Patient Education
At ACT we believe in empowering our patients through knowledge to take active part in their treatment. World over this method has improved the treatment outcomes and patient satisfaction. While there is no dearth of health care related information, the accuracy and reliability of the available information is questionable. This section aims to give accurate information to patients. The links that are provided take you to the sites which have been checked for accuracy.
New Patients
1. What is Arthroscopy?
Arthroscopy is the technique of seeing inside a joint, with a special instrument known as arthroscope.
2. Benefits of Arthroscopy
- Arthroscope can be inserted using small stab incisions, without tearing the muscles and fascia around the joint.
- The patient is benefited by less pain, almost no blood loss, and quick recovery.
- Arthroscopy is the only method of diagnosing joint problems at the earliest stage, allowing accurate treatment.
3. Is arthroscopy better than open surgery?
Arthroscopy means less scars, and less pain. But that is NOT the reason to choose Arthroscopy. Arthroscopy is chosen because it helps in seeing the lesion better, and it helps in treating the disease better. At Arthroscopy Centre, our focus is on perfect surgery and perfect patient outcome, and that is the reason for choosing Arthroscopy.
4. Which conditions need a consultation with an Arthroscopic Surgeon?
An Arthroscopic surgeon is best equipped to deal with joint problems; joint pains, joint injuries etc.
Any patient with a long standing or sudden onset pain in Knee or Shoulder needs a consultation with an arthroscopy surgeon.
Anyone with injury to any joint should consult an arthroscopy surgeon.
5. Fitness without pain. Tips and tricks to exercise without pain.
It is all about technique. Fast walking, about 6km in an hour, is a good exercise, suitable for everyone, without any risk of injury. Other forms of exercises should be started after an evaluation of body status, cardiac status, physical fitness etc. Running, Jogging, Swimming and Cycling are other forms of aerobic exercises with a low risk of injury.
- Running and jogging should be not done be done by obese persons.
- Swimming should be done after learning the proper technique.
Weight training should be done with the correct technique. A trained personal coach is good to observe and correct improper technique.
6. Shoulder pain. What causes, how to avoid?
The commonest causes of shoulder pain are,
- Workplace overuse injuries
- Diabetes related stiff shoulder injury
7. Avoiding overuse injuries in workplace.
- Proper posture avoids overuse injuries.
- Maintaining fitness helps in avoiding overuse injuries.
Know What you should know
At ACT, we believe that the patient should be actively involved in his/her treatment. So we encourage patients should ask questions and be aware. We would like the patients to aware of basic, and more importantly, correct information. In the internet era, the problem is not the availability of information, but rather than the reliability. This section gives the basic information, that is verified for accuracy.
Knee Anatomy and Function
The knee is one of the largest and most complex joints in the body. The knee joins the thigh bone (femur) to the shin bone (tibia). The smaller bone that runs alongside the tibia (fibula) and the kneecap (patella) are the other bones that make the knee joint.
- Cartilage is the super low friction tissue at the ends (White colour).
- As the joint is aligned, and the range of movement is normal, the cartilage will last nearly lifetime.
- But even a small alteration in alignment, or movement in other planes will result in rapid damage to cartilage.
- Tendons connect the knee bones to the leg muscles that move the knee joint. Ligaments join the knee bones and provide stability to the knee (Green Lines).
- The anterior cruciate ligament prevents the femur from sliding backward on the tibia (or the tibia sliding forward on the femur).
- The posterior cruciate ligament prevents the femur from sliding forward on the tibia (or the tibia from sliding backward on the femur).
- The medial and lateral collateral ligaments prevent the femur from sliding side to side.
- Injury to any one of these ligaments will result in abnormal movements in knee, and such movement cause painful “giving way” sensation in the knee, as well as damaging the cartilage and meniscus whenever this “giving way/ slipping” occurs.
- Two C-shaped pieces of cartilage called the medial and lateral menisci act as shock absorbers between the femur and tibia.
- The meniscus can get torn in twisting injuries, most often when ACL is injured.
- The torn meniscus results in two problems,
- The cartilage protective effect of meniscus is lost.
- The torn portion of meniscus acts as an irritants, and causes pain and swollen knee joint. - The ideal solution will be to repair the meniscus as that will solve both problems. However meniscal repair is possible only if it done soon after the injury.
- If a patient presents late after injury, meniscus cannot be repaired, and the torn portion of meniscus will have to be removed. This technique relieves the symptoms due to irritation by torn meniscus, but the loss of the cartilage protective effect cannot avoided.
- The best way to preserve the meniscus is to treat ligament injuries early, to avoid meniscal lesions, or to treat the meniscal lesions as early as possible.
- Please click knee-joint-structure-function-problems for more detailed information.
- Please click Here to know more about knee anatomy.
Common Problems and in Knee
1. Pain
Pain can be due to many diseases. While a dull pain can be tolerated, two situations require consultation with an Arthroscopy specialist.
- Any sharp pain that prevents walking.
- A long standing pain that reduces walking.
2. Swelling
One of the most common symptoms associated with knee problems is local swelling. The accumulation of too much synovial fluid (synovial effusion) is usually due to irritation or inflammation of structures within the joint. Bleeding into the joint (called a hemarthrosis) can also cause a joint to swell.
Patient should consult an Arthroscopist if knee is swollen.
3. Locking (or Catching)
Locking or catching of the knee usually occurs when there is a loose body or a torn meniscus in the knee.
If the symptoms are bad enough, knee arthroscopy may be needed to address the issue.
4. Giving Way
Knee may occasionally feel unstable and you may feel like you’ve momentarily lost control of the muscles around the knee. This may cause you to stumble or even fall.
5. Ankle injuries
Ankle sprains are common, in daily activities, as well as in sports. Most injuries as trivial, and heal without special care. Hence the initial treatment is rest, ice, compression and elevation.
Patients with bruising around the region, and those who have severe pain will need a splint immobilisation for 4 days.
Please click this link for detailed information.
6. Shoulder
The shoulder is one of the largest and most complex joints in the body. The shoulder joint is formed where the humerus (upper arm bone) fits into the scapula (shoulder blade), like a ball and socket. Other important bones in the shoulder include:
- The acromion is a bony projection off the scapula.
- The clavicle (collarbone) meets the acromion in the acromioclavicular joint.
- The coracoid process is a hook-like bony projection from the scapula.
The shoulder has several other important structures :
- The rotator cuff is a collection of muscles and tendons that surround the shoulder, giving it support and allowing a wide range of motion.
- The bursa is a small sac of fluid that cushions and protects the tendons of the rotator cuff.
- A cuff of cartilage called the labrum forms a cup for the ball-like head of the humerus to fit into.
- The humerus fits relatively loosely into the shoulder joint. This gives the shoulder a wide range of motion, but also makes it vulnerable to injury.
- To know all about Shoulder please click this link.
- Please click here to know more about shoulder anatomy (This site complies with the HONcode standard for trustworthy health information).
- Click here to watch shoulder anatomy video.
Patients Planned for Surgery
1. What is ACL reconstruction?
The torn Anterior Cruciate Ligament has a very limited potential to heal. In most patients, the ACL will not be suitable for repair. ACL function is restored by graft transplantation. Tendon graft is harvested from patient himself/herself, and so there is problems of incompatibility, while the area from which graft is harvested has no problems either. This transplanted ACL graft matures in the body, and reforms ACL.
2. What to expect after ACL reconstruction?
The transplanted graft is like a transplanted seedling, it needs care and nurturing for good results.
The surgeon will advice post operative rehab, that which protects grafts, maintains joint flexibility and strength.
The patient can expect to be up and about on Day2 following surgery. He/She can go for clerical work or class after 2 weeks, be able to walk by about 3 weeks, and walk normally by about 6 weeks.
At this time, patients can return to activities requiring light manual work.
Return sports will be advised after personalised assessment and will depend on the ……achieved and the type of sports.
3. How to prepare for ACL Surgery?
Prehab: learn about ACL injury and its treatment. Begin exercises that have been taught.
4. What is Cuff tear?
Rotator cuff is a group of muscles stabilising the shoulder. This shoulder stabilisation acts as a fulcrum to move shoulder. Cuff tear results in the loss of this fulcrum, initial problem will be inability to lift shoulder. If a portion the rotator cuff torn, there is no natural mechanism for it heal. Often, only a part of cuff is torn and hence the initial treatment will be exercises to strengthen the remaining muscles to help patients. The end point of initial treatment, is patient regaining full and painless function of the injured shoulder. If this achieved, older patients can manage without cuff repair. Some patients do not achieve this, and cuff repair is indicated. The torn portion of cuff is sutured to its natural attachment. In younger patients, the loss balance resulting from torn cuff is will lead muscle and joint degeneration and these patients will require early.
5. What is cuff repair?
Cuff tear is the surgery to reattach the torn edge of cuff back to its natural position. Cuff tear is a common problem after shoulder injury, however cuff repair was not a commonly performed procedure. The cuff tear occurs in a deep position between two bone (Acromion and head of humerus). Hence it was difficult to access this site. Arthroscopy has provided an opportunity to visualise in this deep space, without damaging bones and muscles around.
6. How to prepare of cuff repair?
The first step would be know about the condition and the surgeons proposed treatment. Read about the procedure, and clarify any doubts with your surgeon.
7. What to expect after cuff repair?
After cuff repair, the shoulder will be rested in a sling for about 2 months. This is absolutely critical to provide and good tissue environment for the tissue to heal. Meanwhile, depending the patients muscle condition, supervised passive range of movement exercise may be advised. After two months, home exercises are advised.
8. What is Bankart repair?
Bankart repair is suturing of torn labrum. Please click www.shoulderdoc.co.uk/section/12 to learn more about the causes of shoulder dislocation. The torn labrum is the essential lesion, and labral repair is the primary aim of surgery. Labrum is sutured back to bone using all suture (no metal) anchors.
9. How to prepare for Bankart repair?
Prehab. Read about Bankart procedure and practise the exercises that are to be done after surgery.
10. What to expect after Bankart repair?
Following bankart repair, shoulder should be rested well to allow the repaired labrum to heal. Shoulder will be gradually mobilised and strengthened. Full range of movements is achieved by 3-4 months. Sporting activity will be allowed after muscle strengthening.
11. What is PCL reconstruction?
PCL or Posterior Cruciate ligament is the central ligament of the knee. PCL tear results in abnormal position of the knee. Loading in this abnormal position will knee to irreparable damage to cartilage.
12. How to prepare of PCL reconstruction?
- Prehab
- Practice the exercises that are taught.
- Get used to the brace.