Important educational information for Mr Hardy's patients on Knee Injury, Sports Injury and Orthopaedics and Trauma. The following topics are about knee conditions. Click on the image for an
information brochure to print off...
Surgical
Marking for Arthroscopy
Mr
Hardy teaches many of his colleagues arthroscopy skills in a skills
lab in Germany. One of the most important skills that a surgeon must learn
in any busy practice is to mark the patient properly. To Mr Hardy this
means more than the WHO
Safe Surgery Saves Lives check list which he thinks every surgeon
should use. It means asking the patient where the knee pain is worst and
then marking this spot for a reference during the procedure. John
said that this You Tube clip was made by one of the Hospital Managers he
was about to operate on in 2008. John has just seen him again in 2010 and
he remains delighted with his surgery. John said: "Patients know
where the mechanical problems are in their knee so it makes sense on a
busy list to mark these indicated points up before day case surgery.
Invariably the patient is correct within a few millimeters and there is
something abnormal at the site indicated." John said: "I
undertake occasional revision arthroscopy on patients who have sought a
second opinion from me after they feel the first keyhole surgery had not
solved their problem. This is often when the surgeon has been too busy to
carefully assess each patient or when there is more than one problem in
the knee and the second or even third problems have been overlooked like
the intra-articular band in the You Tube clip below...
Intra-articular band
An intra-articular band of the knee is often easy for the patient to localise but rarely are there clinical signs of this painful condition. The MRI scan us usually normal. However, take a careful history in these
patients and the condition can be demonstrated and cured easily with day case keyhole surgery. Depending on its position
these bands is unlikely to cause arthritis. However, Mr Hardy has seen them cause synovial
chondromatosis as in the condition below...
Synovial Chondromatosis
Synovial chondromatosis is a benign condition in which there is a meatplastic transformation of the lining of a joint to produce nodules of
cartilage. It occurs most commonly in the knee, but also has been reported in other
joints. This condition probably arises from metaplasia of the Type
A synoviocytes which have a phagocytic function. The phagocytic
function of Type A synoviocytes confers a biomechanical advantage to
the joint.
Patella Tendonitis
Patellar
tendonitis is a common sport related injury. It is most common in jumping
sports. It is a painful degeneration of the patella tendon usually
involving microtearing of the collagen bundles of the patella tendon.
The pathology of the microtear is related to cyclic loading and possible
also to the relative ischaemia suffered by the tendon during activity in
which compressive
forces occur. It may occur at any location along the patellar tendon,
but the most commonly affected site is beneath the inferior pole of the
patella. When looked at beneath the microscope there is “mucoid”
degeneration of the tendon collagen.......
Knee Arthroscopy
Arthroscopy
of the knee is an operation on a joint which is done by a "keyhole"
technique. A narrow lens, on the back of which is a video camera, is
inserted into the joint to allow examination of the inside. By using
specially designed probes and instruments, the surgeon can also do some
treatments to the inside of the knee joint.
Why should it be done?
It would only be done if you have persistent symptoms from your knee such as pain, locking, swelling or giving way.
These symptoms are indicative of ongoing impingement and wear in the
knee.
Look at this video below of a lateral meniscal tear missed by an MRI
scan. There has been little wear and tear of the surface of the joint
from the hard gristle of the unstable meniscal tear as it was dealt with
promptly by keyhole surgery. Compare it to the video above where time
has elapsed between onset and treatment. It is easy to see why a
neglected or missed meniscal tear is the most common cause of
unicompartmental osteoarthritis.....
Arthroscopy of the
knee is usually done after an injury which is failing to settle at 6
weeks with conservative treatments such as RICE, knee
supports and physiotherapy and where
there is evidence of damage to the ligaments, cartilages, lining or surfaces of the
knee joint. If it is done for an injury, a MRI scan of the knee will be
done first to alert the surgeon to what may be found inside the joint
before the procedure so that he can properly advise on the
prognosis.......
Gout
Gout
is an inflammation of soft tissue caused by the deposition of monosodium
urate crystals in joints and soft tissues.
There are four phases of gout including: asymptomatic hyperuricemia,
acute gouty arthritis, intercritical gout and chronic tophaceous gout...
Aspiration & Injection
This
is a patient information sheet for patients who are going to receive an
aspiration and injection and for doctors who are going to give them. If
rest after injection is indicated do not forget a post
operative knee
brace......
