Knee

Knee Injuries

Pain, swelling and stiffness are the common symptoms of any damage or injury to the knee. If care is not taken during the initial phases of injury, it may lead to joint damage that may end up destroying your knee.

Cartilage Defects

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Osteochondritis Dissecans

Osteochondritis dissecans is a joint condition in which a piece of cartilage, along with a thin layer of the bone separates from the end of the bone because of inadequate blood supply. The separated fragments are sometimes called “joint mice”. These fragments may be localized, or may detach and fall into the joint space causing pain and joint instability.

Meniscus Tears

Meniscus tear is the commonest knee injury in athletes, especially those involved in contact sports. A suddenly bend or twist in your knee cause the meniscus to tear. This is a traumatic meniscus tear. Elderly people are more prone to degenerative meniscal tears as the cartilage wears out and weakens with age. The two wedge-shape cartilage pieces’ present between the thighbone and the shinbone are called meniscus. They stabilize the knee joint and act as “shock absorbers”.

Quadriceps Tendon Rupture

Quadriceps tendon is a thick tissue located at the top of the kneecap. The quadriceps tendon works together with the quadriceps muscles to allow us to straighten our leg. The quadriceps muscles are the muscles located in front of the thigh.

Patella Tendon Rupture

Patella tendon rupture is the rupture of the tendon that connects the patella (knee cap) to the top portion of the tibia (shin bone). The patellar tendon works together with the quadriceps muscle and the quadriceps tendon to allow your knee to straighten out.

Patellar Tendinitis

Patellar tendinitis, also known as “jumper’s knee” is an inflammation of the patellar tendon that connects your kneecap (patella) to your shinbone. This tendon helps in extension of the lower leg. Patellar tendinitis usually results from repetitive trauma or overuse, particularly from sports activities involving jumping such as basketball or volleyball. Therefore, this condition is also known as jumper’s knee. This condition may also occur because of an acute injury to the tendon that has not healed properly.

Patellofemoral Pain

Patellofemoral pain syndrome, also referred to as PFPS, is one of the most commonly reported knee problems, accounting for one in four knee complaints seen by orthopedists.

Patellar Instability

Patellar (knee cap) instability results from one or more dislocations or partial dislocations (subluxations). Patella is the small piece of bone in front of the knee that slides up and down the femoral groove (groove in the femur bone) during bending and stretching movements. The ligaments on the inner and outer sides of patella hold it in the femoral groove and avoid dislocation of patella from the groove.

Complex Knee Injuries

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Knee Dislocation

Patella (knee cap) is a protective bone attached to the quadriceps muscles of the thigh by quadriceps tendon. Patella attaches with the femur bone and forms a patellofemoral joint. Patella is protected by a ligament which secures the kneecap from gliding out and is called as medial patellofemoral ligament (MPFL).

ACL Tears

The anterior cruciate ligament, or ACL, is one of the major ligaments of the knee that is in the middle of the knee and runs from the femur (thigh bone) to the tibia (shin bone). It prevents the tibia from sliding out in front of the femur. Together with posterior cruciate ligament (PCL) it provides rotational stability to the knee.

PCL Injuries

Posterior cruciate ligament (PCL), one of four major ligaments of the knee are situated at the back of the knee. It connects the thighbone (femur) to the shinbone (tibia). The PCL limits the backward motion of the shinbone.

LCL

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MCL Tears

The medial collateral ligament (MCL) is the ligament that is located on the inner part of the knee joint. It runs from the femur (thighbone) to the top of the tibia (shinbone) and helps in stabilizing the knee. Medial collateral ligament (MCL) injury can result in a stretch, partial tear, or complete tear of the ligament. Injuries to the MCL commonly occur because of a pressure or stress on the outside part of the knee. Anterior cruciate ligament (ACL) may be torn along with a MCL injury.

Extensor Tendon Injuries: Quadriceps and Patellar Tendon

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Knee Osteoarthritis

Osteoarthritis, also called degenerative joint disease is the most common form of arthritis. It occurs most often in older people. This disease affects the tissue covering the ends of bones in a joint (cartilage). In a person with osteoarthritis, the cartilage becomes damaged and worn out causing pain, swelling, stiffness and restricted movement in the affected joint.

Microfracture

Microfracture is a surgical technique used to repair articular cartilage damage in the knee called chondral defects. Articular cartilage is a complex avascular (no blood supply) tissue which consists of cells called chondrocytes suspended in a collagenous matrix. It appears as a smooth, shiny, white tissue at the ends of the bones which come in contact with each other to form a joint.

ACL Reconstruction

The anterior cruciate ligament is one of the major stabilizing ligaments in the knee. It is a strong rope like structure located in the center of the knee running from the femur to the tibia. When this ligament tears unfortunately, it does not heal and often leads to the feeling of instability in the knee.

PCL Reconstruction

Posterior cruciate ligament (PCL), one of four major ligaments of the knee are situated at the back of the knee. It connects the thighbone (femur) to the shinbone (tibia). The PCL limits the backward motion of the shinbone.

LCL Reconstruction

Lateral collateral ligament (LCL) is a thin set of tissues present on the outer side of the knee, connecting the thighbone (femur) to the fibula (side bone of lower leg). It provides stability as well as limits the sidewise rotation of the knee. Tear or injury of LCL may cause instability of the knee that can be either reconstructed or repaired to regain the strength and movement of the knee.

MCL Reconstruction

Medial collateral ligament (MCL) is one of four major ligaments of the knee that connects the femur (thigh bone) to the tibia (shin bone) and is present on the inside of the knee joint. This ligament helps stabilize the knee. An injury to the MCL may occur as a result of direct impact to the knee. An MCL injury can result in a minor stretch (sprain) or a partial or complete tear of the ligament. The most common symptoms following an MCL injury include pain, swelling, and joint instability.

Cartilage Transplantation

Articular Cartilage is the white tissue lining the end of bones where these bones connect to form joints. Cartilage acts as cushioning material and helps in smooth gliding of bones during movement. An injury to the joint may damage this cartilage which cannot repair on its own. Cartilage can be damaged with increasing age, normal wear and tear, or trauma. Damaged cartilage cannot cushion the joints during movement and the joints may rub over each other causing severe pain and inflammation.

Cell Transplant

The articular surfaces of the body’s joints are lined by hyaline cartilage, a smooth tissue that serves as a shock absorber and allows easy movement of the bones within the joint. Normal wear-and-tear or injury can damage and cause defects in the cartilage, resulting in irregular articular surfaces that interfere with movement, causing pain, swelling and disability. Cartilage cell transplantation is a technique of transplanting healthy cartilage cells to replace damaged cartilage cells. These procedures are recommended for young individuals with a single articular defect.

Cartilage Repair

Articular Cartilage is the white tissue lining the end of bones where these bones connect to form joints. Cartilage acts as cushioning material and helps in smooth gliding of bones during movement. An injury to the joint may damage this cartilage which cannot repair on its own. Cartilage can be damaged with increasing age, normal wear and tear, or trauma. Damaged cartilage cannot cushion the joints during movement and the joints may rub over each other causing severe pain and inflammation.

Meniscal Transplantation

Meniscal transplantation is a surgical procedure to replace the damaged meniscus of the knee with healthy cartilage.

The meniscus is a C-shaped cartilage ring that acts like a cushion between the shinbone and the thighbone. Each of your knees has two menisci - one on the inside (medial aspect) and the other on the outside (lateral aspect) of your knee. Apart from the cushioning effect, the menisci also provide stability to the knee.

Meniscus Surgery

Meniscus tear is the commonest knee injury in athletes, especially those involved in contact sports. A suddenly bend or twist in your knee cause the meniscus to tear. This is a traumatic meniscus tear. Elderly people are more prone to degenerative meniscal tears as the cartilage wears out and weakens with age. The two wedge-shape cartilage pieces’ present between the thighbone and the shinbone are called meniscus. They stabilize the knee joint and act as “shock absorbers”.

Meniscectomy

Meniscectomy is a surgical procedure indicated in individuals with torn meniscus where the conservative treatments are a failure to relieve the pain and other symptoms. Meniscectomy is recommended based on the ability of meniscus to heal, patient’s age, health status and activity level.

Meniscus Repair

Meniscus tear is the commonest knee injury in athletes, especially those involved in contact sports. A sudden bend or twist in your knees causes meniscal tear. This is a traumatic meniscus tear. Elderly people are more prone to degenerative meniscal tears as the cartilage wears out and weakens with age. The two wedge-shape cartilage pieces present between the thighbone and the shinbone are called meniscus. They stabilize the knee joint and act as “shock absorbers”.

Surgical Cutting of the Bone

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Osteotomies of the Femur and Tibia

The hip is a ball and socket joint with the ball being formed by the head of the femur (thigh bone) and the pelvic bone forming the socket (acetabulum). The correct alignment of the femur in relation to the pelvic bone plays an important role in the proper functioning and health of the joint. Fractures, non-union of treated fractures or deformities may result in an improper relationship between these structures, leading to wear and tear (arthritis) and pain at the joint, and gait deformities. A femoral osteotomy is a surgical procedure that involves reshaping the upper part of the femur to realign it within the socket. The correction of the hip anatomy reduces the symptoms and progression of arthritis.

Medial Patellofemoral Ligament Reconstruction

Medial patellofemoral ligament reconstruction is a surgical procedure indicated in patients with more severe patellar instability. Medial patellofemoral ligament is a band of tissue that extends from the femoral medial epicondyle to the superior aspect of the patella. Medial patellofemoral ligament is the major ligament which stabilizes the patella and helps in preventing patellar subluxation (partial dislocation) or dislocation.

PRP and Stem Cell therapy

Our blood consists of a liquid component known as plasma. It also consists of three main solid components which include the red blood cells (RBCs), white blood cells (WBCs), and platelets. Platelets play an important role in forming blood clots. They also consist of special proteins, known as growth factors, which help with our body’s healing process. Platelet-rich plasma or PRP is a high concentration of platelets and plasma. A normal blood specimen contains only 6% platelets, while platelet-rich plasma contains 94% of platelets and 5 to 10 times the concentration of growth factors found in normal blood, thus greater healing properties.

Unicompartmental Knee Replacement

Unicompartmental knee replacement is a minimally invasive surgery in which only the damaged compartment of the knee is replaced with an implant. It is also called a partial knee replacement. The knee can be divided into three compartments: patellofemoral, the compartment in front of the knee between the knee cap and thigh bone, medial compartment, on the inside portion of the knee, and lateral compartment which is the area on the outside portion of the knee joint.

Patellofemoral Knee Replacement

Patellofemoral Knee Replacement surgery may be recommended by your surgeon if you have osteoarthritis contained to the patellofemoral compartment and you have not obtained adequate relief with conservative treatment options.

Autologous Chondrocyte Implantation (MACI)

Matrix-induced autologous chondrocyte implantation (MACI) is a new procedure to treat the articular cartilage defects of the knee. Articular cartilage is a tissue that covers the surface of the joints and is responsible for pain-free movement of the bones within the joint. If the articular cartilage is damaged, the ends of the bones rub against each other causing pain.

DeNovo NT

The DeNovo graft consists of pieces of viable cartilage in a storage media. Similar to ACI, the damaged cartilage area is prepared and sized. The graft is then prepared with a fibrin sealant and placed on the defect. The sealant precludes the need of a periosteal membrane.

BioCartilage

BioCartilage consists of dehydrated cartilage, which is introduced along with platelet-rich plasma (concentrated blood component, which enhances healing) on the defects after a technique called microfracture is performed.

Osteochondral Allografts

An osteochondral allograft is a piece of tissue taken from a diseased donor to replace damaged cartilage that lines the ends of bones in a joint. A section of cartilage and bone is removed, shaped to precisely fit the defect and then transplanted to reconstruct the damage.

Osteochondral Autografts

Osteochondral autografting (OCG) is a surgery to repair damaged articular cartilage that lines the ends of bones in a joint. An osteochondral autograft is a piece of tissue taken from a healthy section of the joint and transplanted to replace the chondral defects in the joint. There are two techniques used in osteochondral autografting: mosaicplasty and osteochondral autograft transfer system (OATS).

Osteochondritis Dissecans & Avascular Necrosis

Osteochondritis dissecans is a joint condition in which a piece of cartilage, along with a thin layer of the bone separates from the end of the bone because of inadequate blood supply. The separated fragments are sometimes called “joint mice”. These fragments may be localized, or may detach and fall into the joint space causing pain and joint instability.

Avascular necrosis, also called osteonecrosis is a condition in which bone death occurs because of inadequate blood supply to it. Lack of blood flow may occur when there is a fracture in the bone or a joint dislocation that may damage nearby blood vessels.