Arthroscopy And Sports Medicine

OVERVIEW of Sports Medicine Service:

In today’s world, Arthroscopic surgeries are very commonly performed procedures in the field of orthopedics. It has revolutionized the field of Sports medicine. Dr. Rewat Laxman specializes in the field of knee, shoulder and elbow arthroscopy

KNEE arthroscopy

Common procedures are:-

  1. ACL Reconstruction
  2. PCL Reconstruction
  3. Meniscal repair/Meniscectomy

ACL Reconstruction

Tearing or damage of the anterior cruciate ligament (ACL) — is called as  ACL injury.ACL is one of the major ligaments of the knee  joint. ACL injuries commonly occur during sports and activities involving  sudden stops, jumping or changes in direction like football, tennis, volleyball, basketball, during cricket while turning and taking a run/fielding and dancing.

Many people hear or feel a “popping ” sound in the knee. Immediate swelling, instability ensues and the knee becomes too painful to bear weight. It’s an almost similar experience like a fracture.

Most ACL injuries happen during sports and fitness activities that can put stress on the knee:

• Receiving a direct blow to the knee or collision.
• Stopping suddenly
• Turning and rotating  with your foot firmly planted
• Suddenly slowing down and changing direction
• Landing from a jump incorrectly

When the ligament is damaged, there is usually a partial or complete tear.

Symptoms

Signs and symptoms of an ACL injury usually include:

• Severe pain and inability to continue activity(fracture like episode)
• A feeling of instability or “giving way” with weight bearing
• A loud “pop” or a “popping” sensation in the knee• Swelling that begins within a few hours
• Loss of range of motion

Seek a consultation

Seek immediate care if any injury to your knee causes signs or symptoms of an ACL injury. The knee joint is a complex structure of bones, ligaments, tendons and other tissues that work together. It’s important to get a prompt and accurate diagnosis to determine the severity of the injury and get proper treatment.

People who experience an ACL injury are at higher risk of developing knee osteoarthritis, in which joint cartilage deteriorates and its smooth surface roughens. Multiple factors likely influence the risk of arthritis, such as the severity of the original injury, the presence of related injuries in the knee joint or the level of activity after treatment.

Diagnosis

During the physical exam, the doctor will check your knee for swelling and tenderness. He will perform various tests to assess the range of motion and overall function of the joint. A patient may have to undergo tests to confirm and determine the severity of the injury.

• X-rays. X-rays may be needed to rule out a bone fracture.
• Magnetic resonance imaging (MRI).  An MRI can show the extent of an ACL injury and signs of damage to other tissues in the knee.

Treatment

Prompt first-aid care can reduce pain and swell immediately after an injury to your knee. Mainstay of initial treatment are:-

• Rest. rest is necessary for healing and limits weight bearing on your knee.
• Ice. Will help to reduce the swelling.
• Compression. Wrap a compression  bandage
• Elevation.  knee propped up on pillows.

Rehabilitation

Any Acl injury needs 4-6 weeks of rehabilitation according to ACL protocol. A physiotherapist will teach you how to do exercises that you will perform either with continued supervision or at home. You may also wear a brace to stabilize your knee and use crutches for a while to avoid putting weight on your knee.
The goal of rehabilitation is to reduce pain and swelling, restore your knee’s full range of motion, and strengthen muscles.

Surgery

surgery is recommended for:-

• Athletes and who want to continue in their sport, especially if the sport involves jumping, pivoting & sudden change in direction
• More than one ligament or the cartilage are injured
• young and active patients
• Buckling of knee during everyday activities

During ACL reconstruction, the damaged ligament is removed and replaced by a tendon graft that connects muscle to bone. Surgeons use a piece of tendon from another part of your knee. The graft will serve as the scaffolding on which new ligament tissue can grow.After surgery patients resume another course of rehabilitative therapy. Successful ACL reconstruction paired with rigorous rehabilitation can usually restore stability and function to your knee.

After surgery patients resume another course of rehabilitative therapy. Successful ACL reconstruction paired with rigorous rehabilitation can usually restore stability and function to your knee.

Shoulder Arthroscopy

Shoulder Arthroscopy

A shoulder is a complex joint that is capable of more motion than any other joint in the body.This is both a boon and a bane. It has maximum mobility amongst all the other joint at the cost of stability. It’s one of the most common joints to be dislocated.

Any sporting activity like bowling, throwing, tennis, badminton etc which requires vigorous overhead activity can injure shoulder joint.

To develop a simple understanding of shoulder pain , you have to understand two very unique features of shoulder joint:-

1) its shape is like a golf ball on a tee  ie; large ball and small cup. It is supported by a system of muscle tendons(Rotator cuff), Ligaments (glenohumeral ligaments) and capsule. All of these expand the cup to receive the ball that is the head of the humerus(your arm bone). Injury to one or several of these causes shoulder pain/instability/decreased the range of motion.

2) Muscle and tendinous attachments of your shoulder are like a suspension bridge.Even if one of the cables of the suspension bridge breaks other cables manage it.

Common pathologies with regards to shoulder joint are:-

  1. Subacromial Bursitis
  2. Rotator cuff tear
  3. Instability
  4. Labral Tear

All most all of these pathologies except instability can be treated initially conservatively, with analgesics, Steroid injection and 2-3 weeks of physiotherapy.

If the symptoms still persist after above treatment then Arthroscopic surgery is suggested.

After arthroscopic surgery patient undergoes physiotherapy for 2-3 weeks and is gradually rehabilitated to his occupation.