Arthroscopy
Common Disorders we treat
- ACL Injury
- Meniscus Injuries
- PCL Injury
- Multi ligament injury
- Articular Cartilage lesions
- Patellar Instability
Services we offer
- ACL reconstruction
- Revision ACL reconstruction
- Meniscus surgery
- PCL Reconstruction
- Multi-ligament Reconstruction
- Cartilage restoration
- Patella (MPFL) Realignment
- Tibial/ Femoral Osteotomy
- Arthroscopic Loose Body Removal
ACL Injury
Anterior Cruciate Ligament
The ACL (anterior cruciate ligament) is a vital soft tissue structure within the knee joint that stabilizes the knee by connecting the thigh bone (femur) to the shin bone (tibia). ACL injuries commonly occur due to twisting movements during sports or from direct impact and falls.
A completely torn ACL cannot heal on its own and typically requires keyhole surgery (arthroscopy), performed through small incisions using fiber optics and specialized instruments. Partial ACL tears, on the other hand, may heal over time. However, some patients with partial tears may continue to experience knee instability, in which case surgical treatment may still be necessary.
Meniscus Injuries
The meniscus is a pad of fibrocartilage that cushions the knee joint. It acts as a shock absorber between the bones, protecting the articular cartilage from excessive stress. Without a healthy meniscus, the cartilage is exposed to greater pressure, which can accelerate wear and lead to osteoarthritis.
Meniscus injuries are common, particularly in athletes. A sudden twist, sharp turn, or direct impact can cause a tear. The primary symptom is knee pain, often felt along the side of the joint. Initial treatment for acute injuries usually includes rest, ice application, medications, and physical therapy. However, if the injury is severe or conservative measures fail to provide relief, surgical intervention may be required.
PCL Injury
The posterior cruciate ligament (PCL) is located at the back of the knee joint and serves as the primary stabilizer, controlling how far the tibia can move backward beneath the femur. If the tibia shifts too far back, the PCL may rupture.
PCL injuries most often occur from a direct impact to the front of the knee while it is bent. Symptoms can vary, but many patients experience a sense of instability or the knee “giving way,” especially during sudden changes in direction.
Milder PCL tears are generally managed with a structured rehabilitation program. If the injury involves only the PCL, nonsurgical treatment is often sufficient. However, when additional knee structures are damaged, surgery within the first few weeks after injury is usually recommended for better outcomes.
Multi ligament injury
The knee’s stability primarily depends on four major ligaments: the ACL, PCL, MCL, and LCL. These ligaments maintain normal tension, preventing abnormal movements within the joint. When two or more of these ligaments are damaged, the condition is referred to as a multi-ligamentous injury.
Such injuries usually result from high-velocity trauma, such as road traffic accidents. The standard treatment for multi-ligament injuries is surgical reconstruction.
Articular Cartilage lesions
An articular cartilage injury occurs when the smooth, white cartilage that covers the ends of bones at the joints becomes damaged. This cartilage is essential for pain-free movement, as it cushions the bones and allows them to glide smoothly against each other. When injured, it can lead to pain, stiffness, and reduced range of motion.
The treatment approach depends on the severity of the injury and the joint involved. In some cases, small holes may be drilled into the bone beneath the cartilage to improve blood flow and promote healing. In other situations, torn or damaged cartilage may be removed, or cartilage may be replaced using grafting techniques. For severe damage, replacing the entire joint may be necessary.
Patellar Instability
The kneecap (patella) rests in a groove at the lower end of the thighbone (femur). A patellar dislocation occurs when the patella slips completely out of this groove.
Such a dislocation often results in a tear of the medial patellofemoral ligament (MPFL), which normally holds the kneecap in the center of the knee. When the MPFL is deficient, even minor trauma can cause the kneecap to dislocate again. Other contributing factors include altered limb alignment, trochlear dysplasia (a shallow groove beneath the patella), and patella alta (a higher-than-normal position of the kneecap).
Most first-time patellar dislocations are managed non-surgically with a structured rehabilitation program. However, for patients with recurrent dislocations, surgery is usually recommended to restore stability and keep the kneecap properly centered.
Services we offer
- ACL reconstruction
- Revision ACL reconstruction
- Meniscus surgery
- PCL Reconstruction
- Multi-ligament Reconstruction
- Cartilage restoration
- Patella (MPFL) Realignment
- Tibial/ Femoral Osteotomy
- Arthroscopic Loose Body Removal
ACL reconstruction
ACL reconstruction surgery is performed through keyhole techniques (arthroscopy) using small incisions, fiber optics, and specialized instruments. In this procedure, the torn ligament is replaced with a tissue graft that functions like the natural ACL. Typically, a portion of the patient’s own tendon—such as the patellar, hamstring, or quadriceps tendon—is used to create the new ligament.
Small tunnels are drilled into the tibia and femur, through which the graft is passed and fixed securely with screws, buttons, staples, or sutures. This technique restores knee stability and allows patients to return to normal activities.
Revision ACL reconstruction
Revision ACL reconstruction is a second surgery performed to replace a failed or deficient ACL graft. It is generally more complex and technically demanding than a primary ACL reconstruction.
This procedure is recommended for patients who continue to experience knee instability despite undergoing focused rehabilitation and physiotherapy. In some cases, a two-stage revision may be necessary. The first stage involves bone grafting to fill the tunnels created during the previous surgery. Once the bone heals, the second stage is performed to reconstruct the ACL using grafts such as the patellar tendon, quadriceps tendon, hamstring tendon, peroneus longus tendon, or a tendon from the opposite knee.
Meniscus surgery
The meniscus is treated arthroscopically through small key-hole incisions using an arthroscope, a thin instrument equipped with a light and video camera that allows the surgeon to see inside the knee.
Two types of Meniscus Surgery:
- Meniscus Repair – The Torn meniscus portions are stitched together using special instruments and meniscus is allowed to heal.
- Partial Meniscectomy – The damaged meniscal tissue is trimmed and removed leaving the healthy meniscus in place.
Recovery after the Meniscus Surgery
- The recovery time depends on the type of surgery performed.
- Full recovery from Meniscus repair takes between six weeks to twelve weeks.
- After Partial Meniscectomy, the recovery is much quicker.
PCL Reconstruction
In this Surgery, torn PCL ligament is replaced using a piece of tendon or ligament (autograft). The surgery is performed through key hole incisions (Arthroscopy).
Multi-ligament Reconstruction
Multi-ligament injuries always require surgical intervention, which may involve arthroscopic and open ligament reconstruction. The reconstruction typically uses autografts, which are tissues taken from the patient’s own knee, either the same or the opposite knee.
Before surgery, a waiting period of 10–14 days is usually needed to allow soft tissue swelling to subside. Depending on the severity of the injury, the surgery may be performed in a single stage or in two stages.
Cartilage Restoration
Small cartilage defects, typically less than 2 cm, have the best prognosis. These are often treated arthroscopically using a technique called microfracture, where tiny holes are created in the bone to stimulate healing. This encourages marrow cells to produce new cartilage at the defect site, closely resembling the native cartilage.
For slightly larger defects, cartilage may be transplanted from other areas of the knee using a procedure called mosaicplasty or Osteochondral Autograft Transfer System (OATS).
In the case of very large defects, a two-stage procedure called Autologous Chondrocyte Implantation (ACI) is usually required. In the first stage, cartilage cells are harvested from the patient and cultured in a lab. These cultured cells are then implanted at the defect site about three weeks later to restore the joint surface.
Patella (MPFL) Realignment
Patellar instability surgery typically involves several steps. First, the medial patellofemoral ligament (MPFL) is reconstructed using an autograft, performed arthroscopically through small keyhole incisions. Next, tight tissues on the outer side of the knee may be released to improve alignment. In some cases, the attachment point of the patellar tendon on the shin bone is repositioned in a procedure called a tibial tubercle transfer to further stabilize the kneecap.
Tibial Osteotomy
The procedure involves making a cut in the upper part of the tibia (osteotomy). Once the bone is cut, the two sides are separated to create a wedge-shaped opening, which is then filled with a bone graft. The bone is stabilized using specialized plates. This technique realigns the lower leg, redistributing weight onto the healthier side of the knee joint to reduce stress on the damaged area.