Archives des Knee - Dr Majed Issa https://drmajedissa.com/en/category/knee-en/ Chirurgien Orthopédique et Traumatologue Sun, 12 May 2024 19:59:09 +0000 en-GB hourly 1 https://wordpress.org/?v=6.9.4 https://drmajedissa.com/wp-content/uploads/2021/10/cropped-Logo-docteur-majed-issa-bleu-e1690128320683-32x32.png Archives des Knee - Dr Majed Issa https://drmajedissa.com/en/category/knee-en/ 32 32 PATELLAR INSTABILITY SURGERY https://drmajedissa.com/en/patellar-instability-surgery/ Tue, 06 Feb 2024 13:49:03 +0000 https://drmajedissa.com/?p=9286 WHAT IS IT? The medial patellofemoral ligament (or MPFL) is a ligament that attaches to the inner edge of the patella and the inner femoral condyle on the inner side of the femur. It stabilizes the patella by preventing it from dislocating outward during knee flexion. After an episode of patellar dislocation, the MPFL is systematically torn. It is possible to reconstruct it to stabilize the patella and prevent the occurrence of new dislocations: this is the MPFL reconstruction. In agreement with your surgeon and based on the benefit-risk balance, MPFL reconstruction was proposed to you. The surgeon has explained the other alternatives. It goes without saying that your surgeon may, if necessary and depending on the findings during surgery or a difficulty encountered, proceed with another technique deemed by him more beneficial to your specific case. BEFORE THE TREATMENT: An imaging assessment will be carried out by your surgeon to look for factors predisposing to patellar dislocation. This generally involves standard radiographs and a CT scan and/or MRI of the knee. WHAT TREATMENT? The surgical procedure is performed under general or regional anesthesia. A vertical incision of a few centimeters is made on the upper and inner side of the tibia. A hamstring tendon is harvested from the inner side of the tibia (semitendinosus or gracilis tendon). The actual reconstruction of the MPFL requires one or two other incisions at the inner edge of the patella and the inner side of the femur. Tunnels may be created to pass the graft according to the technique used. The new ligament is positioned and fixed to the femur and patella by various means (suture, staple, screw, anchor…). At the end of the procedure, the surgeon tests the patella, which should be stable and not dislocate outward. AND AFTER? The procedure is performed on an outpatient basis. Weight-bearing on the operated limb is allowed from the first day with crutches and a removable brace in extension. Rehabilitation starts immediately. Flexion may be limited during the first few weeks. A preventive anticoagulant treatment for thrombosis may sometimes be prescribed. EXPECTED RESULTS MPFL reconstruction is a straightforward surgical procedure. It is very effective for patellar dislocation. It can often be combined with other treatments for dislocation (tibial tuberosity osteotomy, vastus medialis plasty, lateral retinacular release, trochleoplasty, etc.).

L’article PATELLAR INSTABILITY SURGERY est apparu en premier sur Dr Majed Issa.

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WHAT IS IT?

The medial patellofemoral ligament (or MPFL) is a ligament that attaches to the inner edge of the patella and the inner femoral condyle on the inner side of the femur. It stabilizes the patella by preventing it from dislocating outward during knee flexion.

After an episode of patellar dislocation, the MPFL is systematically torn. It is possible to reconstruct it to stabilize the patella and prevent the occurrence of new dislocations: this is the MPFL reconstruction.

In agreement with your surgeon and based on the benefit-risk balance, MPFL reconstruction was proposed to you. The surgeon has explained the other alternatives. It goes without saying that your surgeon may, if necessary and depending on the findings during surgery or a difficulty encountered, proceed with another technique deemed by him more beneficial to your specific case.

BEFORE THE TREATMENT:

An imaging assessment will be carried out by your surgeon to look for factors predisposing to patellar dislocation. This generally involves standard radiographs and a CT scan and/or MRI of the knee.

WHAT TREATMENT?

The surgical procedure is performed under general or regional anesthesia. A vertical incision of a few centimeters is made on the upper and inner side of the tibia. A hamstring tendon is harvested from the inner side of the tibia (semitendinosus or gracilis tendon).

The actual reconstruction of the MPFL requires one or two other incisions at the inner edge of the patella and the inner side of the femur. Tunnels may be created to pass the graft according to the technique used.

The new ligament is positioned and fixed to the femur and patella by various means (suture, staple, screw, anchor…). At the end of the procedure, the surgeon tests the patella, which should be stable and not dislocate outward.

AND AFTER?

The procedure is performed on an outpatient basis. Weight-bearing on the operated limb is allowed from the first day with crutches and a removable brace in extension. Rehabilitation starts immediately.

Flexion may be limited during the first few weeks. A preventive anticoagulant treatment for thrombosis may sometimes be prescribed.

EXPECTED RESULTS

MPFL reconstruction is a straightforward surgical procedure. It is very effective for patellar dislocation. It can often be combined with other treatments for dislocation (tibial tuberosity osteotomy, vastus medialis plasty, lateral retinacular release, trochleoplasty, etc.).

L’article PATELLAR INSTABILITY SURGERY est apparu en premier sur Dr Majed Issa.

]]> MENISCAL LESIONS https://drmajedissa.com/en/meniscal-lesions/ Tue, 06 Feb 2024 13:42:52 +0000 https://drmajedissa.com/?p=9280 The menisci are two crescent-shaped structures interposed between the femur and the tibia, serving both as stabilizers and shock absorbers for the knee joint. Thus, they protect the cartilage from excessive pressure and hence wear. They have a fairly hard elastic consistency, like rubber. The menisci can either crack or tear following a trauma or wear down gradually over time. In both cases, a more or less significant fragment can detach and sometimes become lodged between the femur and the tibia. ACUTE TRAUMATIC OR DEGENERATIVE LESION? In young patients, meniscal lesions generally occur suddenly. It is often due to a pivoting movement, quickly standing up from a squatting or sitting position, a sudden acceleration/deceleration, lifting a very heavy object, landing from a jump, etc. A sharp pain is felt, sometimes accompanied by a locking with the inability to extend and/or bend the knee completely. A more or less abundant effusion can follow within a few minutes to a few days. Degenerative meniscal lesions, on the other hand, are rather the result of progressive wear of the meniscal tissue over several months or years, with excessive mechanical stresses repeated over time. We most often encounter them in patients over 40 years old who have quite physical sports and/or professional activities: Footballers, hikers, bricklayers, nursery assistants, etc. Certain factors can promote this meniscal degeneration, such as genu varum (“Lucky Luke” knees) and being overweight. The pains are quite chronic, fluctuating, progressively setting in, and accompanied by also fluctuating effusion. It involves the medial meniscus in the majority of cases. The typical image on MRI is a “horizontal tearing” of the meniscus, sometimes accompanied by small meniscal cysts. This can constitute the warning signs of arthritis of the joint. Intra-articular image during an arthroscopy: At the top a normal meniscus, at the bottom a torn meniscus PRINCIPLES OF TREATMENT: While surgical resection of the entire damaged meniscus may relieve symptoms quickly and for several months, it would significantly increase the risks of osteoarthritic degeneration of the knee. We are therefore currently aiming to preserve the meniscus as much as possible. We first opt for a meniscal suture whenever the chances of healing are good. When it comes to a non-suturable tear (significant damage, old rupture, lesion in a non-vascularized zone, etc.), we perform a meticulous excision of the damaged part only (partial meniscectomy). In the case of a “degenerative horizontal tear,” non-surgical treatment is prioritized, since the wear generally affects the entire meniscus: Joint hygiene measures, physiotherapy, crutches, hyaluronic acid injections, PRP injections, etc. THE SURGERY: In the vast majority of cases, the surgery is performed by arthroscopy: through two skin punctures of less than one cm, a camera (the arthroscope) and 4mm instruments are inserted into the knee to perform the surgical procedure. The surgery is most often carried out on an outpatient basis. Depending on your preferences and especially your medical history, the surgery is done under general anesthesia or spinal anesthesia. Skin closure is performed using 2 sutures. POSTOPERATIVE FOLLOW-UP: You leave the same evening of the surgery with a dressing, a knee brace, and crutches. If it is a meniscal suture, you are not allowed to bear weight on the operated side for 6 weeks, the time necessary for the healing of the sutured meniscal lesion. If it is a meniscectomy, you can bear weight normally from the first day. Crutches are then kept only for a few days, the time it takes to resume normal walking. In all cases, you will need to rest your knee for the 3 months following the surgery, avoiding mechanically demanding activities. Physiotherapy sessions may be prescribed depending on the case to maintain your muscles and recover joint flexibility. Thanks to arthroscopy and the outpatient mode, complications from meniscal surgeries have become even rarer (in the order of less than 1 case per 1,000). In case of healing failure after meniscal suture (about 20% of cases), a second surgery may be necessary to remove the part that has not healed. Illustration of the main types of meniscal tears: Bucket handle, meniscal flap, radial tear, fraying of the free edge

L’article MENISCAL LESIONS est apparu en premier sur Dr Majed Issa.

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The menisci are two crescent-shaped structures interposed between the femur and the tibia, serving both as stabilizers and shock absorbers for the knee joint.

Thus, they protect the cartilage from excessive pressure and hence wear. They have a fairly hard elastic consistency, like rubber.

The menisci can either crack or tear following a trauma or wear down gradually over time. In both cases, a more or less significant fragment can detach and sometimes become lodged between the femur and the tibia.

ACUTE TRAUMATIC OR DEGENERATIVE LESION?

In young patients, meniscal lesions generally occur suddenly. It is often due to a pivoting movement, quickly standing up from a squatting or sitting position, a sudden acceleration/deceleration, lifting a very heavy object, landing from a jump, etc.

A sharp pain is felt, sometimes accompanied by a locking with the inability to extend and/or bend the knee completely. A more or less abundant effusion can follow within a few minutes to a few days. Degenerative meniscal lesions, on the other hand, are rather the result of progressive wear of the meniscal tissue over several months or years, with excessive mechanical stresses repeated over time.

We most often encounter them in patients over 40 years old who have quite physical sports and/or professional activities: Footballers, hikers, bricklayers, nursery assistants, etc. Certain factors can promote this meniscal degeneration, such as genu varum (“Lucky Luke” knees) and being overweight. The pains are quite chronic, fluctuating, progressively setting in, and accompanied by also fluctuating effusion.

It involves the medial meniscus in the majority of cases.

The typical image on MRI is a “horizontal tearing” of the meniscus, sometimes accompanied by small meniscal cysts. This can constitute the warning signs of arthritis of the joint.

Intra-articular image during an arthroscopy: At the top a normal meniscus, at the bottom a torn meniscus

PRINCIPLES OF TREATMENT:

While surgical resection of the entire damaged meniscus may relieve symptoms quickly and for several months, it would significantly increase the risks of osteoarthritic degeneration of the knee. We are therefore currently aiming to preserve the meniscus as much as possible. We first opt for a meniscal suture whenever the chances of healing are good.

When it comes to a non-suturable tear (significant damage, old rupture, lesion in a non-vascularized zone, etc.), we perform a meticulous excision of the damaged part only (partial meniscectomy).

In the case of a “degenerative horizontal tear,” non-surgical treatment is prioritized, since the wear generally affects the entire meniscus: Joint hygiene measures, physiotherapy, crutches, hyaluronic acid injections, PRP injections, etc.

THE SURGERY:

In the vast majority of cases, the surgery is performed by arthroscopy: through two skin punctures of less than one cm, a camera (the arthroscope) and 4mm instruments are inserted into the knee to perform the surgical procedure.

The surgery is most often carried out on an outpatient basis.

Depending on your preferences and especially your medical history, the surgery is done under general anesthesia or spinal anesthesia.

Skin closure is performed using 2 sutures.

POSTOPERATIVE FOLLOW-UP:

You leave the same evening of the surgery with a dressing, a knee brace, and crutches. If it is a meniscal suture, you are not allowed to bear weight on the operated side for 6 weeks, the time necessary for the healing of the sutured meniscal lesion.

If it is a meniscectomy, you can bear weight normally from the first day. Crutches are then kept only for a few days, the time it takes to resume normal walking. In all cases, you will need to rest your knee for the 3 months following the surgery, avoiding mechanically demanding activities.

Physiotherapy sessions may be prescribed depending on the case to maintain your muscles and recover joint flexibility.

Thanks to arthroscopy and the outpatient mode, complications from meniscal surgeries have become even rarer (in the order of less than 1 case per 1,000). In case of healing failure after meniscal suture (about 20% of cases), a second surgery may be necessary to remove the part that has not healed.

Illustration of the main types of meniscal tears: Bucket handle, meniscal flap, radial tear, fraying of the free edge

L’article MENISCAL LESIONS est apparu en premier sur Dr Majed Issa.

]]> CARTILAGE GRAFT https://drmajedissa.com/en/cartilage-graft/ Tue, 06 Feb 2024 13:02:20 +0000 https://drmajedissa.com/?p=9274 CARTILAGE GRAFT: WHAT IS IT? Cartilage covers the bone surfaces in joints. It does not regenerate, or does so very minimally. Its disappearance can cause pain and lead to osteoarthritis in the long term. In cases of limited substance loss, it is possible to fill in the gap with your own cartilage. This is harvested from a healthy area along with the corresponding bone portion in the form of a small cylinder. It is then grafted to fill in the substance loss. In agreement with your surgeon and according to the benefit-risk balance, a cartilage graft through mosaicplasty has been proposed to you. The surgeon has explained the other alternatives. It goes without saying that your surgeon may, if necessary based on preoperative findings or a difficulty encountered, proceed with another technique deemed by him more beneficial to your specific case. BEFORE THE TREATMENT: The diagnosis is refined using various examinations such as MRI and/or arthroscopy. These tests allow the visualization of the loss of cartilaginous substance and the determination of its size. The mosaicplasty technique is often proposed for lesions larger than 1cm². WHAT TREATMENT? The surgery is performed under general or regional anesthesia with a tourniquet placed at the root of the thigh. The incision is centered on the cartilaginous lesion and can vary in size depending on the case. The lesion is then visualized and measured. The harvesting of one or more osteochondral cylinders is carried out on the periphery of the joint. This graft, which includes a bony part and a cartilaginous part, is then placed at the site of the substance loss. Depending on the size of the lesion, several grafts may be harvested and grafted. AND AFTER? After the first surgery, you will be prescribed a short-term work stoppage, as well as a few physiotherapy sessions. Full weight-bearing will be allowed immediately. The follow-up is similar to that of a simple arthroscopy. After the second surgery, your knee will be immobilized in a removable brace in extension between physiotherapy sessions for a duration that will be specified by your surgeon. Weight-bearing will be prohibited for several weeks to several months to protect the cartilage graft. An anticoagulant treatment will be prescribed for the non-weight-bearing period. Driving will be possible as soon as full weight-bearing is resumed. The return to sports will be delayed for several months (up to 1 year depending on the lesions). A work stoppage of several months will be prescribed depending on your profession. EXPECTED RESULTS? The mosaicplasty graft technique is a method used to treat medium-sized lesions. The expected result is an improvement or even disappearance of pain or cracking sounds. Do not hesitate to ask your surgeon for more details. IN SUMMARY: Knee cartilage grafting by mosaicplasty technique is a procedure indicated for cartilaginous lesions. It is performed in one stage. There are few complications, but the postoperative follow-up is demanding. Recovery after surgery requires several months. The resumption of sports should be gradual and carried out under medical supervision, respecting the time limits given by your surgeon.

L’article CARTILAGE GRAFT est apparu en premier sur Dr Majed Issa.

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CARTILAGE GRAFT: WHAT IS IT?

Cartilage covers the bone surfaces in joints. It does not regenerate, or does so very minimally. Its disappearance can cause pain and lead to osteoarthritis in the long term. In cases of limited substance loss, it is possible to fill in the gap with your own cartilage. This is harvested from a healthy area along with the corresponding bone portion in the form of a small cylinder. It is then grafted to fill in the substance loss.

In agreement with your surgeon and according to the benefit-risk balance, a cartilage graft through mosaicplasty has been proposed to you. The surgeon has explained the other alternatives. It goes without saying that your surgeon may, if necessary based on preoperative findings or a difficulty encountered, proceed with another technique deemed by him more beneficial to your specific case.

BEFORE THE TREATMENT:

The diagnosis is refined using various examinations such as MRI and/or arthroscopy. These tests allow the visualization of the loss of cartilaginous substance and the determination of its size. The mosaicplasty technique is often proposed for lesions larger than 1cm².

WHAT TREATMENT?

The surgery is performed under general or regional anesthesia with a tourniquet placed at the root of the thigh. The incision is centered on the cartilaginous lesion and can vary in size depending on the case. The lesion is then visualized and measured.

The harvesting of one or more osteochondral cylinders is carried out on the periphery of the joint. This graft, which includes a bony part and a cartilaginous part, is then placed at the site of the substance loss. Depending on the size of the lesion, several grafts may be harvested and grafted.

AND AFTER?

After the first surgery, you will be prescribed a short-term work stoppage, as well as a few physiotherapy sessions. Full weight-bearing will be allowed immediately. The follow-up is similar to that of a simple arthroscopy.

After the second surgery, your knee will be immobilized in a removable brace in extension between physiotherapy sessions for a duration that will be specified by your surgeon. Weight-bearing will be prohibited for several weeks to several months to protect the cartilage graft. An anticoagulant treatment will be prescribed for the non-weight-bearing period.

Driving will be possible as soon as full weight-bearing is resumed. The return to sports will be delayed for several months (up to 1 year depending on the lesions). A work stoppage of several months will be prescribed depending on your profession.

EXPECTED RESULTS?

The mosaicplasty graft technique is a method used to treat medium-sized lesions. The expected result is an improvement or even disappearance of pain or cracking sounds. Do not hesitate to ask your surgeon for more details.

IN SUMMARY:

Knee cartilage grafting by mosaicplasty technique is a procedure indicated for cartilaginous lesions. It is performed in one stage. There are few complications, but the postoperative follow-up is demanding. Recovery after surgery requires several months. The resumption of sports should be gradual and carried out under medical supervision, respecting the time limits given by your surgeon.

IMG-20210607-WA0020
IMG-20210607-WA0019
IMG-20210607-WA0017 (1)

L’article CARTILAGE GRAFT est apparu en premier sur Dr Majed Issa.

]]> KNEE OSTEOTOMIES https://drmajedissa.com/en/knee-osteotomies/ Tue, 06 Feb 2024 12:32:05 +0000 https://drmajedissa.com/?p=9268 Tibial or femoral osteotomy at the knee is a so-called “conservative” surgical technique used in the treatment of early to moderate knee osteoarthritis, in contrast to non-conservative techniques such as knee prostheses. Internal knee osteoarthritis is favored by an anomaly in the axis of the lower limb (genu varum, like “Lucky Luke”). When there is an axis defect, the stresses are poorly distributed, and the body weight applies more on the inside, accelerating wear. Conversely, X-shaped knees (genu valgum) promote wear on the external compartment of the knee. When the osteoarthritis is not too severe yet, it is possible to propose to slow down or even stop its progression by straightening the osseous axis of the knee. The diagnosis of osteoarthritis is confirmed by clinical examination, radiography, MRI, and sometimes arthroscopy. The mechanical axis of the limb is measured to determine the exact angle of correction needed. THE SURGERY: The surgery is performed under general anesthesia or spinal anesthesia, depending on your preferences and especially your medical history. The scar is vertical and averages 8cm in length. A partial cut is made in the bone (osteotomy). An instrument gently spreads the bone edges by a few millimeters, according to the planned correction (8 to 12mm at maximum). A wedge made of bone graft is inserted into the created space, and a titanium plate that conforms to the anatomical shape of the bone is used to secure the correction. Une entaille osseuse et réalisée, puis ouverte de quelques millimètres à l’aide d’instruments précisLa correction osseuse est mesurée au millimètre près, puis est fixée avec une plaque et vis en titaneL’espace créé est comblé avec de la greffe osseuse pour une consolidation plus rapideAspect de la cicatrice à 3 semaines post-opératoires POSTOPERATIVE FOLLOW-UP: The surgery is generally performed on an outpatient basis. A physiotherapist comes to see you before discharge to get you standing and to give you practical advice on using crutches. Weight-bearing on the operated limb is prohibited for 6 weeks, the time needed for the osteotomy to consolidate. During this time, you will be able to move around with crutches, and you will need to have regular sessions (with a physiotherapist and at home) of knee mobilization in flexion/extension, to maintain joint flexibility and prevent muscle atrophy. An anticoagulant treatment will also be prescribed for 6 weeks. The consolidation of the osteotomy will be monitored in consultation with regular radiographs. Driving is possible as soon as full weight-bearing is resumed. EXPECTED RESULTS: It is very important to understand clearly that a knee osteotomy does not repair the osteoarthritis that already exists in your knee. Its purpose is to modify a predisposing factor to osteoarthritis, the poor anatomical alignment, in order to preserve what healthy cartilage you have left. It involves an extra-articular bone procedure, meaning that your surgeon does not touch the inside of your joint. As a result, you will probably continue to experience the pains associated with osteoarthritis after the osteotomy, sometimes for more than a year, but these will gradually decrease since the pressure on the arthritic compartment is now reduced. It is therefore appropriate to act seriously and effectively on all the other predisposing factors to osteoarthritis: Excess weight, demanding activities and sports, lifting heavy objects, sedentary lifestyle, etc. Patient with severe genu varum (Lucky Luke knees, O-shaped) Photo after valgus tibial osteotomy on the left leg Patient with severe genu valgum (X-shaped knees) X-ray before and after varus osteotomy on the distal left femur. The global mechanical axis of the lower left limb is straight.

L’article KNEE OSTEOTOMIES est apparu en premier sur Dr Majed Issa.

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Tibial or femoral osteotomy at the knee is a so-called “conservative” surgical technique used in the treatment of early to moderate knee osteoarthritis, in contrast to non-conservative techniques such as knee prostheses.

Internal knee osteoarthritis is favored by an anomaly in the axis of the lower limb (genu varum, like “Lucky Luke”). When there is an axis defect, the stresses are poorly distributed, and the body weight applies more on the inside, accelerating wear.

Conversely, X-shaped knees (genu valgum) promote wear on the external compartment of the knee. When the osteoarthritis is not too severe yet, it is possible to propose to slow down or even stop its progression by straightening the osseous axis of the knee. The diagnosis of osteoarthritis is confirmed by clinical examination, radiography, MRI, and sometimes arthroscopy.

The mechanical axis of the limb is measured to determine the exact angle of correction needed.

THE SURGERY:

The surgery is performed under general anesthesia or spinal anesthesia, depending on your preferences and especially your medical history.

The scar is vertical and averages 8cm in length. A partial cut is made in the bone (osteotomy). An instrument gently spreads the bone edges by a few millimeters, according to the planned correction (8 to 12mm at maximum).

A wedge made of bone graft is inserted into the created space, and a titanium plate that conforms to the anatomical shape of the bone is used to secure the correction.

Une entaille osseuse et réalisée, puis ouverte de quelques millimètres à l'aide d'instruments précis
La correction osseuse est mesurée au millimètre près, puis est fixée avec une plaque et vis en titane
L'espace créé est comblé avec de la greffe osseuse pour une consolidation plus rapide
Aspect de la cicatrice à 3 semaines post-opératoires

POSTOPERATIVE FOLLOW-UP:

The surgery is generally performed on an outpatient basis. A physiotherapist comes to see you before discharge to get you standing and to give you practical advice on using crutches. Weight-bearing on the operated limb is prohibited for 6 weeks, the time needed for the osteotomy to consolidate.

During this time, you will be able to move around with crutches, and you will need to have regular sessions (with a physiotherapist and at home) of knee mobilization in flexion/extension, to maintain joint flexibility and prevent muscle atrophy.

An anticoagulant treatment will also be prescribed for 6 weeks.

The consolidation of the osteotomy will be monitored in consultation with regular radiographs. Driving is possible as soon as full weight-bearing is resumed.

EXPECTED RESULTS:

It is very important to understand clearly that a knee osteotomy does not repair the osteoarthritis that already exists in your knee.

Its purpose is to modify a predisposing factor to osteoarthritis, the poor anatomical alignment, in order to preserve what healthy cartilage you have left.

It involves an extra-articular bone procedure, meaning that your surgeon does not touch the inside of your joint.

As a result, you will probably continue to experience the pains associated with osteoarthritis after the osteotomy, sometimes for more than a year, but these will gradually decrease since the pressure on the arthritic compartment is now reduced.

It is therefore appropriate to act seriously and effectively on all the other predisposing factors to osteoarthritis: Excess weight, demanding activities and sports, lifting heavy objects, sedentary lifestyle, etc.

Patient with severe genu varum (Lucky Luke knees, O-shaped) Photo after valgus tibial osteotomy on the left leg
Patient with severe genu valgum (X-shaped knees) X-ray before and after varus osteotomy on the distal left femur. The global mechanical axis of the lower left limb is straight.

L’article KNEE OSTEOTOMIES est apparu en premier sur Dr Majed Issa.

]]> RUPTURE OF THE KNEE’S CRUCIATE LIGAMENTS https://drmajedissa.com/en/rupture-of-the-knees-cruciate-ligaments/ Tue, 06 Feb 2024 12:17:27 +0000 https://drmajedissa.com/?p=9263 https://www.youtube.com/watch?v=IWzXL7wWX8Q At the center of the knee joint, two powerful ligaments stabilize the joint in rotational movements and anterior or posterior translations. These are the cruciate ligaments (anterior and posterior), which constitute what is called the central pivot. It’s like two very tight, inelastic ropes that bathe in the joint fluid (synovial fluid). The rupture of the cruciate ligaments is a common accident, especially with the practice of contact sports or pivot sports like football, skiing, martial arts, etc. Acutely, the rupture of a cruciate ligament is accompanied by bleeding and swelling of the joint cavity, as well as partial or total functional impairment. In fact, it is mainly the associated traumatic lesions that cause pain: Bone contusions or fissures, sprains of the extra-articular ligaments, meniscal tear, cartilage lesion, etc. The cruciate ligament itself is little, if at all, painful, once the initial trauma has cooled down. But the absence of pain can be misleading. The knee has not returned to normal. Indeed, unlike the extra-articular ligaments, a cruciate ligament ruptured in full substance does not have the capacity to heal by itself. Its absence leads to millimetric anteroposterior and rotational instability, which is responsible in the medium and long term for progressive wear of the joint. Patients often experience giving way, a lack of confidence in their knee, especially if they practice pivot sports, contact sports, or those with strong accelerations/decelerations. With a ruptured cruciate ligament, the increased risk of long-term knee osteoarthritis is estimated at 40%, according to scientific publications. In an active, athletic patient of a young physiological age, the reconstruction of the cruciate ligament is indispensable to restabilize the knee and prevent as much as possible the arthrosic evolution over time. At the other extreme, in a sedentary patient of an advanced physiological age, or already showing signs of osteoarthritis beforehand, the reconstruction of the cruciate ligament may not necessarily have enough advantages to justify surgery. PREPARATION FOR THE SURGERY: The immediate aftermath of a trauma with cruciate ligament rupture is consistently marked by varying degrees of stiffness, weakening, and muscular atrophy, particularly of the quadriceps. It is essential to regain good joint flexibility and good muscular tone before surgery: The quality of the postoperative result and the speed of recovery depend on it. Therefore, physiotherapy sessions are prescribed preoperatively, to properly prepare for the surgery. THE SURGERY: Cruciate ligament reconstruction, also known as ligamentoplasty, lasts 1 hour and can be performed under general anesthesia or spinal anesthesia (injection in the back, only the lower body is numbed). It is most often carried out on an outpatient basis. The surgery is performed by arthroscopy: Through two small skin incisions of 5mm at the front of the knee, a 4mm camera and multiple instruments are inserted into the joint cavity to perform the procedure. There is no need for a large surgical opening. To reconstruct a new cruciate ligament, a portion of a tendon from the lower limb is harvested: This involves either the hamstring tendons (DT4 and DI-DT technique) or the patellar tendon (KJ or Kenneth Jones technique), more rarely the quadriceps tendon. We have chosen to preferentially perform the DT4 technique. As its name suggests, it involves harvesting a single hamstring tendon, the semitendinosus (DT), through a 3cm incision in the proximal leg, which is folded in four to serve as a new cruciate ligament. The graft is inserted into the knee through the same arthroscopic openings, then fixed in a tibial bone slot on one side, and a femoral bone slot on the other. The tension of the graft is adjusted as needed using a well-perfected system of cords. This is the least invasive technique available to date, which therefore allows for a less painful and faster recovery: Only one hamstring tendon is harvested (compared to DI-DT), no morbidity at the harvest site (compared to KJ sometimes), no drilling of bone tunnels (compared to DI-DT and KJ). Intra-articular image of an anterior cruciate ligament reconstruction POSTOPERATIVE FOLLOW-UP: After the surgery, you are taken to the recovery room where you stay on average for 2 hours. A postoperative control radiograph is systematically performed before you are taken back to your room. On the evening of the surgery, a physiotherapist comes to see you, gives you some instructions, and then helps you get up and walk, with the protection of a brace and crutches. You are allowed full weight-bearing on the operated leg after a standard ligamentoplasty. If a meniscal suture has to be performed at the same time, the resumption of weight-bearing is delayed for 4 to 6 weeks to wait for the meniscal healing. Physiotherapy starts two to three days after the surgery, according to a specific protocol and schedule. It lasts at least 6 months and typically 1 year, ending with a step of getting back to sports. The healing of the ligamentoplasty graft in the bone is estimated at 1 year. During this period, sports and activities with pivoting or contact such as martial arts, football, tennis among others are prohibited, at the risk of rupturing or stretching the new ligament. We meet regularly in postoperative follow-up consultation, and we plan together each activity that you wish to resume. Example of scars from a cruciate ligament reconstruction at 6 weeks post-operative

L’article RUPTURE OF THE KNEE’S CRUCIATE LIGAMENTS est apparu en premier sur Dr Majed Issa.

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At the center of the knee joint, two powerful ligaments stabilize the joint in rotational movements and anterior or posterior translations. These are the cruciate ligaments (anterior and posterior), which constitute what is called the central pivot. It’s like two very tight, inelastic ropes that bathe in the joint fluid (synovial fluid).

The rupture of the cruciate ligaments is a common accident, especially with the practice of contact sports or pivot sports like football, skiing, martial arts, etc. Acutely, the rupture of a cruciate ligament is accompanied by bleeding and swelling of the joint cavity, as well as partial or total functional impairment.

In fact, it is mainly the associated traumatic lesions that cause pain: Bone contusions or fissures, sprains of the extra-articular ligaments, meniscal tear, cartilage lesion, etc. The cruciate ligament itself is little, if at all, painful, once the initial trauma has cooled down. But the absence of pain can be misleading. The knee has not returned to normal.

Indeed, unlike the extra-articular ligaments, a cruciate ligament ruptured in full substance does not have the capacity to heal by itself. Its absence leads to millimetric anteroposterior and rotational instability, which is responsible in the medium and long term for progressive wear of the joint.

Patients often experience giving way, a lack of confidence in their knee, especially if they practice pivot sports, contact sports, or those with strong accelerations/decelerations. With a ruptured cruciate ligament, the increased risk of long-term knee osteoarthritis is estimated at 40%, according to scientific publications.

In an active, athletic patient of a young physiological age, the reconstruction of the cruciate ligament is indispensable to restabilize the knee and prevent as much as possible the arthrosic evolution over time.

At the other extreme, in a sedentary patient of an advanced physiological age, or already showing signs of osteoarthritis beforehand, the reconstruction of the cruciate ligament may not necessarily have enough advantages to justify surgery.

PREPARATION FOR THE SURGERY:

The immediate aftermath of a trauma with cruciate ligament rupture is consistently marked by varying degrees of stiffness, weakening, and muscular atrophy, particularly of the quadriceps.

It is essential to regain good joint flexibility and good muscular tone before surgery: The quality of the postoperative result and the speed of recovery depend on it.

Therefore, physiotherapy sessions are prescribed preoperatively, to properly prepare for the surgery.

THE SURGERY:

Cruciate ligament reconstruction, also known as ligamentoplasty, lasts 1 hour and can be performed under general anesthesia or spinal anesthesia (injection in the back, only the lower body is numbed). It is most often carried out on an outpatient basis.

The surgery is performed by arthroscopy: Through two small skin incisions of 5mm at the front of the knee, a 4mm camera and multiple instruments are inserted into the joint cavity to perform the procedure. There is no need for a large surgical opening.

To reconstruct a new cruciate ligament, a portion of a tendon from the lower limb is harvested: This involves either the hamstring tendons (DT4 and DI-DT technique) or the patellar tendon (KJ or Kenneth Jones technique), more rarely the quadriceps tendon.

We have chosen to preferentially perform the DT4 technique. As its name suggests, it involves harvesting a single hamstring tendon, the semitendinosus (DT), through a 3cm incision in the proximal leg, which is folded in four to serve as a new cruciate ligament.

The graft is inserted into the knee through the same arthroscopic openings, then fixed in a tibial bone slot on one side, and a femoral bone slot on the other. The tension of the graft is adjusted as needed using a well-perfected system of cords.

This is the least invasive technique available to date, which therefore allows for a less painful and faster recovery: Only one hamstring tendon is harvested (compared to DI-DT), no morbidity at the harvest site (compared to KJ sometimes), no drilling of bone tunnels (compared to DI-DT and KJ).

Intra-articular image of an anterior cruciate ligament reconstruction

POSTOPERATIVE FOLLOW-UP:

After the surgery, you are taken to the recovery room where you stay on average for 2 hours.

A postoperative control radiograph is systematically performed before you are taken back to your room.

On the evening of the surgery, a physiotherapist comes to see you, gives you some instructions, and then helps you get up and walk, with the protection of a brace and crutches.

You are allowed full weight-bearing on the operated leg after a standard ligamentoplasty. If a meniscal suture has to be performed at the same time, the resumption of weight-bearing is delayed for 4 to 6 weeks to wait for the meniscal healing.

Physiotherapy starts two to three days after the surgery, according to a specific protocol and schedule. It lasts at least 6 months and typically 1 year, ending with a step of getting back to sports.

The healing of the ligamentoplasty graft in the bone is estimated at 1 year. During this period, sports and activities with pivoting or contact such as martial arts, football, tennis among others are prohibited, at the risk of rupturing or stretching the new ligament.

We meet regularly in postoperative follow-up consultation, and we plan together each activity that you wish to resume.

Example of scars from a cruciate ligament reconstruction at 6 weeks post-operative

L’article RUPTURE OF THE KNEE’S CRUCIATE LIGAMENTS est apparu en premier sur Dr Majed Issa.

]]> KNEE REPLACEMENT https://drmajedissa.com/en/knee-replacement/ Tue, 06 Feb 2024 12:13:11 +0000 https://drmajedissa.com/?p=9257 Knee osteoarthritis is a common disease affecting more than one in four people after the age of 65. It leads to a progressive destruction of the knee’s articular cartilage. The wear of the cartilage is accompanied by a degradation of the menisci, muscles, and synovial inflammation. It is a global affliction of the joint that becomes painful and starts to stiffen. In some cases, it is no longer possible to fully extend the knee (flexum). Among the predisposing factors, we can notably mention: A misalignment of the knees: “Lucky Luke” knees (genu varum) or X-shaped knees (genu valgum). Genetic factor. Sequels of old traumas to the bones, cartilage, menisci, or ligaments. Overweight. The practice of intensive sports or very physical professional activity. Inflammatory rheumatism can lead to the destruction of the knee cartilage. The progression of osteoarthritic disease generally occurs through flares of pain and effusions, lasting a few days to a few weeks, separated by periods of calm of varying lengths. WHAT ARE THE OPTIONS? There is no medical treatment available to date that can prevent osteoarthritis or regenerate eroded cartilage. That said, the body often adapts in quite a surprising way to joint wear, sometimes for long durations. The progression of osteoarthritis can be slowed down by avoiding sports and activities that mechanically stress the knee, and by reducing overweight. Physiotherapy sessions focusing on muscle strengthening, injections of corticosteroids, hyaluronic acid, or PRP (Platelet-Rich Plasma) can be very beneficial. These medical measures, when well conducted, can spare the patient from surgery. But if the pain starts to heavily affect the patient’s daily life and becomes difficult to control with non-surgical means, the surgical option of knee replacement is discussed: It involves freshening the damaged joint surfaces, and “dressing” them with prosthetic parts, thus avoiding painful bone friction. Contrary to a widely held misconception among the general population, there is no massive bone resection with knee replacement. It is a matter of dressing or “resurfacing” the two damaged joint edges, while preserving as much as possible the other native anatomical structures. In some cases, the wear is significant but localized to a single compartment of the knee. In such cases, only that compartment can be resurfaced with a partial prosthesis (unicompartmental). THE SURGERY: A radiographic assessment is systematically prescribed for you, in order to plan the ideal sizes and positions of the prosthetic implants and to replicate the alignment of the native knee. Sometimes a CT scan or an MRI is requested to look for a rotational abnormality of the limb or to allow for the manufacture of custom tools specific to your knee, or even to make a tailor-made prosthesis. A blood test, a urine exam, a cardiology consultation, and a dental assessment are necessary for the medical preparation for the surgery. The surgery can be performed under general anesthesia or spinal anesthesia, depending on your preferences and especially your medical history. You will be able to discuss this in detail with the anesthetist during the anesthesia consultation. The surgery generally lasts between 1 to 1.5 hours. The prosthesis consists of a femoral piece and a tibial piece made of a Chrome-Cobalt alloy, each a few millimeters thick, replicating the native anatomy of the knee. They are fixed to the bone with a medical cement (rapid-setting resin). A polyethylene piece (a very resistant polymer) is placed between the femur and the tibia, ensuring smooth mobility. At the end of the surgery, a rather thick and slightly compressive dressing is applied. A drain is sometimes used to prevent the formation of a hematoma in the joint. You will stay in the recovery room for an average of two or three hours, where cold packs will be applied to the knee. A control radiography is performed, then you are taken back to your room. A meal will be served to you there. POSTOPERATIVE FOLLOW-UP: Hospitalization after knee replacement surgery generally lasts 3 to 4 nights. From the next morning, a physiotherapist comes to see you to start mobilizing the knee in flexion/extension, and to have you walk with the aid of a walker or crutches. The physiotherapist will even try to have you climb up and down a few steps before you leave. The nurses change the dressing every 2 days, which will now be a very thin adhesive dressing. It must remain perfectly clean and dry until the wound is completely healed (2 to 3 weeks). A daily anticoagulant injection is essential to ward off the risk of thrombosis. You will be able to cover increasingly longer distances. You can dispense with the crutches as soon as you feel stable enough. Due to the poor function of your knee before the operation, your muscles have likely weakened over several months or even years. Therefore, they will need time to regain their strength and flexibility. It is not uncommon for the knee to remain sensitive and easily fatigued during prolonged efforts or squatting. This should not discourage you. The time for healing, for your skeleton to adapt to your prosthesis, and for the recovery of your flexibility and strength is long. Progress will be steady, and it often takes nearly a year to achieve a “forgotten knee.” To get there more surely and more quickly, you will be asked to do very regular sessions of knee mobilization in flexion/extension yourself, from the day after your surgery, wherever you are, in bed, sitting on your sofa, or outside, without forcing through pain. You should not rely solely on the time spent with the physiotherapist. You remain the main actor in your recovery.

L’article KNEE REPLACEMENT est apparu en premier sur Dr Majed Issa.

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Knee osteoarthritis is a common disease affecting more than one in four people after the age of 65. It leads to a progressive destruction of the knee’s articular cartilage.

The wear of the cartilage is accompanied by a degradation of the menisci, muscles, and synovial inflammation.

It is a global affliction of the joint that becomes painful and starts to stiffen. In some cases, it is no longer possible to fully extend the knee (flexum).

Among the predisposing factors, we can notably mention:

  1. A misalignment of the knees: “Lucky Luke” knees (genu varum) or X-shaped knees (genu valgum).
  2. Genetic factor.
  3. Sequels of old traumas to the bones, cartilage, menisci, or ligaments.
  4. Overweight.
  5. The practice of intensive sports or very physical professional activity.
  6. Inflammatory rheumatism can lead to the destruction of the knee cartilage.

The progression of osteoarthritic disease generally occurs through flares of pain and effusions, lasting a few days to a few weeks, separated by periods of calm of varying lengths.

WHAT ARE THE OPTIONS?

There is no medical treatment available to date that can prevent osteoarthritis or regenerate eroded cartilage. That said, the body often adapts in quite a surprising way to joint wear, sometimes for long durations.

The progression of osteoarthritis can be slowed down by avoiding sports and activities that mechanically stress the knee, and by reducing overweight.

Physiotherapy sessions focusing on muscle strengthening, injections of corticosteroids, hyaluronic acid, or PRP (Platelet-Rich Plasma) can be very beneficial.

These medical measures, when well conducted, can spare the patient from surgery.

But if the pain starts to heavily affect the patient’s daily life and becomes difficult to control with non-surgical means, the surgical option of knee replacement is discussed: It involves freshening the damaged joint surfaces, and “dressing” them with prosthetic parts, thus avoiding painful bone friction.

Contrary to a widely held misconception among the general population, there is no massive bone resection with knee replacement. It is a matter of dressing or “resurfacing” the two damaged joint edges, while preserving as much as possible the other native anatomical structures.

In some cases, the wear is significant but localized to a single compartment of the knee. In such cases, only that compartment can be resurfaced with a partial prosthesis (unicompartmental).

THE SURGERY:

A radiographic assessment is systematically prescribed for you, in order to plan the ideal sizes and positions of the prosthetic implants and to replicate the alignment of the native knee.

Sometimes a CT scan or an MRI is requested to look for a rotational abnormality of the limb or to allow for the manufacture of custom tools specific to your knee, or even to make a tailor-made prosthesis.

A blood test, a urine exam, a cardiology consultation, and a dental assessment are necessary for the medical preparation for the surgery.

The surgery can be performed under general anesthesia or spinal anesthesia, depending on your preferences and especially your medical history. You will be able to discuss this in detail with the anesthetist during the anesthesia consultation.

The surgery generally lasts between 1 to 1.5 hours.

The prosthesis consists of a femoral piece and a tibial piece made of a Chrome-Cobalt alloy, each a few millimeters thick, replicating the native anatomy of the knee. They are fixed to the bone with a medical cement (rapid-setting resin). A polyethylene piece (a very resistant polymer) is placed between the femur and the tibia, ensuring smooth mobility.

At the end of the surgery, a rather thick and slightly compressive dressing is applied. A drain is sometimes used to prevent the formation of a hematoma in the joint. You will stay in the recovery room for an average of two or three hours, where cold packs will be applied to the knee.

A control radiography is performed, then you are taken back to your room. A meal will be served to you there.

POSTOPERATIVE FOLLOW-UP:

Hospitalization after knee replacement surgery generally lasts 3 to 4 nights.

From the next morning, a physiotherapist comes to see you to start mobilizing the knee in flexion/extension, and to have you walk with the aid of a walker or crutches. The physiotherapist will even try to have you climb up and down a few steps before you leave.

The nurses change the dressing every 2 days, which will now be a very thin adhesive dressing. It must remain perfectly clean and dry until the wound is completely healed (2 to 3 weeks). A daily anticoagulant injection is essential to ward off the risk of thrombosis.

You will be able to cover increasingly longer distances. You can dispense with the crutches as soon as you feel stable enough.

Due to the poor function of your knee before the operation, your muscles have likely weakened over several months or even years. Therefore, they will need time to regain their strength and flexibility. It is not uncommon for the knee to remain sensitive and easily fatigued during prolonged efforts or squatting.

This should not discourage you.

The time for healing, for your skeleton to adapt to your prosthesis, and for the recovery of your flexibility and strength is long. Progress will be steady, and it often takes nearly a year to achieve a “forgotten knee.”

To get there more surely and more quickly, you will be asked to do very regular sessions of knee mobilization in flexion/extension yourself, from the day after your surgery, wherever you are, in bed, sitting on your sofa, or outside, without forcing through pain.

You should not rely solely on the time spent with the physiotherapist. You remain the main actor in your recovery.

    L’article KNEE REPLACEMENT est apparu en premier sur Dr Majed Issa.

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