General Orthopaedics & Sports Medicine
Knee Arthroscopy is performed through small incisions in the skin, using an arthroscope, a narrow telescope attached to a video camera. The surgeon can also insert surgical instruments through other small incisions in your knee to remove or repair damaged tissues.
Compared with open surgery, which involves a larger incision, arthroscopy is:
- Less painful
- Carries less risk of infection
- Enables people to recover more quickly
ACL RECONSTRUCTION – ARTHROSCOPIC METHOD
Most surgeons now favor reconstruction of the ACL using a piece of tendon or ligament to replace the torn ACL. This surgery is most often done with the aid of the arthroscope with small incisions usually around the knee, but doesn’t require the surgeon to open the joint. Most ACL surgeries are now done on an outpatient basis and most patients go home the same day as the surgery.
- The operation also usually takes less time because the graft does not need to be harvested from your knee
The main goal of discectomy surgery is to remove the part of the disc that is putting pressure on a spinal nerve root.
- Surgery can alleviate symptoms from a herniated disc in the low back
- Taking out the injured portion of the disc also reduces chances that the disc will herniate again
- The traditional procedure is called laminotomy or discectomy
- It requires a larger incision and tends to require a longer time to heal
- A newer method, microdiscectomy, is becoming the standard for lumbar disc herniation. With this method:
- Only a very small incision is required in the low back with surgical microscope making it a minimally invasive surgery
- It’s easier to perform
- Prevents scarring around the nerves and joints
- Patients typically recover more quickly
Hand and Upper Extremity
TRIGGER FINGER RELEASE
The usual solution for treating a trigger digit is surgery to open the pulley that is obstructing the nodule and keeping the tendon from sliding smoothly. This surgery can usually be done as an outpatient procedure.
- Surgery can be done using general anesthetic or regional anesthetic
- Surgery also can be performed by simply injecting lidocaine (regional anesthetic) around the area of the incision
- Several types of incisions can be made, but most are made along the natural creases and lines in the hand
- The surgeon carefully divides the tendon pulley – once separated the skin is sewn together with fine stitches
ENDOSCOPIC CARPAL TUNNEL SURGERY
The surgeon makes a small, single incision just below the crease in the wrist. This opening allows the surgeon to place the endoscope into the carpal tunnel.
- A metal or plastic cannula (a tube with a slot on the side) is placed alongside the median nerve
- A special knife is inserted through the cannula that cuts backwards, dividing the carpal ligament, without cutting the the skin of the palm
- Once divided, the median nerve is no longer compressed and begins to return to normal
- After the carpal ligament is released, the surgeon stitches the small skin openings and leaves the loose ends of the carpal ligament separated
- Eventually, the gap between the two ends of the ligament fills with scar tissue
ROTATOR CUFF ARTHROSCOPIC REPAIR
It has become common to repair tears of the rotator cuff using the arthroscope; a special type instrument designed to look into a joint or other space inside the body.
- Several small incisions are made to insert the arthroscope and other special instruments that help remove bone tissue or torn and degenerative tissue that are rubbing on tendons
- Once removed, the torn rotator cuff tendon can be reattached to the bone
- Suture anchors are designed to reattach soft tissues (ligaments and tendons) to the bone
- These devices are small enough that they can be placed into the bone through the use of the arthroscope
The results that you can expect from a shoulder arthroscopy depend on what is wrong with your shoulder, what can be done inside your shoulder to improve the problem and your effort at rehabilitation after the surgery.
- The surgeon begins this operation by making two or three small openings into the shoulder, called portals
- These portals are where the arthroscope and surgical instruments are placed inside the shoulder joint to diagnose the problem
- Once the surgical procedure is complete, the arthroscopic portals and surgical incisions will be closed with sutures or surgical staples
UNI-COMPARTMENTAL KNEE REPLACEMENT and TOTAL KNEE REPLACEMENT
Similar in procedure, the uni-compartmental knee replacement operation is designed to replace only the portions of the joint that are most damaged by arthritis.
- Once the knee joint is opened, a special positioning device (a cutting guide) is placed on the end of the femur, cutting several pieces of bone
- The tibia is then cut to correct alignment and the metal femoral component is placed on the femur
- Uncemented prosthesis: The metal piece is held snugly onto the femur because the femur is tapered to accurately match the shape of the prosthesis
- Cemented variety: Epoxy cement is used to attach the metal prosthesis to the bone
- The metal tray that holds the plastic spacer is then attached to the top of the tibia
- This metal tray is either cemented into place or held with screws if the component is of the uncemented variety
- The plastic spacer is then attached to the metal tray of the tibial component
- Soft tissues are sewn back together and staples are used to hold the skin incision together