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KNEE JOINT

Knee ligament injuries

They are caused by past sprains and dislocations of the knee joint and may lead to post-traumatic instability of the joint. Simple and complex instabilities can be distinguished and they are caused by an injury to one or more ligaments of the knee joint.

In most cases, the knee ligament injuries should be treated operatively. Discontinuation of such treatment contributes to chronic instability which causes secondary injuries to the internal anatomical structures of the knee joint, usually in the form of articular cartilage injuries.

Anterior Cruciate Ligament Injury (ACL)

It is a serious disease of the knee joint which may interfere with proper functioning of the joint. Joint instability is a major symptom. This prevents the patient from living in comfort and doing most kinds of sport. It may also cause chondromalacia (Patellofemoral Pain Syndrome), a meniscus tear (cartilage tear) as well as recurring exudates which cause joint edema. Untreated joint instability may lead to degenerative joint disease.

Meniscus tear

Meniscus is a crescent-shaped fibro-cartilaginous structure. It can be torn, commonly after a forceful twisting injury to the knee. This ususally happens in sport and is sometimes connected with injuries to the ligaments and the articular cartilage of the knee. Other reasons for a meniscus tear are joint overloads and degenerative joint disease. Here, the meniscus is torn as a result of heavy overloads, microinjuries and any abnormalities in the morphological structure of the meniscus.

Meniscus tear may be treated by means of:

  • Partial meniscectomy (partial knee cartilage removal)
  • Meniscus repair (suturing the torn edges using dissolvable stitches or staples, etc.)
  • Meniscal transplanation
  • Meniscal replacement

The decision as to the type of the procedure is made by a specialist after discussing it with the patient.

Articular cartilage injury

It very frequently results from joint instability as well as a meniscus tear. Other risk factors are: intra-articular fractures, direct injuries to the knee, degenerative joint disease and rheumatism. Obesity is the most frequent cause of articular cartilage injuries. Cartilage does not undergo the process of regeneration, yet only the process of scar formation.Therefore, this kind of injury is regarded as a serious therapeutic problem. Surgical treatment and proper rehabilitation are important in treating this kind of injury.


TREATMENT

ARTHROSCOPY

All the above knee joint injuries, such as anterior cruciate ligament injury (ACL), a meniscus tear, as well as articular cartilage injury can be treated arthroscopically.

It is a modern and minimally invasive surgical procedure that allows the doctor to both examine and treat the joint. It is performed by using an arthroscope (endoscope) that is inserted into the joint cavity through a small incision of 0,5 cm, and a picture of the interior of the joint can be seen on a video screen. This method allows the doctor to perform repair surgery by inserting surgical instruments into the joint cavity through different small incisions in the skin. Arthroscopic procedures can be performed to treat such injuries as a meniscus tear and ligament injury. We also perform reconstructive operations of the injured structures by means of high-quality surgical instruments. This allows the doctor to perform meniscus suturing and arthroscopic reconstruction of the anterior cruciate ligament using an autogenous graft harvested from the patient’s semimembranosus or semitendinosus. Other diseases treated arthroscopically in our hospital are articular cartilage injuries and early degenerative joint disease utilizing microfracture and shaving (debridement) techniques. The scar that forms on the damaged articular surface replaces the injured cartilage. This helps restore joint function. 

Length of stay:

The average length of stay is approximately 1 to 3 days after which the patient is provided with initial rehabilitation allowing them to walk on crutches.

After surgery:

After the surgery, the patient stays under constant medical supervision in the orthopedic outpatient clinic then sent to a reputable rehabilitation center.

Waiting time:

The average waiting time for the surgery is approximately 2 to 3 weeks.

KNEE REPLACEMENT

A surgical procedure that replaces a joint with artificial parts (called prostheses). This method restores joint function and enables the patient to walk and lift heavy objects. It is the only method that allows the patient to walk without pain.

Most of the endpprostheses of the knee joint consist of three major elements, namely titanium femoral and tibia parts and a meniscus element. These prostheses differ only in terms of the type of fixation used to hold an implant in place. Therefore, knee replacements may be either cemented or cementless. The first method relies on a stable interface between a prosthesis and cement, and a solid mechanical bond between cement and the bone. The other method consists in uncemented parts relying on a process called biologic fixation. Sometimes weak mechanical resistance of the bone makes it impossible to perform uncemented replacement.

The patient is qualified for the surgery after being examined by an orthopedist and an anesthesiologist. We use American endoprostheses of SMITH & NEPHEW and BIOMET.

Length of stay:

The average length of stay is approximately 5 to 10 days after which the patient is provided with initial rehabilitation allowing them to walk on crutches.

After surgery:

After the surgery, the patient stays under constant medical supervision in the orthopedic outpatient clinic then sent to a reputable rehabilitation center.

Waiting time:

The average waiting time for the surgery is approximately 2 to 4 weeks.

ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION (ACL)

It is a surgical tissue graft replacement of the anterior cruciate ligament usually with an autogenous graft harvested from the patient’s tendon or ligament. The patient’s semimembranosus and semitendinosus are most frequently used. A harvested graft is inserted through previously made holes in the tibial and femoral bones and it is fixed with anchors, interference screws and other implants. The surgery is performed arthroscopically. From the first day after the surgery, the patient is able to walk on crutches, but they are forbidden to overload an operated limb. Once drains are removed (usually on the second day after the surgery), the patient is allowed to walk on crutches with partial overloading of an operated limb and initial rehabilitation begins.

Length of stay:

The average length of stay is approximately 2 to 3 days after which the patient is provided with initial rehabilitation allowing them to walk on crutches.

After surgery:

It is important for the patient to wear a knee orthosis until they are allowed to remove it. The patient can go back to normal life approximately 6 to 12 weeks after the surgery. This  depends upon a kind of work they perform. When it comes to sport, it usually takes 4 months until the patient is ready to start training.

Waiting time:

The average waiting time for the surgery is approximately 2 to 4 weeks. 

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