WHEN SOMETHING THAT YOU LOVE MAKES YOU WEAK IN THE KNEES!

Before your mind runs wild, let me make it clear that this isn’t completely dirty and painful. Or is it? Each person is on their own, picking up what they like and love persuading towards that particular activity. While you’re at it, doing what you love there are often times when a small misjudgment or a miscalculation might end up giving months of terrible and excruciating pain. One such incident might be A LIGAMENT TEAR.

Ligament tear usually occurs in the joints of our body when a great force is applied to a particular joint. Let’s focus on the knee joint as of now. The knee joint has 4 ligaments namely,

• Anterior cruciate ligament(ACL)
• Posterior cruciate ligament(PCL)
• Medial cruciate ligament(MCL)
• Lateral crucial ligament(LCL)

These ligaments hold the knee joint in place and help in locking and unlocking the joint. When you walk, run, dance, gym or jump these ligaments work continuously. When the knee joint is locked, the greater force applied on it ends up tearing the ligament depending upon the direction of this unaided force.

Injury to PCL – Ligament tears are also common in a road traffic accident. Usually, in a car accident, the posterior cruciate ligament is torn. The harm occurs when the tibia is forced back to the femur. This is rather rare in a sports person whose anterior cruciate ligament is at risk.

Injury to ACL – Twisting a semi-flexed knee, which already made you say “ouch” is quite cumbersome to deal with as it often causes injury to the medial meniscus and MCL. (O’Donoghue triad)

Injury to MCL – Any force the pushes the tibia towards the femur in an inside fashion causes the rupture of this ligament.

Injury to LCL – MCL, and LCL are attached to either side of the joint, media is on the inner side and lateral on the opposite. So the damage to the lateral ligament occurs when the force is applied to adduct the tibia to the femur.

So now, describing the proper anatomy. The knee joint is a hinge joint.

A hinge joint is one which is made up of more than 2 bones and moves along one axis only. Elbow joint is another such synovial joint. Knee joint consists of the tibia and the femur, a tibiofemoral joint. Then there is patella which glides over the front of the tibial end of the femur, forming a patellofemoral joint. The knee Ligaments act like the joint’s best friend, providing support and stability. When this harmony is disturbed, a painful unstable state happens to be.

The ligament injury can be associated with,

• Chipping of the bone to which the ligament it is attached.
• A mid-substance tear ( tear in the ligament)
• Severity may vary on the tear being complete or incomplete.
• One ligament involvement or more.

The combination depends upon the force acting on the joint. More severe the injury more intricate the treatment regimen gets.

Diagnosis can be made through clinical examination and a detail on the event of the grievance. Complications that present with the tear are dislocation of the joint, blood clots, swelling. The pain may be localized over the torn ligament. Radiological examination of the knee joint is important to check if the bone has been chipped off, which might have been avulsed from the ligament attachment. Contrary to the Stress X-rays, MRI is a non-invasive method to diagnose ligament injuries. The arthroscopic examination may be needed in a few cases.

Treatment of this condition was conventionally done by non-operative methods. Now that there are better techniques and with the recent advances, better results are achieved through operative reconstruction. Operative reconstruction has become popular in high demand athletic individuals like Tom Brady, Alex Morgan Adrian Peterson and a lot more NBA players. Celebrity or not we are all made up of the same cells and same anatomy and ligament injury can be treated and normal functioning of the knee can be obtained and hence decreasing your time not spent on doing what you love.

Methods that are undertaken are,

• Conservative method – The blood clot/ hematoma is aspirated and the knee is immobilized in a cylinder cast or a knee immobilizer. If the injury is grade I or grade II, a conservative method is successful for treatment. Followed by this, strengthening physiotherapy is required.
• Operative methods – These are to be done when there is a combination of ligament injuries, involving multiple ligaments especially in young athletes or dancers. Usually, the surgery is done 2-3 weeks after the injury when the inflammation is fairly reduced.

What do the surgeons do actually? They first go by repairing the ligament. It is performed on grade III ligament tears, which means the ligament is completely torn. If the surgery is done after the 2-3 weeks, an additional reinforcement is provided by a tendon or fascial graft as the original torn ligament would have lost the strength due to a complete tear.

Secondly, they reconstruct the unstable knee injuries which present later than usual. An allograft or an autograft of a tendon or a fascia lata is used; a synthetic graft can also be used. Auto is better than all as there are lesser chances of rejection.

Knee ligament tears are very common and are often undiagnosed. Ligament tears are usually not seen on X-rays and might get neglected. The usual presenting symptom is the instability of the knee joint. Treatment is biased depending upon the activity level of the patient. If you’re a ninja then you’ll probably need surgery. If you’re the person who probably has a sedentary lifestyle, the doctor might perhaps recommend physiotherapy. Usually, the ACL tends to get damaged more often than the others. ACL reconstruction is done with the help of an autograft and bio-absorbable screws. Arthroscopic ACL reconstruction is the surgery of choice as it is minimally invasive, and results are outstanding as the patients revert back to normal with negligible risks.

By Dr. Apoorva Manjunath.

For more information visit- https://surgeryxchange.com/

Should I undergo Knee Replacement Surgery?

Every year approximately 700,000 knee replacement procedures are performed in the United States of America. This number is projected to increase to 3.48 million procedures per year by 2030. https://www.uptodate.com/contents/total-knee-replacement-arthroplasty-beyond-the-basics) However, this number represents the tip of the iceberg. An astounding number of patients, continue to look for pain relief and non-surgical treatment options.

Most of them are advised weight loss, physiotherapy, braces, medications, and injectables. While these treatment modalities are effective at initial stages of knee arthritis, at later stages they provide limited or no relief.

Despite being in pain, patients often delay or avoid surgery. We asked our experts at SurgeryXchange, what are the most common apprehensions that patients have?

Is knee replacement surgery the right decision for me?

If your knee pain has aggravated to a point that you have pain at night or even when you’re resting, you might want to consider surgical treatment. If you have already tried medicines, injections, physiotherapy and still you’re bogged down with pain, surgery may be the only option. The most important question you need to answer is if pain or lack of mobility is hampering you from living a normal life, then yes, surgery is the answer.

What happens during knee replacement surgery?

Arthritis or osteoarthritis, which usually happens as age progresses, is a process that leads to wear and tear of the joint. The joint surface is covered by a smooth layer of a substance known as cartilage that allows smooth movement in the joint. With age, there is a breakdown of this joint cartilage. The damage, in turn, limits movement of the joint and causes pain. During knee replacement or arthroplasty, the surfaces of the knee which are damaged are removed and replaced with artificial material.

How long does it take to recover from knee replacement surgery?

The procedure last 1.5 to 2 hours. Physiotherapy is the cornerstone to recovery. Patients are discharged with 1-3 days. Patients can resume normal daily activities such as walking and bathing within several days of discharge. A trained physiotherapist assists them post-surgery and works closely with them over the next few weeks till they recover strength and mobility.

How long does the new knee last?

Scientific data suggests that for patients who got their joint replaced today have a 90-95% chance that their joint will last 10 years and an 80-85% that it will last 20 years.

(https://www.sciencedaily.com/releases/2011/02/110217082925.html)

How is life after knee replacement surgery different from the life before?

More than 90 percent of patients suffering from severe pain and inability to walk experience a dramatic reduction in knee pain and a significant improvement in the ability to perform common activities. (https://www.sciencedaily.com/releases/2011/02/110217082925.htm) But the bigger gain is the impact on quality of life. Most patients describe the surgery as transformative, as it gives excellent pain relief and provides them with the ability to be independent in their day-to-day functioning of life.

So, are you struggling with knee pain? If you’re having trouble getting up out of bed, going to the toilet or fetching yourself a glass of water, it’s time to consider surgery at www.surgeryxchange.com.  A thorough examination by an Orthopedic Surgeon should be the right next step. For booking an expert opinion, visit 
https://surgeryxchange.com/best/cost-of-total-knee-Replacement-Surgery-in-bangalore

TYPES OF HEART SURGERY

Coronary Artery Bypass Grafting
The most common type of heart surgery is Coronary Artery Bypass Grafting (CABG). CABG improves blood flow to the heart. Surgeons use CABG to treat people who have severe coronary heart disease (CHD).
CHD is a disease in which a waxy substance called plaque builds up inside the coronary arteries. These arteries supply oxygen-rich blood to your heart.
If the plaque ruptures, a blood clot can form on its surface. A large blood clot can mostly or completely block blood flow through a coronary artery. This is the most common cause of a heart attack. A healthy artery or vein from the body is connected to the blocked coronary artery during CABG. The grafted vein or artery bypasses the blocked portion of the coronary artery. This generates a fresh path for oxygen-rich blood to flow to the heart muscle.
Surgeons can bypass multiple blocked coronary arteries during one surgery.

Transmyocardial Laser Revascularization
TMR or Transmyocardial laser revascularization is surgery used to treat angina.
In case TMR is done, the procedure may be executed through a small opening in the chest. During TMR, a surgeon uses lasers to make small channels through the heart muscle and into the heart’s lower left chamber (the left ventricle).

Heart Valve Repair or Replacement
Heart surgery is performed to repair leaflets that do not open as wide as they should. This may happen if they become stiff or thick or fuse together. As a result, not enough blood flows through the valve.
Heart surgery also is used to fix leaflets that don’t close tightly. Rather than only moving forward into the arteries as it should, this issue can make blood leak back into the heart chambers.
To fix these problems, surgeons either repair the valve or replace it with a man-made or biological valve. Biological valves are made from human, cow or pig heart tissue and may have man-made parts as well.
To repair a mitral or pulmonary valve that’s too narrow, a cardiologist will insert a catheter through a large blood vessel and guide it to the heart.
The cardiologist will put the end of the catheter in the narrow valve. They will deflate and inflate a little balloon at the tip of the catheter, to widen the valve, allowing more blood to flow through it. This approach is less invasive than open-heart surgery.

Arrhythmia Treatment
Arrhythmia is an issue with the rhythm or rate of the heartbeat.
Surgical methods are used to implant an implantable cardioverter defibrillator (ICD) or a pacemaker.
An ICD is a device which is connected to your heart with wires. After checking your heartbeat, if the device senses a dangerous arrhythmia, it sends an electric shock to your heart to restore a normal heart rhythm.
Wires connect the pacemaker to your heart chambers. The device uses low-energy electrical pulses to control your heart rhythm. Most pacemakers have a sensor that starts the device only if your heart rhythm is abnormal.
Another arrhythmia treatment is called maze surgery. For this type of surgery, the surgeon creates a fresh path for the heart’s electrical signals to travel through. This type of surgery is used to treat atrial fibrillation, the most common type of serious arrhythmia.

Aneurysm Repair
An aneurysm is a balloon-like bulge in the wall of an artery or the heart muscle. Repairing an aneurysm involves surgery to replace the weak section of the artery or heart wall with a patch or graft.

Heart Transplant
A surgery or surgical method to remove a patient’s diseased heart and swap it with a healthy heart from a deceased donor is a heart transplant. Heart failure is a condition in which the heart is damaged or weak.
Patients waiting for a donor's heart receive an ongoing treatment for heart failure and other medical conditions. Total Artificial Hearts (TAHs) or Ventricular Assist Devices (VADs) might be used to treat these patients.

Surgery to Place Total Artificial Hearts or Ventricular Assist Devices
TAH is a device that replaces the two lower chambers of the heart (the ventricles).
VAD is a mechanical pump that is used to sustain blood flow and heart function in people who have weak hearts.
Placing either device requires open-heart surgery.

Open-Heart Surgery
Open-heart surgery is a type of surgery in which a surgeon makes a large incision in the chest to open the rib cage and operate on the heart. The surgeon also may open the heart, depending on the type of surgery.
Open-heart surgery is used to place VADs and TAHs, do heart transplants, treat atrial fibrillation, replace or repair heart valves, and do CABG.

Off-Pump Heart Surgery
Surgeons also use off-pump or beating heart, surgery to do CABG. The heart isn’t stopped, and a heart-lung bypass machine isn’t used.

Minimally Invasive Heart Surgery
A surgeon makes small incisions in the side of the chest between the ribs for minimally invasive heart surgery. A heart-lung bypass machine may or may not be used in this type of surgery.
Minimally invasive heart surgery is used to do some bypass and maze surgeries. It’s also used to repair or replace heart valves, insert pacemakers or ICDs, or take a vein or artery from the body to use as a bypass graft for CABG.
Robotic-assisted surgery is a type of minimally invasive heart surgery for which a surgeon uses a computer to control surgical tools on thin robotic arms.