This procedure replaces a damaged anterior cruciate ligament (ACL). The ACL connects the front top of the tibia (the lower leg bone), to the rear bottom of the femur (the thigh bone).
An incision is made over the font of the knee to expose the patella (knee cap), and the patellar ligament, which holds the patella in place. A strip from the patellar ligament and tibia is removed. This section, call an auto graft, will be used as a replacement for the damaged ACL.
The incision is then closed and the rest of the procedure will be performed through small cuts on the sides of the knee. The surgeon uses a small video camera called an arthroscope to see inside the knee and make sure the new ACL is positioned correctly. With the knee bent, the damaged ACL is cleared away.
A pin is inserted diagonally, from the tibia to the femur. The surgeon will use the pin as a guide to recreate the ACL. Using the pin as a guide, the surgeon drills holes into the tibia and femur. The auto grafts attached to the guide pin, and is pulled through the holes and into place. The knee is flexed to test the new joint.
ACL Reconstruction with Hamstring
This procedure replaces a damaged or torn anterior cruciate ligament (ACL) with a portion of hamstring tendon from the patient’s leg. The ACL connects the front top of the tibia (lower leg bone) to the rear bottom of the femur (thigh bone). The hamstring tendons attach the hamstring muscles to the lower leg.
Through a small incision below the knee, portions of the hamstrings semitendinous and gracilis tendons are separated from the muscle, but left connected to the tibia. These strips are braided together to create a section of tendon called auto graft, which will be used t replace the damaged ACL.
The rest of the procedure is performed through small incisions on the sides of the knee. The surgeon uses a small video camera called an arthroscope to see inside the knee during the procedure. With the knee flexed, the damaged ACL is cleared away. The rest of the procedure is performed through small incisions on the sides of the knee.
With the knee flexed, the damaged ACL is cleared away. A pin is inserted diagonally, from the tibia to the femur. The surgeon will use the pin as a guide to recreate the ACL. The surgeon follows the guide pin, drilling a tunnel through the tibia and femur. A second tunnel is drilled to intersect with the femoral tunnel and a horizontal screw is partially inserted.
The hamstring grafts will be looped over this screw. In order to pull the hamstring grafts over the horizontal screw, a graft-passing strand is captured by the bone mulch screw within the femoral tunnel. The horizontal screw is then advanced and embedded into the bone securely. The hamstring grafts are tied to one end of the strand and pulled up through the joint and over the horizontal screw to create the new ACL.
After the knee is straightened, the loose ends of the grafts are pulled tight and held securely to the tibia bone with a washer that has nail-like spikes and a screw. The excess auto grafts are trimmed away. And the new pats of the knee are then tested by flexing and extending the knee through its full range of motion.
The meniscus is a band of cartilage in the knee that acts as a shock absorber and provides stability to the knee joint. The meniscus helps protect the articular cartilage, the smooth covering on the ends of the femur and tibia. If a meniscus tears, it can often be repaired through arthroscopic surgery.
The surgeon begins by making small incisions in the front and back of the knee. Then, a tiny video camera called an arthroscope is inserted into the joint. Surgical instruments may be inserted through the other incisions. After finding and inspecting the area of damage, the surgeon decides how to attend to it.
The damaged area is cleared of loose fragments. If the tear is located in the area of meniscus that does not receive a good blood supply, that portion of the meniscus may be removed completely.
Tears that are in an area of the meniscus with a good blood supply are usually repairable because the blood supply promotes healing. The surgeon uses sutures or special fasteners known as anchors to sew or anchor the torn edges of the meniscus together. The meniscus will then heal itself.
Following repair, the incisions are closed with sutures or small bandages and the knee is wrapped and iced to control swelling. The knee may be immobilized for several weeks before rehabilitation begins. If part of the meniscus was removed, weight bearing and rehabilitation may begin soon after the surgery.
Oats Cartilage Repair Surgery
This procedure replaces areas of damage with grafts of the patient’s own healthy hyaline cartilage. The procedure, also known as mosaicplasty, is performed using small instruments through incisions on the sides of the knee.
The surgeon uses a small video camera called an arthroscope to see inside the joint and guide the instruments. Healthy cartilage is harvested from the collection area, a region that has little contact with the tibia. The amount of graft tissue removed is based on the size and location of the damaged cartilage. The curvature of the graft site is also taken into account. Diseased cartilage is removed in the same way, creating a socket for the graft.
The graft is fit firmly into the socket. Then it is tapped into place until its surface matches the level of the surrounding cartilage. The surgeon may need to use multiple donor cores to drill a larger damaged area. Grafts are placed one at a time until the damaged area is filled. For larger lesions, all graft tissue may be used.
The donor areas may be left open to heal. However, the surgeon may use the bone removed from the damaged area to refill the donor site. After surgery, the patient undergoes rehabilitative therapy. The patient may need to walk with crutches for a few months after surgery.
Partial Knee Replacement (using Oxford® implant)
Unlike total knee replacement surgery, this less invasive procedure replaces only the damaged or arthritic parts of the knee. The Oxford® unicompartmental knee uses metal plastic implants designed to potentially last longer and wear down less easily than traditional implants.
The first step in this procedure is to create an incision on the knee. Arthritic, damaged portions of the femur are removed. Parts of the damaged meniscus are removed and some bone is also removed from the tibia to make room for the new metal tibial component. The anterior cruciate ligament (ACL) is not affected.
A small portion of bone is removed from the damaged femoral condyle. The end is reshaped to fit the metal femoral component. A groove is cut into the tibia surface and cement is applied. The metal tibial component is pressed into place.
The prepared area of the femur is filled with the bone cement, and the metal femoral component is pressed into place. A plastic bearing implant is inserted between the metal femoral and tibial implants. The new parts of the knee joint are tested by flexing and extending the knee through its range of motions. The plastic bearing implant is not fixed in place, allowing it to move when the knee moves. This potentially reduces wear on the implants.
Total Knee Replacement (Encore 3DKnee™)
Total knee surgery removes the damaged and painful areas of the femur (the thigh bone) and tibia (the lower leg bone). These areas are then replaced with specially designed metal and polyethylene plastic parts.
First, the damaged portions of the femur bone and cartilage are cut away. The end of the femur is reshaped to allow a metal femoral component to fit in place. The metal component is attached to the end of the femur with bone cement. Alternatively, the component can have a special coating that allows it to be pressed into place without cement. The damaged portion of the tibia bone and cartilage are cut away. The end of the tibia is reshaped to receive the metal tibial component.
The metal tibia component is secured to the end of the tibia bone with bone cement. A polyethylene insert is attached to the metal tibial component. The insert will support the body’s weight and allow the femur to glide over the tibia.
The tibia, with its new polyethylene surface, and the femur, with its new metal component, are put together to form a new knee joint. To make sure the patella (the knee cap) glides smoothly over the new artificial knee, its rear surface is prepared. A polyethylene component is cemented into place on the back of the patella. The new parts of the knee joint are tested by flexing and extending the knee.