1. Micro-fracture technique for treating cartilage injuries.
Treating cartilage injuries in the knee - but also in other joints - is an important issue in orthopedic and sports surgery. A wide range of techniques has been used depending on the extent and location of the lesion: cleansing and chondroplasty, microfractures, osteochondral transplantation (mosaic technique, OATS) and autologous chondrocyte transplantation.
Indications for the microfracture technique:
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Cartilage defects of total thickness (up to hypochondriac bone) in loading surfaces of the knee or in the patellofemoral joint OuterbridgeIV
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Deficits up to 2-2.5cm2
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Stable knees with good axis
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Age up to 60 years to be able to respond to the physiotherapy program
Technique:
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Arthroscopic cleaning with a scraper and shaver of the cartilage lesion up to the subchondral bone with fixed cartilage around the bed
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Drilling holes with special scraper and hammer from the periphery of the lesion to its center at a depth of 3-4mm and at a distance of 3-4mm
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Release of the ischemic ligament and reduction of the pressure of the arthroscopic pump. Blood clot formation clinging to the site of injury.
Restoration:
It is of key importance: immediate start of passive mobilization either with a machine (300-700 movements initially, 1 cycle per minute) or with the help of the other leg (500 repetitions X 3 times a day). Partial charge for 6-8 weeks. Special empowerment program. If the lesion is in the patella the program is modified (Steadman protocol).
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From a biopsy material of the repaired lesion three years after the first lesion (arthroscopy performed for another reason: eg meniscus rupture), the existence of vitreous and fibrochondria is confirmed: hybrid cartilage
The best results are presented in:
1. Age less than 35 years
2. Deficit ≤2cm2
3. BMI ≤ 25kgr / m2
4. Surgery no later than 1 year after the injury
5. Cartilaginous deficits in femoral tubers
Very good results even in high level athletes.
There is no work based on long-term follow-up to apply the technique to other joints.
2. Knee Arthroscopy - Rupture of the meniscus
Arthroscopy is the surgery by which the orthopedic surgeon, through very small holes a few millimeters in front of the knee, inserts a camera (the arthroscope) and sees in real time the condition inside the patient's knee and the injuries or problems he has , while then, with the use of specialists depending on the occasion of surgical instruments and with exceptional precision of movements, intervenes to correct them.
The arthroscope allows the doctor to see any area of the joint and in fact up to 10 times larger than reality. Thus, he has the ability to perform extremely delicate surgeries, which he would not be able to do with any other type of surgery. With arthroscopy, which is a minimally invasive technique that does not injure the soft tissues of the area, large incisions in the patient's skin and tissues, minimizing postoperative pain and trauma and accelerating recovery.
Arthroscopy can be performed under general or spinal anesthesia . The patient's foot is specially prepared in the operating room to ensure the widest possible extension of the knee joint. Next, two small holes are usually made around the joint and the arthroscope is placed. The arthroscope is a small endoscope with a special digital camera on the edge. Finally, the doctor, after locating the lesion, proceeds with gentle movements to treat it.
Patients usually stay in the hospital for a few hours after a knee arthroscopy and are usually able to go home on the same day. In a simple meniscectomy, the patient can walk immediately after the arthroscopy (with or without bacteria) while in a meniscus suture when the injury allows it takes 4-6 weeks until he returns to his normal activities. Muscle strengthening exercises and proper physical therapy, if necessary, can help in faster recovery. The physiotherapist in collaboration with the doctor, gives exercises and personalized tips for rehabilitation, recovery of joint function and return to daily life.
3. Anterior cruciate ligament rupture
Anterior cruciate ligament rupture is a serious knee injury that occurs mainly during sports activities.
According to the usual mechanism of the anterior cruciate ligament injury, the thigh is turned inwards in relation to the tibia which is displaced forward.
The patient immediately feels the following:
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Characteristic sound-feeling 'KRAK' at the moment when the Anterior Cruciate Ligament is broken
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Pain at the moment of the rupture of the Cross
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Soon or in a few hours the knee swells from the severed Anterior Cruciate ligament that bleeds into the joint
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Feeling of instability from the moment of the injury onwards, especially in rotational movements with a change of course.
In the following days after the injury, the patient's condition gradually improves, the swelling subsides and the patient gradually becomes able to walk without difficulty. What remains is instability in complex movements that include changes in course and generally changes in the motor position of the knee.
X-rays are needed to rule out the coexistence of fractures.
MRI shows lesions of the ligaments, tendons, articular cartilage. In the case of the anterior cruciate ligament, the ligament appears to be discontinuously cut; in some cases, it appears to be stuck in the posterior cruciate ligament, and other coexisting lesions within the joint are also identified.
The presence of bone edema in the external femoral condyle and on the posterior surface of the tibial plateau confirms the rotational injury and enhances the diagnosis.
The diagnosis of anterior cruciate ligament rupture results from the evaluation of all data and mainly from the clinical examination. The doctor will evaluate the history of the injury and look for the symptoms and clinical signs that characterize the rupture. The clinical examination includes clinical trials
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Lachman test
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pivot shift test
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front drawer less often.
Once the clinical diagnosis has been made, it must therefore be determined which type of treatment is appropriate for each patient. In this context, the following is taken into account:
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The age of the injury
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The degree of instability
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The age of the patient
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The level of activity that the patient wishes to have
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Coexisting injuries
Weighing all the above, we decide together with the injured person on the type of treatment that can be conservative treatment or surgical treatment.
It is known that the anterior cruciate ligament does not stick like other extra-articular ligaments when injured. Therefore, no conservative rehabilitation program aspires to restore the Anterior Cruciate Ligament, but to train other structures around the knee to take on and perform part of its role. In people with low mobility requirements this may be enough.
Anterior cruciate ligament rupture surgery completely restores normal knee function, restores joint stability and normal movement, and allows a return to sports and other demanding activities. It should be selected for young and active people of all ages. Surgical treatment is not only recommended to return to sports activities. In a knee without anterior cruciate ligament, the menisci and cartilage are subjected to multiple strains resulting in frequent premature wear and tear on these noble structures and the consequent disorganization and premature joint degeneration.
Surgical rehabilitation after Anterior Cruciate Ligament Rupture requires one day of hospitalization and the patient is discharged the day after admission. The surgery is performed under general or dorsal anesthesia.
Only autografts are preferred. These are implants that come from the patient himself and are therefore free from any immune reactions, in addition they ensure faster and better integration into the area where they will be placed. The posterior femoral implants are usually used, ie the Semi-dentate and in some cases the thin one, which are universally preferred by the majority of Surgeons. Alternatively, a part of the patellar ligament with bone fragments from the tibia and patella may be used as an implant in some cases.
We do not use human frozen carcasses. These transplants have undergone special treatment (irradiation) in order to eliminate the risk of transmitting infectious diseases to the recipient and therefore do not have good biological behavior.
Usually after anterior cruciate ligament ligation 95% of patients report very good and excellent results.
Stiffness or lack of extent is the most common complication. Rarely, the implant may fail or rupture. Postoperative inflammation and venous thrombosis are very rare complications that must be diagnosed early and treated immediately by a doctor.
With good physical therapy and well-designed rehabilitation programs the athlete can shorten his period of absence from active sports activity. Most patients return within 4 to 6 months after surgery.
