Anterior Cruciate Ligament Reconstruction

The anterior cruciate ligament is an important ligament in the knee that acts as a bridge between the bone of the thigh and the shin. The ligament traverses the knee in the middle and stabilizes it. When this ligament tears (which happens mostly during high-impact contact sports), the person will feel severe pain and buckling of the knee. In such cases, ACL reconstruction can be performed to replace the ligament with a tendon. The tendon is usually taken from patients same or from opposite leg.

Before surgery, physical therapy will commence with the goal of reducing inflammation. This is done to improve the outcome of surgery as a stiff, rigid knee may not benefit fully from the surgery. The procedure will be performed under spinal anaesthesia through very small openings or slits. After the procedure, the patient will have to use crutches with the knee being secured in a brace for protection. The doctor will help in pain management after surgery. Detailed post-operative care instructions will be given, which will have to be followed. Physiotherapy too will start. Recovery will take a few weeks.

Multi-ligamentous Injury Knee Reconstruction

In a multi-ligament knee injury, two or more of the knee ligaments suffer damage. Research has shown that treatment with surgery gives better outcome than any other non-invasive method. However, the surgery is a complicated one and needs detailed physical examination and imaging tests like x-ray and MRI. Sometimes, more than one surgery may be necessary. The surgery done arthroscopically is least invasive. The exact procedure will differ from patient to patient - for some patients, only one ligament may need repair, while for another all three might need reconstruction. Typically, grafts from the patient or a donor will be used for reconstruction.

After surgery, it is important to slowly mobilize the knee while keeping the reconstructed ligaments intact. Mobilizing the knee early will give the knee a better range of movement. Crutches and knee braces can be used. Depending on the patient’s progress, the doctor will take a call on when to walk without crutches. Knee strengthening and other physiotherapy exercises should be carried out for the next 4-6 months after surgery. The doctor will schedule reviews at regular intervals to monitor the patient’s progress.


The knee contains two menisci – one on the exterior edge of the knee and the other towards the interior. These menisci perform many vital functions:

  • They help in smooth, friction-free movement of the knee.
  • They help in distributing the body weight over the knee joint.
  • They absorb shocks and sudden jerks.
  • They provide stability to the knee joint.

Damage to the menisci may lead to the need for either a total or partial meniscectomy. Menisci injuries are quite common and minor tears will not need surgery. But if the menisci do not mend with conservative treatments or if the knee starts to lock, surgery is recommended. When a surgery is decided on, it is best to start knee-strengthening exercises before the surgery to improve surgical outcome. The surgery itself, done arthroscopically, will involve only three small cuts to repair the menisci. During surgery, the damaged parts of the menisci are removed. Patients are usually discharged on the same day. They can walk but will have to use crutches to prevent over-exerting the knee. Mild pain and inflammation in the knee are expected after surgery and are nothing to be concerned about. Pain medication will be given to manage it. It is important to do strengthening exercises at home after discharge.

Meniscal Repair

Meniscal repair is another surgery, also done arthroscopically, to repair torn menisci in the knee. Usually sustained during some kind of sporting activity, meniscal tears are accompanied by a popping sound. Walking after the tear might be possible but painful. Meniscal tears may also be caused by wear and tear, but this kind of tear usually subsides on its own without surgical intervention. Other symptoms that indicate meniscus tear are inflammation, limited movement of knee and a feeling of instability in the knee. Diagnosis involves the McMurray test and imaging tests to confirm diagnosis. If non-invasive treatments are ineffective, then surgical meniscal repair is performed.

During surgery, the torn menisci is sutured and then held in place. Physiotherapy will commence after surgery and complete recovery will take 4-6 weeks.

Root Repair

In a meniscus root tear, the part of the meniscus that attaches to the bone i.e. the root of the meniscus is damaged. The pain from a meniscus root tear is usually chronic; the tear itself can limit knee movement, make the knee unstable and increase the risk of osteoarthritis. The root tear can be of two types: traumatic and degenerative. A traumatic tear usually affects sportspeople and hence is more common in younger adults. A degenerative root tear is caused as a result of wear and tear; older adults are more prone to this. When the doctor is of the opinion that non-surgical treatments will not yield desired results, surgery is done arthroscopically.

During surgery, the roots of the meniscus are repaired and connected to the bone once again. Recovery after surgery will take around 4-6 weeks. During the recovery period, the patient will be advised to use crutches to minimize the load on the knees; physiotherapy will also commence.

Cyst Excision

A cyst in the knee, called a popliteal cyst or a Baker’s cyst, may develop in people suffering from arthritis. Usually found at the back of the knee, the cyst is in simple terms a sac of fluid. Surgery can be done to remove the cyst, but it is important to understand that the cyst may recur unless the underlying cause is treated.

The knee joint is covered in cartilage. The synovial membrane, which is the lining of the joint, produces a fluid to keep the joints moving smoothly. When an excess of this fluid is produced, the extra is contained in a sac at the back of the knee in the form of a cyst. This cyst can be felt when the back of the knee is touched. Other than arthritis, a knee injury may also be a cause of the cyst.

Treatment can be surgical or conservative. Only if the cyst is very painful, surgery is recommended. During surgery, the cyst is removed and any damage caused by the cyst to the lining of the joint is rectified. Treating the cause of the cyst is important to prevent its recurrence.

Cartilage Defect Treatment -OATS, BMAC

As the name suggests, a cartilage defect is a part of the cartilage that has been injured. The cause may be accidents, osteonecrosis or other knee conditions. Cartilage defects usually occur along with damage to knee ligaments like an ACL tear. The surgeon will always try to treat the defect non-invasively with physiotherapy, medication and injections. Only if this is not successful will other invasive procedures be considered. With a cartilage defect, the patient may experience pain and also a possibility of arthritic changes. Diagnosis is done with an MRI.

  • Treatment with OATS – Osteochondral autograft transfer is preferred for younger adults especially, if the bone is also damaged. Here, healthy cartilage replaces the defective cartilage.
  • Treatment with bone marrow aspirate concentrate (BMAC) – This procedure is carried out when the affected area is large. Stem cells from the bone marrow are harvested and injected back into the patient.


Bankart’s Repair

Like in all other joints, there is cartilage surrounding the shoulder socket as well. This cartilage, called the glenoid labrum, can suffer damage due to sporting injuries or other shoulder conditions. This tear to the cartilage is called Bankart’s tear and is quite a common condition. Shoulder pain is the symptom, and if left untreated, shoulder dislocation may become more frequent. Treatment starts with conservative methods; if the desired results are not obtained, the doctor will suggest the Bankart’s repair, which is done arthroscopically.

The surgery involves small incisions. During surgery, the cartilage and any torn ligaments are reconnected to the bone. The recovery duration after surgery will vary from patient to patient – it can be anywhere between 3-6 months. Physical therapy plays a very important role in strengthening the shoulder and restoring range of movement.

Latarjet Procedure

The shoulder has three bones which all join to create a ball and socket joint. The ball sits in the socket of the shoulder and is held in that position by various ligaments and tendons. When these ligaments and tendons are not able to keep the ball in the socket, shoulder dislocation takes place. Left untreated, repeated dislocations could damage the bone of the shoulder blade. A shoulder dislocation could manifest as severe shoulder pain, swelling, and inability to move the shoulder normally. The Latarjet procedure is recommended for such patients having recurrent dislocations, especially in those with a bony defect. Earlier the surgery was done as an open surgery, but now it can be done through arthroscopic means.

During the procedure, the coracoid from the shoulder blade replaces the damaged bone and thus prevents further dislocations from happening. The success rate of the procedure is good, and recovery will take around 3-6 months. The shoulder will be immobilized with the help of a sling during recovery. Physical therapy is important, and complete recovery can be achieved in around 6 months.

Rotator Cuff Repair

The rotator cuff in the shoulder is made of muscles and tendons. These muscles and tendons secure the ball of the shoulder in its socket. Thus, it is responsible for us being able to perform a number of functions like raising our hands up and being able to do activities like swimming, basketball, etc. Simply put, the ability to rotate our shoulder is attributed to the rotator cuff. A rotator cuff tear may happen due to overuse of the shoulder. Other causes include road traffic accidents, lifting big objects and a fall with your body weight being taken up by the arm.

To treat rotator cuff repair, earlier an open surgery had to be performed. But now, it is possible to do the procedure arthroscopically. The procedure differs depending on the kind of tear and is decided on by the surgeon. As in any procedure, rehabilitation plays an important role in recovery. Physiotherapy is started with mild exercises and will progress to exercises involving more movement. Recovery takes around 6 months. The results after surgery are encouraging with patients reporting pain-free shoulders with increased stability.

Neglected Rotator Cuff Tear Repair

A rotator cuff tear will not heal without treatment. Supply of blood is necessary for healing, and in its absence, the rotator cuff tear will worsen. The initial line of treatment is always conservative – in the form of physiotherapy. There are no medicines available to heal a torn rotator cuff; medicines are given only to alleviate pain. In physiotherapy, other muscles and tendons are strengthened to make up for the function of the torn rotator cuff. Unfortunately, there is always a chance of the rotator tear getting inflamed again.

When timely treatment is not given, the tear can get bigger, and the shoulder joint can become extremely unstable. This condition is called cuff tear arthropathy. Sometimes a condition called pseudo-paralysis may manifest where the range of shoulder movement is badly affected. Both are serious conditions that need aggressive treatment. For cuff tear arthropathy in senior citizens, a reverse shoulder replacement is recommended. If the patient is younger, then a muscle transfer (taking a muscle from the shoulder to do the function of the rotator cuff) or a superior reconstruction (introducing a graft from the thigh to aid in shoulder stability) can be done.

Subacromial Decompression

When the roof of the shoulder presses down on the rotator cuff, it results in a condition called shoulder impingement that is very painful. In most cases, it is a bone spur that presses the rotator cuff. This condition only aggravates with time. It starts as mild shoulder pain; the pain may be more when the hand is raised. Slowly the pain increases and lifting the hand overhead may not be possible at all. As with any treatment, surgery is the last option and is considered only when physiotherapy, medications, and corticosteroid injections do not give the desired results.

The surgical procedure is called subacromial decompression or acromioplasty. The surgery is done arthroscopically through small cuts. It involves removing the tissue and, in some cases, removing the bursa too if it is inflamed. The entire procedure is performed under general anaesthesia. Recovery typically happens within a month with the shoulder being immobilized in a sling. Once the sling is removed, physiotherapy will commence and complete recovery will take a year.

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