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ADVANCED SURGICAL OPTIONS
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Shoulder
Frozen Shoulder Treatment
Frozen Shoulder Treatment Book an Appointment Frozen shoulder or adhesive capsulitis is a condition of shoulder in which the capsule has become very stiff and tight leading to pain and limitation of the motion. Diagnosis It is a clinical examination based diagnosis in most cases. X-ray: . X-ray in frozen shoulder is useful to rule out the osteoarthritis of the shoulder joint and fractures around the shoulder joint. MRI Scan: . MRI Scan shows certain signs such as thickening of Coraco-humeral ligament which is one of the reliable signs to confirm frozen shoulder. Treatment Pain management & Exercises Controlling the pain with short course of medication and / or physiotherapy can help in facilitating the frozen shoulder exercises which are vital to improve the range of movement and pain. Applying heat before exercises can help to stretch better. Steroid injection to the joint In patients with severe pain stopping them from doing the exercises, it can be a useful tool to help. However, post injection exercises still have to be done regularly to get the motion back. Manipulation under anaesthesia with steroid injection Manipulation under general anaesthesia will help to bring the range of motion back and injection helps the pain. Post this, exercises are still required, but it will be a lot easier to do the exercises to maintain the range of motion. Arthroscopic release of Anterior capsule In patients with persistent shoulder stiffness for prolonged period, an arthroscopic (keyhole) surgery to release the tight bands can help restore the range of motion.
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Elbow
Golfers Elbow Treatment
Golfers Elbow Treatment Book an Appointment Diagnosis Golfers Elbow or Medial Epicondylitis is easy to diagnose with clinical examination alone. However, an X-ray would help to rule out any underlying bone condition contributing to the problem. Treatment Exercise based treatment. Golfers Elbow responds well to simple stretching exercise based treatments. Home based or physiotherapy guided exercise regimes work well for majority of patients. Wearing an elbow band in addition, particularly for the hand work may help in preventing further irritation of the tennis elbow. Steroid Injection Steroid injection is a safe and effective treatment for the golfers elbow. However, there is a risk of recurrence with the injection alone. Post injection stretches can minimize the risk of recurrence. PRP (Platelet Rich Plasma) Injection PRP Injection is a safe and effective treatment for golfers elbow. The whole procedure of drawing blood, time to centrifuge and then injection is around 40 minutes of time in the out patients. For the PRP to be effective and average of 4 to 6 weeks of time is required. In some, more than one PRP injection may be required to cure the condition completely. Golfers Elbow Release Surgery In patients with no improvement with all other conservative measures, surgery is considered. This is performed either as an open surgery or arthroscopically (Keyhole). The incision for open surgery is around 3cm long. The tendon is released and debrided (the frail tissue removed). Small puncture holes are made in the bone underneath so that there is some bleeding to that area and healthy tissue can grow to that area. Rehabilitation Post-surgery, the bulky dressing is removed after 4 days. Early mobilization is allowed. Gentle passive stretches for the elbow are started as early as 2 weeks. Strengthening exercises are embarked upon after 4 weeks. One is expected to return to full activity by around 6 weeks post-surgery.
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Hip
Hamstring Repair Surgery
Hamstring Repair Surgery Book an Appointment While hamstring strain is a very common problem in sporting population, the proximal hamstring tear is an uncommon injury. Majority of them are likely to be partial tears, however a small number of them are complete tears with retraction of the proximal hamstrings. Often the tear would be due to avulsion of the periosteum of the bone along with the proximal hamstring muscle. Diagnosis With good physical examination, the bruising, gap in the hamstring tendon and free SLR without the restraint to passive stretch are indicative of the the proximal hamstring tear. X-ray: X-ray is performed and is useful to rule out any bone injuries. However, the hamstring muscle tear is not visible on the X-ray. MRI Scan: MRI Scan is the gold standard investigation to identify the type and extent of the hamstring tear. In addition, it helps to assess the retraction of the tendon. Treatment First Aid for proximal hamstring tear involves the typical R.I.C.E therapy for the first week. Rest. It is important to minimize walking around. Icepacks. Cold packs 3 to 4 times a day helps reduce the swelling Compression. Thigh compression band is sufficient to help with compression. Elevation. Keeping it elevated on a pillow when resting helps. Chronic Partial tear of Proximal Hamstrings Non-healing partial tears can be treated with PRP injection. In patients with no improvement with this treatment and in those with high grade 2 or grade 3 tears, surgery becomes necessary. Proximal Hamstring Repair Surgery Proximal hamstring needs fixation back to the ischial bone. Fiber-wires are used to stitch and pull the muscle tendon back to the bone. Bone is freshened up first to create the cancellous bone bed to help grow the tendon back to the bone Fixation is by using either PEEK (high grade polymer) or Bio Suture anchors inserted into the ischial bone. The fixation technique is called speed-bridge technique which helps compress the tendon to the bone. Hamstring repair Surgery Rehabilitation Rehabiliation starts immediately after the surgery. Post-surgery you can expect to be allowed to walk with a walker with short stride and bending the knee. You will be asked to keep the knee bent and not stretch and load to avoid strain on the repair. You can expect to walk comfortably outdoors by 6 weeks. By 3 -4 months light jogging is allowed. Around 6 months post surgery, you can expect to return to the sports on the ground or court.
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Knee
High Tibial Osteotomy or HTO
High Tibial Osteotomy or HTO Book an Appointment High Tibial (leg bone) Osteotomy or HTO and Distal Femoral (thigh bone) Osteotomy or DFO are the alignment correction procedures. These are valuable alternatives to Knee replacement in a selected group of patients. This is preferred approach in suitable patients for several reasons. As this does not lead to bone loss, at a later date even if the patient needs Knee replacement it will be primary knee replacement at that point of time. Indications Osteoarthritis. Advanced medial compartment knee arthritis with severe pain and / or limitation of mobility. Severe Angular Deformity predisposing to uni-compartmental osteoarthritis. Who is suitable for the HTO Surgery? Young (40 to 60 Years of age) and active patient Healthy otherwise Non- obese patient Persistent pain and disability affecting daily activities Single compartment of the knee involvement Compliant to follow post-operative protocols Risks Risks of HTO surgery are low however a small overall risk of adverse outcomes remains. Fracture: During the surgery there is a small risk of fracture of the bone extending to the other side making the fragments unstable. However, the modern implants are strong enough to hold the bone fragments together and support well till the bone heals. Infection: Risk of infection is low with the advanced techniques and improvised theatre environment. Infection if picked up early, are likely to respond to antibiotics. In some instances it may need further washout or even removal of the implant. Blood Vessel or Nerve Damage: Rare, but can lead to numbness or weakness down the leg. In most patients, that recovers within 3 months. Clots in legs and lungs: To prevent clots (Deep vein thrombosis and pulmonary embolism), medications are given for first 14 days post-surgery. Stiffness: Stiffness of the muscles is common post-surgery and needs good physiotherapy support. Preparing for the surgery A good control of medical conditions such as diabetes and blood pressure is required. In addition to that a thorough check up by the physician and advice regarding the dosage of the medications and any alterations to that the days before and after the surgery needs to be taken. Stopping smoking is necessary as smoking affects the healing of the surgical wound. HTO Surgery The surgery is either performed with injection in the back to numb the legs or alternatively under general anaesthesia where you are put to sleep for about the 1.5 hours of surgical time. Post-surgery you can expect to see a large dressing around your knee. The surgery involves making a cut in the bone either on the inner or outer side of the upper part of the leg bone (proximal tibia). Post that the bone is either opened up as a wedge or a wedge of bone is taken out and the rest of the bone is closed down (Open Wedge or Closed Wedge Osteotomy). Often a bone substitute or a bone graft is used to fill the gap. Then the bone is fixed with a plate and screws. This balances out the stress in the knee and hence relieves the pain in one compartment. Post-Surgery Post-surgery you can expect rehabilitation to start early. On the day 1 Physiotherapists will ask you to move your ankles and press your knee down. On day 2, you can expect to sit on the edge of bed also take a few steps with the help of walker and the physiotherapist. A stay of 2 to 3 days in hospital is expected. You can expect to walk comfortably without a walker support by 2 to 3 weeks.
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Knee
Knee Ganglion Cyst Excision
Knee Ganglion Cyst Excision Book an Appointment Diagnosis With good physical examination, the ACL or PCL ligament laxity can be identified in patients with ganglion cyst. Usually the laxity will be mild. X-ray: . X-ray is performed and is useful to rule out any bone injuries, however, ligaments are not visible on the X-ray. MRI Scan: . MRI Scan is the gold standard investigation to identify the type and extent of the ACL and PCL ligament condition. The fluid filled cyst stretching the ACL or PCL stretching the fibers of the ligament can be identified. Treatment Ganglion cysts of the knee remain so and can gradually expand, leading the symptoms of instability of the knee. Although strengthening the Quadriceps (thigh muscles) with eccentric exercises may help to minimise the signs of instability, the pain due to ganglion cyst often persists especially on doing squats and with cross legged sitting. Platelet Rich Plasma (PRP) Injection PRP injection to ACL can help improve the stability in these patients. As the ACL or PCL is usually overstretched and not torn, PRP injection can actually help in improving the stability of the ligament. Post PRP injection, a period of 4 to 6 weeks is needed for the injection to work. However, pain may persist inspite of the improved stability of the joint. Under those circumstances, surgery is warranted. Arthroscopic Ganglion cyst excision Arthroscopic (key hole)/procedure-surgery surgery is performed for this condition. The ganglion cyst is identified and the cyst wall is cleared with instruments. Post cyst removal, the ACL and PCL ligaments are assessed for stability. If they are overstretched then a PRP injection is also performed during the surgery. Post ganglion cyst excision rehabilitation Post-surgery, you are allowed to walk on the same day evening. Walking without any support is possible in most patients, but some may need the support of a walker for upto a week. Physiotherapy in the form of exercises to activate quadriceps (thigh muscles) and range of movement exercises are started on the day 1. Full return to sporting activity is usually delayed upto 6 weeks particularly if the ligament laxity was identified during surgery.
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Shoulder
Latarjet Procedure – Shoulder
Latarjet Procedure – Shoulder Book an Appointment Diagnosis Shoulder in/bone-joint-school/stability. Repeated movement of the shoulder bone out of the socket (recurrent dislocations) is the cause of concern in patients usually belonging to the age group of 18 to 40. Apprehension sign where the patient experiences the scare of joint dislocation in certain angles of shoulder movement is noted. X-ray: Xray may reveal if there is a bony Bankarts, where a fragment of bone is lifted up from the front edge of the socket (Glenoid bone). Xray may also reveal a large dent in the back part of the upper portion of the shoulder bone (head of the humerus). However, in majority of patients with this problem, X-ray may not reveal any abnormalities. MRI Scan: With contrast is the gold standard investigation for identifying the extent of the tear of the lip (labrum), the dent (Hill Sach’s lesion) on the back side of the shoulder bone due to rubbing against the front of the socket. Treatment Acute dislocation of the shoulder joint needs immediate medical attention to reduce the shoulder joint back into place. Once the pain and inflammation reduces, it needs a prompt assessment regarding the risk of further dislocation. Latarjet Procedure In patients with risk of repeated dislocations with ligament laxity or in patients with previous Bankarts repair (Labral repair) which has failed, the Latarjet procedure is undertaken. If a significant amount of glenoid (socket) bone loss is observed, then Latarjet procedure is indicated. Latarjet procedure entails detaching a part of the coracoid bone (a part of shoulder wing bone) and fashioning it to sit and fuse with the front portion of the glenoid (socket) bone. This will provide a mechanical block for the humerus head to jump out from its position. In addition, the muscles attached to coracoid bone work like a dynamic sling preventing dislocation. This is done either as a mini-open fracture or as an arthroscopic procedure. The Coracoid bone gets fixed to the glenoid bone by using titanium screws. Rehabilitation Post-surgery, for the first 6 weeks using a broad arm sling is recommended. Gentle passive stretches are started early. Upto 6 weeks external rotation and abduction movements need to be avoided. Return to non-contact sports by around 4 months and for contact sports by 6 months.
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Knee
LCL Surgery
LCL Surgery Book an Appointment Diagnosis With good physical examination, the Lateral collateral ligament (LCL) injury is relatively easy to identify. However, to establish the extent and grade of injury, further investigations would be helpful. X-ray: X-ray is performed and is useful to rule out any bone injuries. Ligaments are not visible on the X-ray. MRI Scan: MRI Scan is the gold standard investigation to identify the type and extent of the MCL injury. In addition, it helps to assess the condition of the meniscus (cushions in the knee joint), cartilage and other ligaments. Often these structures are also affected and need attention. Treatment First Aid for LCL injuries involves the typical R.I.C.E therapy for the first week. Rest. It is important to minimize walking around. Icepacks. Cold packs 3 to 4 times a day helps reduce the swelling Compression. Crepe bandage is sufficient to help with compression. Elevation. Keeping it elevated on a pillow when resting helps. Conservative Management Isolated LCL injury can be treated with Range of motion (ROM) knee brace in most patients. The angle of bending the knee is adjusted gradually. For the complete healing of the ligaments around 6 to 8 weeks of time is necessary. By 3 weeks, reassessment can help to understand the progress of the healing. PCL + LCL Injury (Postero lateral corner injury) This is a more common type tear in which both LCL and PCL are injured. In patients with multi ligament injury, surgery to reconstruct the posterolateral corner and also PCL ligament is expected to achieve the best outcome. Whether this is performed as 1 stage or 2 stage operation is tailor made to individual’s inury pattern. LCL Surgery LCL reconstruction surgery is a day care surgery in which the torn ligament is replaced by your own spare piece of tissue. This is called auto-graft. Graft material can be obtained from cadaver source (another person), however own tissue is preferred and the healing and take up of the material is better. Hamstring muscle tendon from the inner side of the thigh is used. The two ends of the tendon is fixed to the thigh bone (femur) by using a biocomposite screw or titanium button and midportion to the leg bone (fibula) with a suture anchor made of either PEEK (high grade polymer) or biocomposite material. LCL Rehabilitation Post-surgery, you are allowed to walk with partial weight on the same day evening. You will need the ROM knee brace for upto 3 weeks. Physiotherapy exercises start early. In the first 6 weeks the focus is mainly on getting the full ROM and help regain the muscle strength. The whole rehabilitation process will take about 4 to 6 months before returning back to playing sports on the ground or court.
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Knee
LETS – Lateral Extra-articular Tenodesis
LETS – Lateral Extra-articular Tenodesis Book an Appointment Procedure LETS Procedure is often performed in addition to the ACL reconstruction to provide further stability to the knee in the antero-lateral direction. It is not required in every patient undergoing the ACL reconstruction, however a small percentage of people with subtle instability even after the ACL reconstruction may need LETS procedure. This decision often has to be taken by the operating surgeon in the OT. ACL Reconstruction ACL surgery is performed in the standard fashion by using one of the autografts (Hamstrings / Peroneus longus / Quads tendon / Bone Tendon Bone). The ACL graft fixation is either by using the Tightrope Button and Bioscrew or Tightrope Button fixation on both the sides of the ligament. Post the secure fixation of the ACL, joint is assessed clinically on the table for stability using 3 different clinical tests. On examining, if there is subtle laxity in certain angles then we proceed with the LETs procedure. In patients where revision ACL surgery is being performed LETs is done routinely to give extra stability. LETS Procedure LETS or lateral extra-articular tenodesis is an open procedure and not through arthroscopy. A 3 to 4 cm incision over the outer side of the knee is needed. A part of the IT band is separated from the proximal end while leaving its distal attachment to the leg bone intact. The proximal end is then passed under the LCL (Lateral Collateral Ligament) and brought upto just proximal to the bone prominence on the outer side of the knee (Lateral epicondyle) and fixed to the bone by using a suture anchor (PEEK or Bio material based). ACL + LETs Rehabilitation ACL Rehab starts from the day 1. Rehabilitation for ACL + LETs is no different from the standard rehab protocol post ACL Reconstruction alone. Post-surgery, you are allowed to walk on the same day evening. If your meniscus is intact and only ACL reconstruction surgery has been performed, then you are allowed to walk with full weight on the leg. Initial one week you may need the support of a walker. Within a week most people manage to walk without support. Physiotherapy exercises are started early. In the first 6 weeks the focus is mainly on getting the full range of movement and help regain the muscle strength. The whole rehabilitation process will take about 6 to 8 months before returning back to playing sports on the ground or court.
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Knee
MCL Surgery
MCL Surgery Book an Appointment Diagnosis With good physical examination, the Medial collateral ligament (MCL) injury is relatively easy to identify. However, to establish the extent and grade of injury, further investigations would be helpful. X-ray X-ray is performed and is useful to rule out any bone injuries. Ligaments are not visible on the X-ray. On occasions we See a small bone fragment pulled (avulsed) out on the inner side of the thigh or leg bone. When found, this represents the MCL ligament injury. This is called Segond fracture. MRI Scan: MRI Scan is the gold standard investigation to identify the type and extent of the MCL injury. In addition, it helps to assess the condition of the meniscus (cushions in the knee joint), cartilage and other ligaments. Often these structures are also affected and need attention. Treatment First Aid for MCL injuries involves the typical R.I.C.E therapy for the first week. Rest: It is important to minimize walking around. Icepacks: Cold packs 3 to 4 times a day helps reduce the swelling Compression: Crepe bandage is sufficient to help with compression. Elevation: Keeping it elevated on a pillow when resting helps. Conservative Management MCL injury can be treated with Range of motion (ROM) knee brace in most patients. The angle of bending the knee is adjusted gradually. For the complete healing of the ligaments around 6 to 8 weeks of time is necessary. By 3 weeks, reassessment can help to understand the progress of the healing. ACL + MCL Injury In patients with multi ligament injury, it is prudent to use ROM knee brace for 3 weeks. If MCL is healing naturally, then can proceed with the ACL reconstruction alone. If poor healing of MCL, then a decision to perform both MCL and ACL reconstruction may need to be taken. Partial MCL Tears or Non-healing MCL tears Body will be trying actively to heal the ligament in the first 4 to 6 months. If satisfactory healing is not taking place in partial tears of MCL, then a PRP (Platelet Rich Plasma) injection can help to stimulate the healing process. MCL Surgery MCL surgery is a day care surgery in which the torn ligament is replaced by your own spare piece of tissue. This is called auto-graft. Graft material can be obtained from cadaver source (another person), however own tissue is preferred and the healing and take up of the material is better. Hamstring muscle tendon from the inner side of the thigh is used. The tendon is fixed to the thigh bone (femur) by using a biocomposite screw or titanium button and back to the leg bone (tibia) with a suture anchor made of either PEEK (high grade polymer) or biocomposite material. MCL Rehabilitation Post-surgery, you are allowed to walk on the same day evening. You will need the ROM knee brace for upto 3 weeks. In patients with MCL surgery alone, can start walking with full weight on the leg from the day one. Physiotherapy exercises start early. In the first 6 weeks the focus is mainly on getting the full ROM and help regain the muscle strength. The whole rehabilitation process will take about 4 to 6 months before returning back to playing sports on the ground or court.
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Knee
Meniscal Repair
Meniscal Repair Book an Appointment Diagnosis With good physical examination meniscal (cushions in the knee joint) tear can be identified. However, to establish the extent and grade of injury, further investigations would be helpful. X-ray: X-ray is performed and is useful to rule out any bone injuries. Menisci are not visible on the X-ray. MRI Scan: MRI Scan is the gold standard investigation to identify the type and extent of the meniscus injury. In addition, it helps to assess the condition of the cartilage and ligaments. Often these structures are also affected and may need attention. Treatment First Aid for the acute meniscal injuries involves the typical R.I.C.E therapy for the first week. Rest: It is important to minimize walking around. Icepacks: Cold packs 3 to 4 times a day helps reduce the swelling Compression: Crepe bandage is sufficient to help with compression. Elevation: Keeping it elevated on a pillow when resting helps. Non-surgical Management Meniscal injuries with no pain, locking or catching symptoms, can be observed. Small tears may not need any other active treatment. Meniscal tears in the outer most (red-red) zone of meniscus may self heal over a period of time. However, majority of symptomatic tears may not heal. ACL + Meniscal Injury In patients with ACL and meniscal tear, at the time of ACL reconstruction surgery, meniscus surgery is undertaken as well to help stabilise the knee. Meniscal Surgery Meniscal surgery is an arthroscopic (key hole ) surgery which can by done as a day care procedure. There are various types of surgeries undertaken for the meniscus depending on the type and location of the tear. Meniscal repair Meniscal repair All suture meniscal repair Peek meniscal repair Inside out meniscal repair Outside in meniscal repair Meniscal root repair Meniscal transplantation Partial Meniscectomy (meniscal balancing) - removal of part of the meniscus which is loose and not viable. Meniscal Repair Rehabilitation Post-surgery, you are allowed to walk on the same day evening. In patients with meniscal repair, partial weight bearing on the front of the foot and use of walker or a stick is advised for upto 4 weeks. In patients with partial meniscectomy, full weight bearing on the leg is allowed within first few days as the pain settles. Physiotherapy exercises start early. In the first 6 weeks the focus is mainly on getting the full ROM and help regain the muscle strength. The whole rehabilitation process will take about 4 to 5 months before returning back to playing sports on the ground or court.
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Knee
Meniscal Transplant Surgery
Meniscal Transplant Surgery Book an Appointment Diagnosis With good physical examination meniscal (cushions in the knee joint) tear can be identified. However, to establish the extent and grade of injury, further investigations would be helpful. The irreparability of the meniscus will be determined based on the MRI scan evaluation. X-ray: X-ray is performed and is useful to rule out any bone injuries. Menisci are not visible on the X-ray. MRI Scan: MRI Scan is the gold standard investigation to identify the type and extent of the meniscus injury. In addition, it helps to assess the condition of the cartilage and ligaments. Often these structures are also affected and may need attention. Treatment Meniscal Transplant Surgery Meniscal transplant surgery is an arthroscopic (key hole ) surgery. If the bone + meniscus transplant is being undertaken then a mini open cut may be utilised. In patients with irreparable meniscus this surgery is considered. In patients with meniscus and cartilage damage, bone and meniscus transplant is undertaken. The criteria for undergoing this surgery are Young and active patient irreparably damaged meniscus No signs of joint arthritis Patients with previous meniscectomy surgery The availability of the matching sized cadaveric meniscus is mandatory before the surgery is undertaken. During the surgery any remaining parts of the non-viable meniscus is removed. Using special technique, the healthy meniscus is rail-roaded into the joint using sutures and special technique. The meniscus is fixed to the remaining capsule of the joint and the shin bone using special sutures and tightropes and endobutton. Meniscal Transplant Rehabilitation Post-surgery, you are allowed to walk on the same day evening. Partial weight bearing on the front of the foot and use of walker is recommended for upto 4 weeks. Physiotherapy exercises start early. In the first 6 weeks the focus is mainly on getting the full ROM and help regain the muscle strength. The whole rehabilitation process will take about 4 to 5 months before returning back to playing sports on the ground or court.
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Knee
Meniscus Root Repair
Meniscus Root Repair Book an Appointment Diagnosis With good physical examination meniscal (cushions in the knee joint) tear can be identified. However, to establish the extent and grade of injury, further investigations would be helpful. X-ray: X-ray is performed and is useful to rule out any bone injuries. Menisci are not visible on the X-ray. MRI Scan: MRI Scan is the gold standard investigation to identify the type and extent of the meniscus injury. In addition, it helps to assess the condition of the cartilage and ligaments. Often these structures are also affected and may need attention. Treatment First Aid for the acute meniscal injuries involves the typical R.I.C.E therapy for the first week. Rest: It is important to minimize walking around in the first week. Icepacks: Cold packs 3 to 4 times a day helps reduce the swelling. Compression: Crepe bandage is sufficient to help with compression. Elevation: Keeping it elevated on a pillow when resting helps. Non-surgical Management Meniscal root tears cannot be managed with non-surgical modes of treatment. Meniscal root repair effectively makes the meniscus completely non-functional. Hence it needs surgery to reattach the meniscal root. ACL + Meniscal In In patients with ACL and meniscal tear, at the time of ACL reconstruction surgery, meniscus surgery is undertaken as well to help stabilise the knee. Meniscal Root Repair Surgery Meniscal root repair surgery is an arthroscopic (key hole ) surgery which can by done as a day care procedure. Firstly the meniscal root tear is identified. A fiberwire stitch is passed through the root. A small bone tunnel is drilled from outside part of the shin bone to the meniscal root footprint area using a special jig. The fiberwires are retrieved out through the bone tunnel. Using a titanium button, the threads are tightened so that the meniscal root gets firmly fixed to the bone. Meniscal Root Repair Rehabilitation Post-surgery, you are allowed to walk on the same day evening. In patients with meniscal root repair, partial weight bearing on the front of the foot and use of walker or a stick is advised for upto 4 weeks. Physiotherapy ROM exercises start early. In the first 6 weeks the focus is mainly on getting the full ROM and help regain the muscle strength. The whole rehabilitation process will take about 4 to 5 months before returning back to playing sports on the ground or court.
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Knee
MPFL Ligament Surgery
MPFL Ligament Surgery Book an Appointment Diagnosis MPFL or Medial Patello-Femoral ligament injury due to recurrent dislocations of patella is often identifiable clinically by assessing for the pain, tenderness, swelling and Apprehension sign in which one would be extremely apprehensive when doctor tries to bend the knee slowly while trying to put pressure to push patella (knee cap) to the outside. X-ray: X-ray is performed and is useful to rule out any bone injuries, however, ligaments are not visible on the X-ray. MRI Scan: MRI Scan is the gold standard investigation to identify the type and extent of the MPFL injury. In addition, it helps to assess the condition of the meniscus (cushions in the knee joint), cartilage and other ligaments. Often these structures are also affected and need attention. Treatment First Aid for MPFL injuries involves immediate reduction (relocation) of the patella (knee cap) to the place where it belongs to. Further to that R.I.C.E therapy for the first week is invaluable. Rest: It is important to minimize walking around. Icepacks: Cold packs 3 to 4 times a day helps reduce the swelling Compression: Crepe bandage is sufficient to help with compression. Elevation: Keeping it elevated on a pillow when resting helps. Knee Rehabilitation Post MPFL ligament injury, if other restraints of the knee cap are working and if the Apprehension test is negative, then management would be particularly by improving Quads strength, VMO (Vastus medialis obliqus) muscle strength. Physiotherapists play a major role in this as well as improving patellar tracking to prevent further dislocations of the knee cap. MPFL Surgery Surgery is recommended in younger people particularly with recurrrent (repeated) dislocations of the patella. Patellar cartilage loss in addition to MPFL injury warrants the surgery to reconstruct MPFL as well as chondroplasty (regeneration of cartilage). If there are multiple restraints affected, then you may need a bone correcting procedure as well, in addition to the MPFL reconstruction. MPFL surgery is a day care surgery in which the torn ligament is replaced by your own spare piece of tissue. This is called auto-graft. Graft material can be obtained from cadaver source (another person), however own tissue is preferred and the healing and take up of the material is better. Often it would be hamstring muscles tendon from the inner side of the thigh, where the spare muscle tendons are harvested through small keyholes. The graft is fixed using suture anchors and a bio-composite screw. MPFL Rehabilitation Post-surgery, you are allowed to walk on the same day evening using the help of a walker. Within a week most people manage to walk without support. Early mobilistion to get the full range of movement is necessary. Physiotherapy exercises start early. In the first 6 weeks the focus is mainly on getting the full ROM and help regain the muscle strength. The whole rehabilitation process will take about 6 to 8 months before returning back to playing sports on the ground or court.
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Knee
PCL Surgery
PCL Surgery Book an Appointment Diagnosis With good physical examination, the PCL or Posterior Cruciate Ligament injury can be identified, however when the knee is acutely swollen and painful, it may be difficult to examine. X-ray: X-ray is performed and is useful to rule out any bone injuries, however, ligaments are not visible on the X-ray. MRI Scan: MRI Scan is the gold standard investigation to identify the type and extent of the PCL injury. In addition, it helps to assess the condition of the meniscus (cushions in the knee joint), cartilage and other ligaments. Often these structures are also affected and need attention. Treatment First Aid for LCL injuries involves the typical R.I.C.E therapy for the first week. Rest. It is important to minimize walking around. Icepacks. Cold packs 3 to 4 times a day helps reduce the swelling Compression. Crepe bandage is sufficient to help with compression. Elevation. Keeping it elevated on a pillow when resting helps. PCL Prehabilitation PCL Prehab exercises can be started once the pain and swelling improve. These help in regaining the knee movements and keep the muscles in a good condition. PCL Surgery Surgery is recommended in people leading an active lifestyle and are physiologically fit. Without surgery, one can manage but will have to limit the activities and be cautious on uneven surfaces to not twist again. PCL surgery is a day care surgery in which the torn ligament is replaced by your own spare piece of tissue. This is called auto-graft. Graft material can be obtained from cadaver source (another person), however own tissue is preferred and the healing and take up of the material is better. The graft material is either the hamstring tendons or peroneal muscle tendon from the side of the lower leg harvested through small cuts. The whole surgery is performed with the help of the camera (arthroscopy) and small cust (keyholes). Usually on one side the graft is fixed with a small titanium button and on the other side with a bio-composite screw. In some instances to increase the thickness of the graft, an all inside technique where both sides small titanium buttons are used. PCL Rehabilitation Post-surgery, you are allowed to walk on the same day evening. If meniscus is intact and only PCL reconstruction surgery has been performed, then you are allowed to walk with full weight on the leg with the support of a walker. Within a week most people manage to walk without support. Physiotherapy exercises start early. In the first 6 weeks the focus is mainly on getting the full ROM and help regain the muscle strength. The whole process of rehabilitation will take about 6 to 8 months before returning back to playing sports on the ground or court.
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Shoulder
Pectoralis Muscle Repair
Pectoralis Muscle Repair Book an Appointment Pectoralis Major Muscle covers the whole one side of the chest and inserts on to the inner side of the arm bone (humerus). The tear of the muscle from its insertion is occurs typically when weightlifting – chest press – due to sudden loss of control. It is a rare injury, but causes sudden loss of power and severe pain. Diagnosis Physical examination reveals pain, weakness, change of shape of the chest contour and bruising in and around upper arm and adjacent area of the chest. Ultrasound Scan: Ultrasound scan can help in diagnosing the tear, however the extent and retraction may not be clear on occasions. MRI Scan: MRI Scan helps delineate the Pec tear, the extent of retraction and the status of the surrounding soft tissue. Treatment Pectoralis Major repair Surgery Pectoralis Major muscle repair surgery is a day care surgery. A delto-pectoral cut in the front of the shoulder is utilised to access the tear. Often the clavicular component of the Pectoralis major muscle would be intact and sternal part of that would be torn. The torn muscle is often retracted and hence needs to identified and brought back to approximate it to the pectoral groove in the humerus bone just lateral to the biceps tendon. Before fixing, the bone bed is roughened and multiple small holes with k wire are made to help better healing. Using three set of fiberwires, the muscle tendon is approximated to the bone and fixed using suture anchors. The suture anchors are made up of different materials • PEEK (high grade polymer) • Biocomposite (becomes bone) • Metal (titanium) Pectoralis Major Repair Rehabilitation Post-surgery, you can expect to be in a broad arm pouch supporting your arm. Rehabilitation in the form of gentle passive mobilisation is started early usually by 2nd week. Active ROM exercises are started 4 weeks post-surgery. Strengthening exercises typically start post 6 to 8 weeks. To achieve full functionality including lifting weights, you can expect it to take around 4 to 6 months.
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Joints, Bones, Muscles
PRP Injection (Platelet Rich Plasma)
PRP Injection (Platelet Rich Plasma) Book an Appointment PRP or Platelet Rich Plasma injection has been described first in 1970s. However, it has found wider acceptence and evidence in Orthopedic field only in the last 15 years. It now has been an establised treatment in different areas of medicine including Dermatology, General Surgery in addition to Orthopedics. Its treatment value has been equated to that of stem cell therapy in many regards. This is an innovative procedure performed in the clinic as out patient. Indications Tendinopathies Tennis Elbow Achilles tendinopathy (Heel) Patellar tendinopathy (Knee) Rotator Cuff partial tear (Shoulder) Plantar fasciitis Ligament tears (Partial) ACL (Knee) ATFL and CFL (Ankle) TFCC (Wrist) MCL (Knee) Osteoarthritis (Mild to moderate) How is it performed? The preparation for this begins with drawing blood from the patient in the same way as drawing blood for investigations. Blood is carefully collected in the special test tubes and is centrifuged. With this the blood and the plasma get separated. Out of which the lowest layer of plasma, which is rich in platelets is separated. This is then injected to the area of need. Local anaesthesia gel is usually applied to the area prior to the injection. Post injection, you need to avoid taking any NSAID pain killers for 15 days. What to expect post Injection? Post Injection, there may be a mild increase in pain for the first 2 to 3 days. After that the injection pain settles down. Stretching exercises are resumed after 3 days. You can expect improvement in the condition in around 4 to 6 weeks. Another way of doing PRP is by using the blood drawn from the bone marrow (BMAC – bone marrow aspiration concentrate). In certain instances, this is preferred over the standard PRP. However the donor site pain may persist for few weeks.
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Joints, Bones, Muscles
Rehabilitation
Rehabilitation Book an Appointment Orthopedic and sports rehabilitation is a multi- disciplinary field involving Physiotherapists, Occupational therapists, Trainers and Doctors working closely to achive the pre-injury level of fitness and mobility for the patient. Prehabilitation For most orthopedic and sports injuries, prehab is a very useful tool to help reduce the swelling, keep the muscles in good shape and condition and improve the range of movements. One of the common surgeries where prehab is used in the ACL Injury. This has been shown to improve the post surgery outcomes and recovery. Wherever possible, the time before surgery is best utilised in prehab. Rehabilitation Rehabilitation has to start early post surgery. Infact, same day physiotherapy inputs has been found to be extremely valuable. Keeping the joints above and below mobile helps a great deal in recovery of the joint on which surgery has been performed. Early muscle activation exercises wherever permissible are important for recovery. For patients with risk of post surgery stiffness, it is important to use Continous passive motion (CPM) machine. First phase of rehabilitation Initial phase of rehabilitation is mainly aimed at regaining the full range of movement of the joint and improving the muscle strength. Second phase of rehabilitation Once this is achieved, the next targets would be to Further improvement of the muscle strength Proprioception (joint and body's ability to sense movement, action, and location) Landing techniques (on jumping and landing, the correct way to land to prevent further injuries) Pliometrics (speed and force to improve the muscle power and function) What symptoms warrant surgery? Functional training specific to the sports involved in. Fourth phase of rehabiliation Return to active sports.
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Knee
Revision ACL Reconstruction
Revision ACL Reconstruction Book an Appointment Diagnosis Clinical examination can reveal laxity in patients with ACL retear. However, confirming partial or complete tear by examination can be difficult. Often the knee may not be swollen like it does in primary tear. MRI Scan: MRI Scan is an important investigation, however the MRI images may not always give a clear picture due to artifacts post surgery. A 3 Tesla MRI scan is often better than 1.5 Tesla MRI scan in identifying the ACL retear. In addition, it is important to assess the condition of the meniscus (cushions in the knee joint), cartilage and other ligaments. Treatment ACL Revision Prehabilitation ACL Prehab exercises can be started once the pain and swelling improve. These exercises help in regaining the knee movements and keep the muscles in a good condition. Revision ACL Reconstruction Revision ACL reconstruction is a bigger procedure than the primary ACL surgery. When considering revision surgery, it is important to take the position of the tunnels, bone quality around the tunnels, rest of the joint structures integrity need to be taken into account. Based on these parameters a decision will have to be taken as to whether the surgery will be single stage or two stage procedure. If there is a lot of bone loss, then first stage of the surgery to perform bone grafting and second stage is to do the reconstruction. In patients needing a 2 stage procedure a gap of 3 to 6 months between the 2 procedures is needed for bone healing. Next concern is regarding the type of graft to be chosen for this. As the first surgery may have utilised either hamstrings or patellar tendon (BTB or Bone tendon bone) for graft, the graft material will have to be carefully chosen. The tendon thickness and tendon alone or bone tendon bone graft matters. Usually quadriceps tendon from thigh or the peroneus longus tendon from the leg is utilised for this. Thirdly, additional joint problems such as cartilage loss and / or meniscal tears if present, needs pre planning in terms of type of chondroplasty and meniscal repair techniques for the treatment. Revision ACL Rehabilitation Post-surgery, you are allowed to walk on the next day. If meniscus is intact and only revision ACL reconstruction surgery has been performed, then you are allowed to walk with full weight on the leg. Initial one to three weeks you may need the support of a walker. Within 2 weeks most people manage to walk without support. Physiotherapy exercises start early. In the first 6 weeks the focus is mainly on getting the full ROM and help regain the muscle strength. The whole rehabilitation process will take about 9 to 12 months before returning back to playing sports on the ground or court.
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About Our Surgical Procedures
Our orthopedic surgical procedures are designed to address a wide range of musculoskeletal conditions, from sports injuries to degenerative joint diseases. Our experienced surgeons utilize the latest techniques and technology to provide optimal outcomes for our patients.
When considering surgery, we believe in thoroughly educating our patients about their options, potential benefits, risks, and recovery expectations. Each procedure page provides detailed information to help you make informed decisions about your care.
Whether you require minimally invasive arthroscopic surgery or complex joint reconstruction, our team is committed to delivering personalized care and supporting you throughout your surgical journey.