months.
- ACL reconstruction is advised to patients with persistent knee instability despite physiotherapy trial of at least 6 weeks. In cases of road traffic accident patients with high energy trauma who develop ACL tear along with variable injury to other ligaments and bony contusions, we prefer to wait for approximately 10-12 weeks before offering ACL reconstruction surgery. This allows adequate time for healing of other structures, before ACL reconstruction is undertaken.
- ACL reconstruction is commonly performed as Arthroscopy assisted procedure, with minimal scar. We routinely perform ACL reconstruction surgery using Endobutton technique with Double bundle Hamstring grafts harvested from Semitendinosus and Gracilis muscles.
- In this surgery tendinous grafts are harvested from the back of knee, doubled over to increase the tensile strength, and then looped over an Endobutton. This graft –endobutton composite is tunnelled across the tibia and femur along the axis of original ACL ligament. The tibial end is usually secured with titanium or bio-absorbable screws.
- After surgery, patients are allowed to walk with Knee brace and walker support from the next day. Knee bending is increased in a sequential manner with increments week by week. Supervised physiotherapy is required for an estimated 6 weeks.
- It is estimated that most patients are able to walk full weight bearing after approx. 6 weeks, and walk without support after an average of 10-12 weeks
Anterior Cruciate Ligament Tear (ACL)
- The anterior cruciate ligament (ACL) is one of the most commonly injured ligaments of the knee. In general, the incidence of ACL injury is higher in people who participate in high-risk sports, such as basketball, football, skiing, and soccer.
- Injury to the ACL ligament results in forward translation of Tibia over Femur. This produces an instability pattern if the patient is walking brisk or walking on uneven surfaces or climbing stairs.
- ACL reconstruction is required if the instability due to damaged ACL fibres is limiting the activity level of patient to a significant extent; or if the patient wants to pursue an active athletic activity/ sport.
There is some evidence that a torn ligament may accelerate the rate of degenerative changes in the knee, due to excess instability.
Ksna Clinic provides best Ligament Tear Treatment in Gurgaon
Knee Cartilage Defects
- Knee Cartilage defects or Osteochondral lesions may produce pain and stiffness of the joint. If un-treated such lesions may lead to development of full thickness cartilage loss, and eventual arthritis.
- Arthroscopic Chondroplasty can be performed in such cases, to allow cartilage regrowth, and delay the development of full blown arthritis.
- Arthroscopic Chondroplasty procedure involves Microfracture/ Abrasion chondroplasty/ Laser. This allows the growth of fibrocartilage and help to fill up the void created by cartilage loss.
- In cases of large solitary Osteochondral defects, Mosaicplasty may also be performed.These procedures help in delaying Arthritis, and are very useful in younger patients with knee pain not responding to conservative trial and physiotherapy. The patients are usually admitted in hospital for 24-48 hours. Ambulation with walker/ stick support is started the next day of surgery.
Shoulder Rotator Cuff Tear
- Rotator cuff is formed by a group of four muscles around the shoulder joint. This is responsible for sideways elevation of shoulder and rotational movements.
- Rotator cuff is a frequent site for development of inflammation, also called Rotator cuff Tendinitis. Most frequently involved muscle is Supraspinatus. Such inflammation produces pain on overhead elevation of shoulder, and often produce a painful arc syndrome
- Recurrent Rotator cuff inflammation leads to fibrosis and weakening of the muscles. This can ultimately lead to Rotator Cuff Tear.
- A tear of rotator cuff muscles may also occur due to sudden jerk as in lifting heavy weights.
- A rotator cuff tear is diagnosed clinically and confirmed by doing an MRI of shoulder joint.
Treatment of Rotator cuff tear depends upon the extent of tear. Most of the partial tears can be managed by supervised physiotherapy. Arthroscopic rotator cuff repair is indicated in patients with complete tear on MRI, and those who do not respond with physiotherapy.
For the best Rotator Cuff Tear Treatment visit Krsna Clinic
Knee Ligament Tear (MCL, LCL)
- Knee Collateral ligaments include the Medial Collateral Ligament, and the Lateral Collateral Ligament. Collateral ligaments provide angulatory stability against varus/ valgus (sideways) stress.
- Injuries to collateral ligaments of the knee may commonly occur due to fall while running or in cases of road traffic accidents, such as fall from bike.
- Most collateral ligaments injuries are partial rupture of ligaments.
- MRI of the knee joint is the best way to diagnose the extent of injury.
Most cases of Collateral ligament injuries around the knee can be satisfactorily managed with bracing and rest. However, in some cases with complete tear of ligament, surgical intervention may be indicated.