1. SPORTS AND SPINE ORTHOPEDICS
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2. BONES
Tibia
The tibia is the lower leg bone . Also called the shin bone , it is the longest bone of the body, and is located below the
knee.
Femur
The femur , also known as the thigh bone, is longest and heaviest bone of the body. It is located above the knee
Fibula
The fibulas is the thin bane located on outside of the tibia
Patella
The patella, or the knee cap, is a bone that is connected to the patella ligament, below and quadriceps tendon above.
The underside of the patella has a smooth surface and glide over the knee joint when the leg is extended or bent.
SOFT TISSUE
Meniscus
The medial meniscus and the lateral meniscus act like cushions and distribute the weight of the femur
Collateral Ligaments
The lateral and medical collateral ligaments minimize side to side movement and help stabilize the knee.
Condyle
The condyle makes up the rounded end of the femur. This smooth surface allows the femur to move easily over the
tibia’s meniscus.
Patella Tendon
This patella tendon helps secure the patella over the front of the knee joint
Quadripceps tendon
This tendon connects the patella to the quariceps femoral muscle above it. The muscle and tendon pull the patella
over the front of the knee joint to extend the lower leg.
Posterior cruciate ligament
The posterior cruciate ligament (PCL) keeps the tibia from sliding backward
Anterior curicate ligament
The anterier cruciate ligament (ACL) connects the front of the tibia to the back of the femur. It keeps the tibia from
slidiing forward and limits its rotation
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3. Overview
This procedure replaces damaged anterier crucicate ligament(ACL). The ACL
connects the front top of tibia (the lower leg bone), to the near bottom of the
femur (the thigh bone)
Incision Made
An incision is made over the front of the knee to expose the patella (knee cap), and
the pateller ligament, which holds the patella in place.
Autograft Cut
A strip from the pateller ligament and the tibia is removed. The section , called an
autograft , will be used as a replacement for the damaged ACL.
Arthroscope inserted
The incision is closed. The rest of the procedure will be performed through small
cuts on the side of the knee. The surgeon uses a small video camera called an
anthroscope to see inside the knee and make sure the new ACL is positioned
correctly.
ACL Removed
With the knee bent, the damaged ACL is cleared away.
Guide Pin Inserted
A pin is inserted diagnally, from the tibia to the femur. The surgeon will use the pin
as a guideto recreate the ACL.
Holes Drilled
Using the pin as a guide, The surgeon drills holes in the tibia and femur.
Autograft Attached
Tha autugraft is attached to the guide pin. It is pulled through the holes and placed
at desired place.
End of Procedure
The knee is flexed to test the new joint.
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4. Overview
This minimally invasive procedure repairs damaged cartilage in the knee joint.
Small holes are drilled into the bone at the base of the damaged area to
stimulate the growth of healthy “scar” cartilage.
Preparation
The patient is positioned so that the front of the knee is clearly visible to the
physician, and the area is cleaned and sterilized . Local anesthesia is
administered to numb the incision site. General anesthesia or sedation is used.
Accessing the joint
Two to five small incision are made on either side of the patella . An
arthroscopic camera and other tools are inserted. The camera allows the surgeon
to view the procedure on a monitor.
Creating the Micro fractures
The joint is examined , and any loose or damaged cartilage is removed. A small ,
sharp awl is used to create several small holes in bone.
End of Procedure and After care
The incision are closed with sutures or surgical staples and the knee is bandaged.
Patients are given pain relievers and will be able to leave hospital on the same
day. Weight should not be put on the leg for 6 to 8 weeks. Full recovery often
takes 4 to six months.
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5. Overview
Unlike total knee replacement surgery, this less invasive procedure replaces only the damaged or
arthritic parts of the knee. The Oxford uni compartmental knee uses the metal and plastic
implants designed to potentially last longer and wear down less easily than traditional implants
1.Knee Accessed
An incision is made in the knee. Arthritic ,damaged portions of the fumur are removed.
2.Damaged Areas Removed
Parts of the damaged meniscus are removed, Some bone is also removed from the tibia to make
room for the new metal tibial component.
3. Bone Reshaped
A small portion of bone is removed from the damaged femoral condoyle. The end is reshaped to
fit the metal femoral component.
4. Tibial Component Installed
A groove is cut into the tibia surface , and cement is applied . The metal tibial component is
pressed into place.
5. Femoral Component Installed
The prepared area of the fumur is filled with bone cement and the metal femoral component is
pressed into place.
6.Bearing Inserted
A plastic bearing implant is inserted between the metal femoral and tibial implants.
End of Procedure
The new parts of the knee joint are tested by flexing and extending the knee through its range of
motion. The plastic bearing implant is not fixed in the place, allowing it to move when the knee
moves. This potentially reduces wear on the implant.
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6. Overview
This minimally invasive outpatient procedure is designed to remove the damaged
portion of meniscus , and layer of cartilage on the top of tibia that cushions and
stabilizes the knee joint. The procedure may be performed with local or regional
anesthetic.
Preparation
The patient is positioned so that knee area is clearly visible to the physician and the
area is clean and sterilized.
Accessing the joint
The surgeon makes 2 to 5 small incisions . An arthroscopic camera is inserted . The
surgeon uses it to evaluate the cartilage and ligaments in the knee. The other incisions
will be used to access points for other arthroscopic tools.
Repairing the Meniscus
The surgeon cuts or shaves away the torn piece of meniscus preserving as much
healthy tissue as possible . The edges of the area is cleaned and smoothed, and the
rest of the joint is inspected for damage.
End of Procedure
The instruments are removed and the incisions are closed with sutures or surgical
staples. The knee is bandaged
After Care
Rehabilitation varies depending on the patient and type of injury. Patients may use
crutches. But can generally work on the knee within one or two days of the
procedure. A treatment plan may include exercise to strengthen the joint. Full
recovery usually takes 2 to 4 weeks.
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7. Overview
Total knee surgery removes the damaged and painful areas of the femur (thigh bone) and
tibia (lower leg bone). These areas ar then replaced wit specially designed with metal or
polythylene plastic parts.
1. Femur Reshaped
The damaged portions of the femur bone and cartilage are cut away. The end of the femur
bone is reshaped to allow a metal femoral component to fit in place.
2.Metal Component Attached
A metal component is attached to the end of femur using bone cement.
3. Tibia Reshaped
The damaged cartilage and the bone are cut away from the end of tibia with bone cement.
4. Tibial Component Attached
The metal tibial component is secured to the end of the tibia with bone cement.
5. Plastic Inserted Attached
A polyethylene insert is attached to the metal tibial component . The insert will support the
body’s weight and allow the fumur to glide over tibia
Components Joined
The tibia , with its new polythylene surface , and the femur , with its new metal component,
are put together to form a knee joint.
Patella Resurfaced
To make sure the patella (the knee cap) glides smoothly over the new artificial knee, its rear
surface is prepared to receive a polyethelyne plastic component. The component is cemented
into the place.
End of Procedure
The new parts of the knee joint are tested by flexing and extending the knee.
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8. Overview
Arthritis also called osteoarthritis or degenerative arthritis, involves the swelling
and damage of the joints. It causes pain, stiffness and limited movement. Since
knees are primary weight bearing joints in the body, they are most at risk for
osteoarthritis. Risk factors include age , heredity, injury and obesity.
Damaged Cartilage
Cartilage is a smooth, protective joint tissue that cushions the bones and allows
joints to move freely. Cartilage can deteriorate over time. As it loses its cushioning
ability, heavy use or injury may increase its rate of deterioration.
Cartilage Loss
Eventually , as cartilage wears away completely. Bone runs against bone.
Bone Spurs
Over time lumpy growths of bone called bone spurs or osteophytes from along
the edges of the joint.
Symptoms
An arthritic knee may feel stiff, and leg motion may be limited. Standing or
walking for long periods may make pain in joint worse. Severe arthritis may create
pain all times, even when at rest. If the cartilage wear is only on one side of the
knee, the sufferer may become bow-legged or knock-kneed.
Treatment
Treatment options may include cortisone injections, non-steroidal anti-
inflammatory medications, use of splint or brace, exercise, weight loss and
modification of daily activities. In some cases , arthroscopic or surgical correction
may be needed. In severe cases , total or partial joint replacement with metal or
ceramic components may be required .
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9. Overview
The meniscus is comprised of two C-shaped wedges of cartiliage that cushion and
stabilze the knee joint. A torn meniscus can cause pain and limited mobility in the
knee.
Causes:
The meniscus can become torn from injury or trauma to the knee, or from
degenerative condition such as osteoarthritis. Since most of the meniscus has no
blood supply, these tears are difficult to heal and may worsen over time.
Symptoms:
The most common symptom of a meniscus tear is pain in the knee . Other
symptoms may include swelling , tenderness when pressing on the sides of the
knee joint, a popping or clicking sound or sensation when moving the knee, or
limited mobility.
Treatment:
Treatment options for torn meniscus include rest, cold compress, physical therapy,
anti-inflammatory medications and immobilization of the knee in a brace or cast.
Severe cases may require surgery.
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10. Overview
This condition is an irritation of the cartilage on the back of the
patella (the kneecap) that causes pain in one or both knees.
Causes:
Although the exact cause is unknown , patella femoral pain
syndrome can develop because of over use, tyically as a result of
high-impact athletic activities that require running and jumping or
because of improper tracking of the patella on the femur. These
activities can place severe stress on the patella as it slides against
the knee joint, particularly in people whose patella are slightly
misaligned.
Symptoms:
The most common symptoms is a dull aching sensation under and
around the kneecap that becomes most noticable after long periods
of sitting , squatting or walking down stairs. The knee may also
catch, grind or pop.
Treatment:
Treatment options include rest, ice, medications, physical therapy,
taping, knee sleeve and in severe cases, surgery
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11. Overview
This condition is a painful swelling, usually along the front of the lower leg,
that is common among runners and other athletes.
Causes:
Shin splints are usually caused by over use of the leg muscles, particularly
the anterior tibialis, a muscle that runs along the front of the tibia. This
muscles can become stretched, gradually tearing away the connective tissue
that attaches it to the tibia. Shin splints are common in athletes that run on
hard or angled surfaces, or in those who wear shoes with hard soles or poor
padding.
Symptoms:
Dull, aching pain along the front or inside edge of the lower leg is the most
common symptoms of shin splints. Redness and swelling may also occur, and
pain may increase with activity and decrease with rest.
Treatment:
Treatment options include rest, cold compress, elevating the leg, anti-
inflammatory medications, physical therapy, cross training, use of a shoe
with proper padding and arch support, or use of a brace. Severe cases may
require surgery.
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12. Overview
This condition occurs when the anterior cruciate ligament ( ACL), the
band of tissue that connects the femur to the tibia inside the knee
joint, becomes torn or worn away, causing pain and instability of the
knee.
Causes:
An ACL tear is typically caused by a severe injury or trauma to the
knee, often during athletic activity. A sudden stopping and twisting
motion of the knee, or a blow to the knee that forces the joint to bend
beyond its normal range of motion may cause the ACL to stretch and
tear.
Symptoms:
The most common symptom of a torn ACL is pain in the knee. Other
symptoms may include immediate weakness or popping sound in the
knee, swelling, stiffness and brusing. Walking is painful and the knee
may feel unstable.
Treatment:
Treatment options for torn ACL include rest, cold compress, wrapping
the knee, elevating the knee, physical therapy and anti-inflammatory
medications. Surgery is commonly required.
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