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ARTHROSCOPIC RECONSTRUCTION OF THE POSTERIOR CRUCIATE LIGAMENT (PCL)

Introduction

The posterior cruciate ligament (PCL) is located to the back from the anterior cruciate ligament – just like the ACL, it connects the femur to the tibia. The structure prevents the so-called posterior tibial translation or moving the tibia backwards in relation to the femur, it also stabilizes the joint.

Causes

An injury of the posterior cruciate ligament is much rarer than that of the anterior cruciate ligament. The structure is much more durable than the anterior cruciate ligament. It is usually damaged when the bent knee is hit from the front, i.e. during traffic accidents or practicing competitive sports.

Symptoms

Like an injury of the anterior cruciate ligament, damage to the posterior cruciate ligament causes joint instability. In the acute phase, there is also swelling and pain, often with the limited mobility. The symptoms are significantly influenced by the condition of the remaining articular structures – menisci, cartilage and other ligaments, which are often also damaged during an injury.

Diagnosis

The initial diagnosis is often made after taking medical history and performing a clinical examination of the joint, it is confirmed by a diagnostic examination – magnetic resonance imaging of the knee.

Treatment

In most cases, the treatment is surgical. The chief aim of the operation is to restore the function of the PCL, i.e. to prevent excessive shifting of the tibia back against the femur – improving the stability of the knee.

Type of operation

The operation is performed by arthroscopy. In addition to three arthroscopic portals located in typical places, a fourth, longer incision (about 3-4 cm) is made below the knee – this is necessary to collect the tendons for transplantation.

When preparing the graft for reconstruction, the doctor assesses the joint, treats other injuries (for example, meniscus damage) and prepares the site for a new ligament – removes the remains of damaged PCL and carefully plans the location of the graft.

Then, using arthroscopic portals and the site after the tendon collection, the doctor drills canals in the femur and tibia and places the previously prepared graft in the appropriate position. After fixing the graft and controlling its function, the wounds are sutured, drains are placed and a sterile dressing is applied. A joint orthosis is usually put on already in the operating theater.

Postoperative period

In most cases, the day after surgery, the drains are removed and the patient gets out of bed with the help of elbow crutches. The operated limb is held in an orthosis. If everything is fine, the patient is discharged from the hospital. Rehabilitation should begin as soon as possible, because it is relevant after the reconstructive surgery. The therpay should start within 5 days of the procedure.

In the Szpital Zakonu Bonifratrów, reconstructions of the cruciate ligaments are performed by a team of specialists in orthopedics and traumatology:

Stanisław Szymanik, MD – Head of the Diagnostic and Treatment Department

Michał Latos, MD

Michał Starmach, MD

REHABILITATION

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ARTHROSCOPY OF THE ANKLE

Introduction

Arthroscopy is a “keyhole” surgery. An instrument set containing a miniature video camera (arthroscope) is inserted into the joint along with other miniature tools to repair the damage. This allows a surgeon to accurately assess the problem and repair it in a single operation. Arthroscopic procedures of the ankle usually require a one-day stay in the hospital. Anaesthesia can be general or nerve block – depending on an anaesthesiologist. In order to introduce operating instruments into the joint, small skin incisions are made around the joint. After inserting the instruments, the joint is filled with sterile saline solution, under the control of a precise pump. After repair (reconstruction) of intra-articular damage, sutures are placed and a dressing is applied. In reconstruction of joint instability, the use of an ankle stabilizer is required. The next day, the patient is discharged home with the recommendations on check-ups, rehabilitation and the need to walk with elbow crutches.

Causes

The most common reasons for arthroscopy of the ankle are conflicts within the soft tissues of the anterior and posterior ankle joint compartment, cartilage and bone injuries of the ankle, free bodies, ankle fractures, arthrodesis (stiffening) of the ankle joint, ankle instability, infectious inflammation of the ankle joint and arthrofibrosis.

Symptoms

Typical symptoms of ankle injuries are pain (especially during sports activity), swelling, limited mobility of the joint, instability, clicking and local temperature increase.

Diagnosis

During the preoperative consultation, the doctor takes medical history (information on the condition, previous treatment) and performs a clinical examination, including specialized tests to determine the cause of ailments. The next step is to perform X-ray imaging, computed tomography and high-field magnetic resonance, which is currently the most common examination. All these diagnostic elements together allow for precise diagnosis.

Treatment

Arthroscopic procedures of the anterior and posterior ankle joint compartment allow for resection (excision) of massive fibrosis, hypertrophied synovium, removal of interposing chondro-osseous outgrowths on the tibia and talus, removal of free bodies, and repair of articular surface defects, in particular osteochondral necrosis (OCD) of the talus. Arthroscopic stiffening, or arthrodesis of the joint is performed in severe degenerative changes. Under arthroscopy, intra-articular fractures are connected in the area of the ankle, the cartilage surfaces are precisely reconstructed. In joint instability, especially in sport-active patients, ligament reconstructions are carried out. Arthroscopy of the ankle is also carried out in infectious cases.

Postoperative period

The patient spends the day after the surgery in the hospital. The next day, after changing the dressing, removing drains from the joint, control of sensation and blood supply to the operated limb, the patient is verticalized and taught to walk with crutches under the supervision of a physiotherapist. Next, the patient receives recommendations on further management and receipt of medical records, and leaves the hospital. Further treatment-check-ups at the attending doctor and rehabilitation consultations take place on an outpatient basis.

In the Szpital Zakonu Bonifratrów, arthroscopy of the ankle is performed by a team of specialists in orthopaedics and traumatology:

Stanisław Szymanik, MD – Head of the Diagnostic and Treatment Department

Michał Latos, MD

Michał Starmach, MD

REHABILITATION

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ARTHROSCOPIC RECONSTRUCTION OF THE ANTERIOR CRUCIATE LIGAMENT (ACL)

Introduction

An injury of the anterior cruciate ligament (ACL) is a common trauma, especially in active people who often do sports. Most cases are eligible for surgery. There are many ways to perform the operation. One of them is to collect the tendons of the gracilis and semitendinosus muscles from the patient and use them to reconstruct the ACL. With proper preparation of the graft, its durability is as high as that of a healthy ACL. The ligaments connect bones to each other. The ligament located in the knee joint starts at the thigh and ends at the tibia. Medially, slightly to the back of the thigh, there are muscles, the tendons of which are taken for the graft – gracilis and semitendinosus. Their points of insertion are located below the knee, on the tibia. The function of the muscles is to bend the limb at the knee.

Causes

Sports trauma is the most common cause of anterior cruciate ligament damage. Sports in which there is a sudden change in the direction of movement dominate, e.g. football and skiing.

Symptoms

An injury of the cruciate ligament causes joint instability. In the acute phase, there is also swelling and pain, often with the limited mobility. The symptoms are significantly influenced by the condition of the remaining articular structures – menisci, cartilage and other ligaments, often also damaged during an injury.

Diagnosis

The initial diagnosis is often made after taking medical history and performing a clinical examination, it is confirmed by a diagnostic examination – magnetic resonance imaging of the knee.

Treatment

In most cases, the treatment is surgical. The main goal of the operation is to restore the ACL function, i.e. to prevent excessive shifting of the tibia forward in relation to the femur – improving the stability of the knee.

Type of operation

The operation is performed by arthroscopy. In addition to two arthroscopic portals done in typical places, a third, longer (about 3-4 cm) incision is made below the knee – this is necessary to collect the tendons for transplantation. When preparing the graft for reconstruction, the doctor assesses the joint, treats other injuries (for example, meniscus damage) and prepares the site for a new ligament – removes the remains of damaged ACL, and carefully plans the location of the graft. Then, using arthroscopic portals and the site after tendon collection, the doctor drills canals in the femur and tibia and places the previously prepared graft in the appropriate position. After fixing the graft and controlling its function, the wounds are sutured, the drains are placed and a sterile dressing is applied. Usually, in the operating theater, a joint orthosis is put on.

Postoperative period

In most cases, the day after surgery, drains are removed and the patient gets out of bed with the help of elbow crutches. The operated limb is held in an orthosis. If everything is fine, the patient is discharged from the hospital. Rehabilitation should begin as soon as possible. Rehabilitation after reconstructive surgery is crucial. It should start within 5 days of the procedure.

In the Szpital Zakonu Bonifratrów, reconstructions of the cruciate ligaments are performed by a team of specialists in orthopedics and traumatology:

Stanisław Szymanik, MD – Head of the Diagnostic and Treatment Department

Michał Latos, MD

Michał Starmach, MD

REHABILITATION

czytaj więcej +

KNEE

ARTHROSCOPY OF THE KNEE JOINT
ARTHROSCOPIC RECONSTRUCTION OF THE ANTERIOR CRUCIATE LIGAMENT (ACL)
ARTHROSCOPIC RECONSTRUCTION OF THE POSTERIOR CRUCIATE LIGAMENT (PCL)
DAMAGE TO THE MENISCUS/CARTILAGE

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DAMAGE TO THE ACROMIOCLAVICULAR JOINT (AC)

Introduction

A shoulder dislocation is a fairly common injury, especially in certain sports. Most of the injuries are damage to the acromioclavicular joint (AC). The AC joint connects the shoulder blade and the collarbone. Shoulder dislocation and damage (dislocation) of the acromioclavicular joint are often confused with each other. These are completely different injuries. This guide will help you understand: what is the acromioclavicular joint (AC)? What happens when the joint is damaged (dislocated)? How is the AC joint damage treated?

Anatomy

How is the AC joint built and what is its function? The shoulder joint consists of three bones: scapula, humerus and collarbone. The part of the shoulder blade that forms the vault of the joint is called the acromion. The AC joint is the junction between the acromion and collarbone. The ligaments stabilize the connection. The ligaments are bands of the soft tissue that connect the bones. The acromioclavicular ligaments surround and stabilize the AC joint, forming the articular capsule. It is a waterproof bag that surrounds the joint, it is filled with joint fluid. Two other ligaments, the coracoclavicular ligaments, stabilize the collarbone by attaching to the coracoid process of the scapula. Damage to the AC joint can be mild to severe, depending on which ligaments have been stretched or torn. The mildest type of an injury is a minor damage (strain) of the acromioclavicular ligaments. It is the first degree injury, while the second degree injury is damage to the AC ligaments and the coracoclavicular ligaments. Complete rupture of the AC ligaments and the coracoclavicular ligaments is the third degree injury with a positive “piano key sign”.

Causes

How does the AC joint damage occur?

The most common cause of AC joint damage is a fall on the shoulder. When the limb hits the ground, the force of the impact moves the blade downwards. Because the collarbone is attached to the chest, it cannot move enough to follow the movement of the shoulder blade. As a result – the ligaments stabilizing the AC joint are damaged, displacing the collarbone.

Symptoms

The symptoms range from mild to severe pain of the AC joint in the event of complete dislocation. The second and third degree injury may cause swelling and bruising. In the third degree injury, the patient can experience the feeling of loose collarbone displacement (‘piano key sign’) and deformation of the AC joint.

Diagnosis

What examinations will be performed?

Your doctor will need to obtain the information about an injury and take detailed medical history. You will be asked questions about recent shoulder injuries. You will have to assess pain on a scale from one to ten. Diagnosis is usually preceded by a physical examination. The doctor can move the shoulder. It can be painful, but it is very important that your doctor finds the exact location of pain and identifies movements triggering pain. The doctor may order an X-ray to visualize damage to the joint and exclude collarbone fracture. Occasionally, an X-ray with loading of both hands is performed in order to confirm instability.

Treatment (What are treatment options?)

NON-SURGICAL TREATMENT

Treatment of the first and second degree injury is usually analgesic with a short period of rest using a sling. The rehabilitation program is prepared by a physiotherapist. Treatment of the third degree AC injury is somewhat controversial. Many studies have shown no difference between surgical and conservative treatment. Even with surgery, there is a possibility of persistent deformity of the area of an injury. A large proportion of patients after operation need another, additional surgery.

Research has revealed the condition of the AC joint after an injury. Many patients, regardless of whether they have undergone surgery or non-surgical treatment, will require surgery in the future. This is due to the fact that a damaged joint degenerates faster than an intact joint. It becomes deformed and painful over time. The process may take several years, but sometimes even one to two years.

SURGICAL TREATMENT

Some surgeons prefer to operate third degree AC joint injuries, especially in competitive hammer/discus/javelin athletes. Surgery is usually done through an incision over the AC joint. A surgeon sets the articular structures in the correct position (reposition). A screw or other type of fixation is used to stabilize the collarbone during the process of biological healing of the ligaments. Stabilization of the AC joint with a screw is based on joining the shoulder end of the collarbone with the coracoid process of the scapula. Some operators use tape to fix the clavicle with the coracoid process. Small holes are made in the collarbone and the coracoid process, tape is threaded through the structures and fixed, in some cases, ligaments are also repaired. If a screw is used, it is usually removed six to eight weeks after surgery.

In the Szpital Zakonu Bonifratrów, arthroscopy of the shoulder is performed by a team of specialists in orthopedics and traumatology:

Stanisław Szymanik, MD – Head of the Diagnostic and Treatment Department

Michał Latos, MD

Michał Starmach, MD

REHABILITATION

czytaj więcej +

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