How Often Is A Second Surgery Required To Repair Knee Cartilage
Knee cartilage surgery
You have cartilage damage
You lot are going to undergo knee cartilage surgery
- Video
- Definition
- Operation
- Cartilage surgery
- Post-operative
- Risks and complications
- Results
Video presentation : Articulatio genus Cartilage Impairment
What is knee cartilage impairment ?
The knee is the joint between the bottom of the femur and the tiptop of the tibia. The joint surfaces are lined with a thin layer of cartilage 1 to two mm thick which allows the bones to glide smoothly over each other, reducing the friction and absorbing the pressure on the bone. The menisci are small C-shaped cushions between the cartilage of the femur and the tibia which ameliorate the contact and act equally daze absorbers. Ligaments are ribbons of varying elasticity which aid maintain the stability of the knee (figures i and two).
Cartilage damage can occur following a blow, recurrent minor traumas, or due to a growth imperfection. The damaged cartilage comes away from its natural position alone or with a small slice of underlying bone (figures 3 and 4). Information technology tin come away partially creating a flap, or completely leaving a fragment that can move around the joint. The expanse of damaged cartilage can vary in size and depth.
Cartilage damage can crusade hurting, locking, swelling and sometimes joint weakness, thus restricting walking and other activities. Ligament or meniscal harm can be associated with and participate in the symptomatology.
Why an operation ?
The capacity of cartilage to repair and regenerate itself is very limited. A cartilage defect does not repair itself spontaneously, a partially detached lesion does not heal itself and a free fragment tin get stuck between the joint, damage the salubrious cartilage and eventually atomic number 82 to its deterioration.
A small lesion can initially be treated medically. Surgery will be proposed in the example of a symptomatic flap or fragment, or a major cartilage defect. The objective of the functioning is to restore a uniform sliding surface to relieve the hurting, locking and swelling, and enable a return to normal walking and activities, thus preventing the progressive deterioration of the joint.
What is cartilage surgery ?
Cartilage surgery concerns localised lesions. Information technology aims to reattach or extract a partially or completely detached lesion. Information technology as well treats the zone of the defect past cartilage grafting or stimulating cartilage repair.
In the case of a deep, broad lesion in the form of an osteochondral flap or intra-articular fragment, reattachment can exist considered to enable healing. Afterwards repositioning the fragment in its original site, it is stock-still with a screw to enable the homogenous reconstruction of the cartilage surface (figure 5). In the case of a shallow lesion, the chances of healing are minimal. The lesion is excised and the edges are rectified (figure six).
If the cartilage defect is small and superficial, nix else is done.
In the instance of a more than extensive cartilage defect, two procedures are possible to repair the defect according to its position and extent :
- The microfracture technique consists in stimulating the blank bone using a pointed tool to create a rough surface (figure 7); this causes local haemorrhage and stimulates cartilage regeneration and repair (effigy viii).
- The mosaicplasty technique consists in replacing the defective zone with osteochondral grafts taken from the less weight-begetting periphery of the same articulatio genus. For that, one or several osteochondral plugs are harvested, generally around the periphery of the femur, using a special instrument (figure 9). The lacking bone is prepared to receive the graft. The osteochondral grafts are then inserted adjacent like a mosaic to recover a homogenous sliding surface (effigy 10).
Cartilage surgery is performed arthroscopically or an incision is made in the front end of the knee. Arthroscopy consists in making 2 small v-mm incisions in the front of the knee. An arthroscope, or small camera, is inserted through one of the incisions to view the joint, and in item the damaged cartilage. Small instruments are inserted through the other incision to carry out the surgery.
Arthroscopic surgery is often used for cartilage reattachment likewise as the microfracture technique. The operation lasts about half an 60 minutes and requires ane or ii days in hospital. The mosaicplasty technique often requires an incision in the front of the knee. The operation lasts about an hour and requires 3 or 4 days in infirmary.
The operation is carried out under regional or general amazement. Your anaesthesiologist will decide with yous the best type of amazement according to your country of health.
Afterwards the functioning, the incisions are covered with a sterile dressing, which is left in place for 10 days. The hurting volition be managed and monitored very closely during the postal service-operative menstruation, and the treatment will exist adjusted appropriately.
Post-operative rehabilitation and render to activities
Yous volition begin rehabilitation with your physiotherapist after the operation. The objective is to maintain knee joint flexibility and musculus mass.
In the case of a reattachment or mosaicplasty, you volition have crutches to help yous movement around for 6 weeks so equally not to put too much weight on the knee.
Driving as well as returning to work can be envisaged in the second month, depending on your profession; office work tin be sooner. You can more often than not resume gentle sports activities such as cycling and swimming afterward the tertiary month.
In the case of microfractures, the non weight-bearing period is three weeks. Driving equally well as returning to piece of work can be envisaged in the 1st month, depending on your profession; office work can be sooner. You can by and large return to gentle sports activities such as cycling and swimming after the 2nd month.
Whichever technique is used, information technology is necessary to wait 4 to 6 months before a full return to all sports activities.
What are the risks and complications ?
In addition to the risks associated with any surgery and the anaesthetic, there are some risks specific to this surgery :
- Joint stiffness can develop if the post-operative rehabilitation is non carried out properly.
- Exacerbated inflammatory reactions which sometimes represent to algodystrophy. However, new treatments be that tin can assistance manage this rare complication more hands.
- A haematoma may announced effectually the surface area operated on due to haemorrhage. According to the extent of the haemorrhage, drainage may exist necessary.
- The occurrence of an infection, although rare (risk below 1 % in our institution), is a serious complication and may require surgical revision and a course of antibiotics.
- Pocket-size blood clots tin class and block the veins in the legs resulting in phlebitis, which volition require an anti-coagulant treatment for several weeks.
- The mobilisation of a graft or the displacement of a fixed cartilage fragment can occur and require revision surgery.
This listing of risks is not exhaustive. Your surgeon can provide you with whatsoever additional explanations and volition be available to discuss the advantages, disadvantages and risks of each specific instance with you.
What is the expected event of the performance ?
Whichever procedure is performed, the locking, swelling and instability volition disappear rapidly later on the operation.
The healing of stock-still osteochondral fragments varies from 75 % to 90 %; post-traumatic lesions have a greater adventure of healing.
Regarding the microfracture technique, the comeback in cartilage function and status is about fourscore % in the case of an isolated cartilage lesion.
Regarding mosaicplasty, moderate discomfort around the harvesting site is observed in about xv % of cases. Notwithstanding, the results remain very encouraging equally good results are obtained in most 90 % of cases when located on the femur, 85 % of cases when located on the tibia and fourscore % for the patella.
How Often Is A Second Surgery Required To Repair Knee Cartilage,
Source: https://www.orthopaedic-surgery-paris.com/the-surgeries/knee-surgery/knee-cartilage-surgery/
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