Dr. Shailesh Mishra

The Anterior Cruciate Ligament (ACL) is one of the most important ligaments in the knee. Sportsmen have the highest risk of ACL injuries. As the ACL is stretched while making sudden turns, running or jumping, it may get damaged or even tear. The ACL is responsible for holding the leg bones together at the knee. Hence, if it is torn, the patient may have trouble putting pressure on the knee, standing for a long duration of time or even while walking.

Slight tears in the ACL can be treated with physical therapy. If the ACL is completely torn, reconstruction surgery is usually advised. This is an outpatient procedure that involves removing the torn ligament and replacing it with a donor tendon or a tendon from another part of the knee. It may be performed with a minimally invasive technique.

The surgery is usually preceded by several weeks of physical therapy. This aims at reducing the swelling and pain in the knee and strengthening the muscles. It also helps the knee heal better after the procedure and regain full range of motion. Certain types of medication such as blood thinners may have to be stopped before the surgery.

The surgery is typically performed while the patient is under general anesthesia. Small incisions are made around the affected knee through which surgical instruments can be inserted. The damaged ligament is removed and replaced with a healthy tendon. The surgeon will then drill tunnels or sockets into the thigh and shin bone to put the tendon in place. This may then be secured to the bone with screws. As the new ligament tissue grows, this tendon acts as scaffolding to support it.

It is a daycare procedure. The patient may be advised to wear a splint or knee brace and may have to walk with the help of crutches for a while. Rest is the best way to recover after this surgery. The knee will also need to be iced every two hours. As the knee heals, physical therapy will be prescribed to help the muscles regain their strength and to improve flexibility. Full range of motion should be achieved within a few weeks of the surgery.

Though the surgery is considered safe, there are a few risks associated with it. Bleeding and infection are potential risks. The patient may also complain of stiffness in the knee, pain and poor healing of the grafted tendon.

Newer technique: Bone preserving ALL INSIDE anatomical reconstruction of ACL, helps in faster recovery. Surgery is performed local (spinal Anaesthesia).

The knees and shoulder are two of the most prominent joints in the human body. While the shoulder is known as the most flexible joint, the knee is the strongest joint. These joints are susceptible to a number of issues. Depending on the problem, it may be treated non-surgically or surgically. In some cases, delaying surgical treatment can cause more trouble in the long run. Hence, it is important to get a clear diagnosis as early as possible.

Shoulder issues that require surgery
Partial or complete rotator cuff tears are issues that require surgical treatment. This involves repairing the rotator cuff and removing spurs from the underside of the joint. Patients suffering from frequent shoulder dislocations may also be advised surgery. This can be performed arthroscopically or through open surgery. This type of surgery ideally should be followed by physical therapy. Another issue related to the shoulder that may require surgery is multiple shoulder fractures or fracturing of the humerus head. As with the shoulder joint, multiple fractures may also need surgery. Patients suffering from osteoarthritis or rheumatoid arthritis that causes pain in the shoulder and restricts movement may be advised to undergo a shoulder replacement surgery. This may involve replacing the entire socket or replacing only the head of the humerus.

Knee issues that require surgery
Knee surgery may be advised to treat many different conditions that cause knee pain. Osteoarthritis is one of the most common of such conditions. Other such conditions that may involve knee surgery are:

1. Tendonitis that causes the knee joint to become inflamed. A surgery can prevent it from recurring.
2. An acute injury susceptible to further complications.
3. Ligament tears, in particular, an ACL injury which requires reconstruction of the ligament that involves removing the damaged ligament and replacing it with a tendon from another part of the body.
4. Repairing a damaged tendon in the knee is sometimes done by surgery.
5. Realigning the kneecap in cases of lateral release.

If the bones and cartilage in the knee joint are damaged beyond repair, a knee replacement surgery may be advised. In some cases, only a partial knee replacement may be needed.

These surgeries are considered quite safe but as with any other surgery, there are a few side effects and risks associated with them. Temporary pain/swelling of the joint is the most common amongst these but it typically resolves itself in a few days.

A shoulder dislocation is a shoulder injury which is characterized by the upper arm bone popping out of the socket of your shoulder blade. The shoulder joint is the most mobile among all the joints in the body, making it the most prone to dislocation. The dislocation of the shoulder joint can either be partial or complete depending on the injury.

Rotator Cuff Tear is one of the most common disabilities observed amongst adults above 40 years of age. Rotator Cuff is a group of four muscles that keep the Humerus (arm bone) attached to the socket of the Shoulder. The Rotator Cuff keeps the Shoulder Blade attached to the arm, and when there’s a damage (tear) in one of these muscles, excruciating pain is felt by the patient.

Kinds of Rotator Cuff Tear-

• Partial Tear: This happens when one of the Tendons amongst the four Tendons is damaged or torn.
• Full Tear: This occurs when all the Tendons are torn; this is also called Complete Tear. Severe pain is experienced in this type of tear and surgery might be required.

Symptoms-

● A person may experience excruciating pain while performing daily tasks like Combing hair, Picking up Laundry, etc.
● Muscle weakness and stiffness on Shoulder.

Diagnosis of Rotator Cuff Tear-

● Ultrasound is used to check the internal structure of the shoulder and the damaged muscle pattern. The waves directed into the shoulder create images of the Tendons and ligaments of the shoulder. This allows the doctor to access the severity of the damage on the shoulder.
● MRI: When the doctor needs a better look at the Tendon damage, radio waves provide a better imagery than Ultrasound.

Treatment of Rotator Cuff Tear-

• RICE (Rest Ice Compression Elevation): In Case of partial rotator cuff injuries with very little damage, RICE is a good treatment option to treat temporary partial damage in the shoulder. Applying cold water and moving the hands slowly helps the muscles to get into shape.

• Injections: Non-inflammatory drugs are prescribed to the patient suffering from Full Rotator Cuff injury to deal with the pain. A Tendon tear can cause extreme pain, which might give the patient some sleepless nights. Non-inflammatory painkillers temporarily numb the shoulder, allowing the patient to sleep.

• Physical Therapies: Physical therapy is one of the most sought out treatment option. Physical therapy allows a person to recover from a rotator cuff injury through exercises and mild movements of the arms and shoulders.

• Surgery: When the injury is too severe for conventional treatment and medication, a patient might have to go through some complex surgeries.

A) Arthroscopic Tendon Repair: In this surgery, the doctor makes a small incision on the shoulders and then inserts a Laparoscope type instrument (Arthroscope) into the muscles, with a camera attached on the top. This instrument allows the surgeon to see the muscle structure and also helps in re-joining the tendons.

B) Open Tendon Repair: Arthroscopic Tendon Repair can be a bit complex, that’s why an open tendon repair is preferred by most doctors. In this surgery, the surgeon makes a bigger incision and attaches the Tendons surgically.

Conclusion-
Rotator Cuff Tears is a severe problem for the locomotion of body, but it is treatable, as long as one doesn’t delay going to an experienced doctor.

Knee replacement surgery — also known as knee arthroplasty (ARTH-row-plas-tee) — can help relieve pain and restore function in severely diseased knee joints. During knee replacement, a surgeon cuts away damaged bone and cartilage from your thighbone, shinbone and kneecap and replaces it with an artificial joint made of metal alloys, high-grade plastics and polymers.

Why is it done?

The most common reason for knee replacement surgery is to relieve severe pain caused by osteoarthritis. People who need knee replacement surgery usually have problems walking, climbing stairs, and getting in and out of chairs. Some also have moderate or severe knee pain at rest.

The Procedure

The procedure begins with you being administered general anesthesia, after which, an incision of 9-12 inches is made on the knee. The part of the joint that has been damaged is gotten rid of, following which the surfaces of the bone are redesigned to hold an artificial joint. Cement is used to attach the artificial joint to the shin, knee cap and the thigh bone. Once the fitting is complete, the artificial joint is supported by the surrounding muscles.

Results

For most people, knee replacement provides pain relief, improved mobility and a better quality of life. Talk with your doctor about what you can expect from knee replacement surgery.

Three to six weeks after surgery, you generally can resume most daily activities, such as shopping and light housekeeping. Driving is also possible at around three weeks if you can bend your knee far enough to sit in a car and if you have enough muscle control to operate the brakes and accelerator.

After you've recovered, you can enjoy a variety of low-impact activities, such as walking, swimming, golfing or biking. But you should avoid higher impact activities — such as jogging, skiing, tennis and sports that involve contact or jumping. Talk to your doctor about your limitations.

Aftercare

The duration of the hospital stay is around 2-3 days. The effects of the surgery start becoming noticeable within a month of the surgery being carried out. Initially, you may require walking aids. It takes about 5-6 weeks to regain your ability to walk without any external or physical support.

You will have to undergo physical therapy after the surgery to improve your muscle strength. The physiotherapist may prescribe various exercises to strengthen the muscles around the knees. You need to follow certain precautions after the surgery; squatting and kneeling become certain activities which you should avoid. Avoid activities that places undue stress on the knees.

With recent advances in technology, better metals and designs have become available which increase the life of replaced knee and with greater mobility. Many patients due to knee pain loose mobility, hense start putting on weight which inturn increases knee pain by increasing load on the knee. Knee replacement restores mobility, helps patient to manage their weight, diabetes better.

The shoulder is one of the most important joints in the body that uses a ball and socket to join the arm to the rest of the body. Any pain can make it difficult to carry out motion in a comfortable manner. The shoulder consists of the long arm bone called the humerus, the collarbone or the clavicle, as well as the shoulder blade called the scapula. A layer of cartilage provides essential padding to the bones in this area and its two main joints. There are a number of issues that can cause shoulder pain.

Let us get to know the six most common ones. 

1. Rotator Cuff Injury: This is the most common cause of shoulder pain and it occurs when the four muscles or the tendons are injured. These muscles and tendons usually control the movement of the arm. This injury can involve strains and tears which may also be caused by constant lifting of heavy objects. 
2. Rotator Cuff Tendonitis: This condition affects the tendons and muscles that help in moving the arm freely. This usually happens due to inflammation in the tendons. It is commonly experienced by patients who are actively involved in sports and other heavy physical pursuits in their line of work. 
3. Frozen Shoulder: This is a debilitating condition that restricts the free movement of the arm and is also known as adhesive capsulitis. When the shoulder tissues become too thick, it leads to the growth of scar tissue that hinders proper movement and causes pain. 
4. Osteoarthritis: Osteoarthritis is a condition that comes as part of aging bones that also become hollow and brittle over the passage of time, which leads to joint and bone pains in various parts of the body. It is a degenerative disease that is caused due to prolonged wear and tear as well as other factors including family history and sports injury.
5. Bursitis: This condition is known to affect the fluid-filled sacs that lie in between the joints. These are known as bursae. When the bursae suffers from swelling, the effect usually shows up as pain in the joints. 
6. Tendon Sheath Inflammation: The fibrous tissue that connects the bones and the muscles is called a tendon. The presence of the tendon makes it possible to pursue activities like running, jumping, lifting, gripping and more. It is protected by a sheath known as synovium, which also lubricates the same. Any injury or tear to this sheath can cause shoulder pain.

Acute and persistent pain that does not abate and gets even worse should be treated with immediate medical intervention.

Rotator cuff tendinosis, Frozen shoulder and Tendon sheath inflammation are more common in Diabetic patients. Essential part of treatment of these conditions include diabetes control and physiotherapy. However in chronic and refractory cases Arthroscopy may be required. Many times chronic rotator cuff tendinosis ends up in rotator cuff tear as a result of minor trauma.

Hi!

I am Dr. Shailesh Mishra an orthopedic surgeon and specialized in shoulder surgery, sports injury and joint replacement. Today I will be talking about anterior cruciate ligament (ACL) injury. It is a very important structure of knee joint. This is knee joint which is made up of thigh bone which is femur, shin bone i.e. tibia and the patella cap. ACL is a stabilizer of knee joint while doing sports or routine activity or walking. It helps in maintaining the stability of knee joint. ACL might get injured because of various activities like sudden stoppage while running. While jumping from a height because of improper landing the ACL might get damaged. In other support activities like football, volleyball and rugby, injury can harm ACL. Immediately after injury, rest, anti-inflammatory compression is the treatment when there is swelling and pain in the knee. It is very important to immobilize the knee with the help of long knee brace. After that, you must consult an ortho who will assess the degree of the injury to the ACL and to the other structure of the ligament to the knee.

The treatment varies as per the structure and injury. If the injury is partial or there is only sprain, it can healed. Symptoms are pain, swelling, restricted movement of the knee and there can also be a locking of the knee, when meniscus gets locked and torn in the knee. There can be clicking or popping sensation in the knee. While climbing stairs there can be instability of the knee. Patient may feel imbalance when they put weight on that particular injury. Treatment depends on the extend of the knee. If injury is just the sprain then ACL can heal on its own. And patient can regain the strength by exercises. If it is completely toned, it does not heal on its own. There is the fluid inside it which doesn't allow to form. Clot formation is very important for any healing processing the body. In such cases, patient usually has to go for surgery.

Surgery is in the form of arthroscopy surgery. Surgery can be performed through 3 holes. While surgery 2 tunnels are made. One is in the upper bone and one in the lower bone. And the graph is passed from the tibia inside the joint to the upper bone. This is the new tissue which can be either taken out from the patient himself that it is called autographt and if it taken from some other body than it is called allograft. In India allograft is not available. It is also not allowed by the government. My preference for autographt is hamstring tendon. With the latest technology the recovery is much faster and it saves more bones in the revision scenario. Patient might get the same injury in the future also. We have to reconstruct the new ligament for the patient. Now patient can walk from next day onwards with the help of walker or crutch.

And after 2 weeks patient can walk on his own. The patient may have questions, when they can start driving. It actually depends on the individual's strength. Neuromascular require the coordination between foot muscles and hand muscles for driving. We ask them to drive at around 6th week. After reconstruction, the ligament is fixed to the bone with the help of screw. However, there is a constant process of new collagen formation and ligament takes a year. The ligament which we are putting is totally substituted by patient own new collagen formation and this whole procedure takes around 1 year. Ligament continues to develop more strength. It also depends upon how well the patient is doing physiotherapy and rehabilitation process. Usually, by end of 1 year, sports man can resume his activities for sports. Sports person also questions whether they can perform on the same level or not. But it is entirely upon the rehabilitation and the physiotherapy.  When they have complied more than 90% of strength, we allow them for the sports activity. With the help of the tests, we can assess the strength. Can they have this kind of injury again in their life? Of course, they can have. Because they are engaging in high risk activities, if they injured for the first time, they can get injured for the next time as well. However, the treatment is possible for 2nd time also. For more information or to book an appointment with me, please contact lybrate.com.

Thank You

A tear in the anterior cruciate ligament or ACL is a common injury in people involved in sports. Any activity that involves sudden stops, jumping or sudden changes in direction have a chance of causing a tear in the ACL. Here is a look at some of the causes, symptoms, and treatment for the ACL injury.

Causes of the ACL injury
While the ACL injury is common in sportspersons, it can occur in others as well, due to sudden or excessive stain on the knee region. Common causes include-

1. Suddenly slowing your pace and changing directions.
2. Improper landing after a jump
3. Suddenly stopping movement
4. A direct and forceful blow to the knees, which is common in some sports, such as football, rugby, etc.

In some cases, the injury is mild enough to simply strain the ligament. However, a tear results when the force of impact on the ligament is high intensity.

Symptoms of the ACL injury

1. A click or popping sensation in the knees during movement
2. Extreme pain, which forces the patient to stop the strenuous activity
3. Limited range of motion
4. Swelling in the knee region
5. Loss of balance when weight is put on the injured leg

Treatment for ACL injury

1. Minor injuries can be treated with an ice pack. Rest can also alleviate the pain associated with such an injury.
2. Anti-inflammatory drugs may be prescribed if there is considerable swelling and pain
3. A knee brace is often required for people who intend to play sports despite an injury to the ACL.
4. Physical therapy and exercises devised to strengthen the knee may also be effective in curing the condition.
5. A severely torn ACL needs to be replaced using surgical procedure. People undergoing this surgery can often return to sports in a year or so.

In case of ACL injuries, prevention is often better than the cure. If you are into sports, make sure you exercise your knees and legs regularly, so that they are able to withstand the intense pressure put on them. In case you have a concern or query you can always consult an expert & get answers to your questions!

Hip replacement surgery is a method wherein a defective hip joint is removed and replaced with an artificial hip joint. This procedure is only opted for after all the other treatments have failed to yield the desired effects. Hip replacement surgery removes damaged or diseased parts of a hip joint and replaces them with new, man-made parts. The goals of this surgery are to:

• Relieve pain

• Help the hip joint work better

• Improve walking and other movements.

Who Should Have Hip Replacement Surgery?

The most common reason for hip replacement is osteoarthritis in the hip joint. Your doctor might also suggest this surgery if you have:

1. Rheumatoid arthritis (a disease that causes joint pain, stiffness, and swelling)

2. Osteonecrosis (a disease that causes the bone in joints to die)

3. Injury of the hip joint

4. Bone tumors that break down the hip joint.

Your doctor will likely suggest other treatments first, including:

1. Walking aids, such as a cane

2. An exercise program

3. Physical therapy

4. Medications.

These treatments may decrease hip pain and improve function. Sometimes the pain remains and makes daily activities hard to do. In this case, your doctor may order an x ray to look at the damage to the joint. If the x ray shows damage and your hip joint hurts, you may need a hip replacement.

The Procedure-

Hip replacement surgery is a procedure that can either be performed by traditional means or a minimally invasive procedure. The primary difference between the two procedures is the size of the incision. The procedure begins with the doctor administering local anesthesia, though in certain cases, general anesthesia is also administered.

1. An incision is then made along the hip and the muscles that are connected to the thigh bone are shifted, so that the hip joint is exposed.

2. An equipment is then used to remove the ball socket of the joint by cutting the thighbone.

3. The artificial joint is then fixed to the thighbone and it is allowed to adhere properly.

4. Once the joint is fixed, the ball of the thighbone is then put in the hip socket.

5. The fluids from the incision area are then allowed to drain.

6. The hip muscles are then put in place and the incision is closed.

Post -surgery-

After the surgery, the recovery stage begins. The period of hospital stay post-surgery usually lasts for 4-6 days. A drainage tube is attached to the bladder to get rid of waste products from the body. Physical therapy begins immediately after the surgery and you will be able to walk after a few days with walking aids. The physical therapy continues for a few months after the surgery.

After care-

It is advised to avoid activities that involve twisting your leg for at least half a year. You should also avoid crossing the leg along the mid portion of your body. Your physiotherapist will provide you with exercises that aid to help you recover. Avoid climbing stairs and sit on chairs that have strong back support. In case you have a concern or query you can always consult an expert & get answers to your questions!