Arthroscopic Arthrofibrosis Release of a patient with PVNS
This patient presents with a tumor like condition called Pigmented Villonodular Synovitis. She had a scarred posterior capsule from her PVNS and could not get her knee straight (0 degrees). In fact her motion was only 15 - 125 degrees and the motion she did have was painful. Failure to address the posterior aspect of the knee is the most common reason for recurrence of symptoms and failure to obtain full extension. Dr Shepard routinely works in the posterior aspect of the knee during Knee Arthroscopies and Ligament reconstructions.
Picture 1 demonstrates the grape like tumors behind her Posterior Cruciate Ligament and posterior to the Medial Femoral Condyle. Pictures a 2 and 3 demonstrate the resection of the tumors and the release of the posterior capsule. This release must be done with great care as the neuro-vascular structures lie in the immediate proximity. In picture 3, you can see the tendon of the gastrocnemius (calf muscle) indicative of a successful release.
Gross Pictures 4 and 5 demonstrate that extension is now 0 degrees (fully straight) and flexion is to 135 degrees. This range of motion equals the patient's opposite knee and feels normal to her.
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Arthroscopic Arthrofibrosis Release of a Total Knee Replacement
Sometimes, a total knee replacement can get stiff or lose range of motion; this is called arthrofibrosis ( arthro – joint, fibrosis – stiff or contracted). If the motion falls below ninety degrees even simple tasks such as sitting, manuevering stairs, and driving can be very difficult and can result in increased knee, hip, and back pain. In an arthroscopic release, Dr Shepard makes several small poke holes in the knee and releases the scar tissue to restore motion. Arthroscopic release is less painful, less invasive, and often times more successful than traditional manipulation under anesthesia or revision knee replacement.
This patient had a knee that only bent from 20 degrees to 80 degrees (Picture 1). Zero degrees would show a knee fully straight and ninety degrees would be a knee bent at a right angle. Arthroscopic Pictures 2 and 3 show scar tissue growing between the polyethylene plastic and the metal knee components. Pictures 4 and 5 show the removal of the scar with an arthroscopic shaver. The video shows the removal of scar tissue from the knee replacement.
Finally, the gross pictures show the knee is now full straight (Picture 6) and flexes to 125 degrees (gross picture 7). The patients knee motion went from 20-80 preoperatively to 0-125 postoperatively.
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What is Knee Ligament Reconstruction?
Knee ligament reconstruction involves the replacement of a torn ligament with a graft that will reproduce the function. Certain ligaments in the knee, like the PCL and MCL, have some ability to heal on their own and may be repaired. Other ligaments, like the LCL and ACL, have very limited healing capabilities and most likely will need to be reconstructed with drill holes and a new piece of tissue (graft). In knee ligament reconstruction, the grafts most likely used are patellar tendon grafts, hamstring grafts, or Achilles grafts. These grafts can be autografts or allografts. Autografts are tissues taken from the patients body. Allografts are tissue taken from a cadaver (dead person). Dr Shepard learned ACL reconstruction during his fellowship with William Clancy MD – the father of modern ACL reconstruction techniques. ACL reconstruction is one of the most common procedures Dr Shepard performs. Each year he performs about 100 knee ligament reconstructions.
Which graft / surgery is right for me?
Not every patient is the same and not every knee injury is the same. Each knee injury and each possible surgery is evaluated on an individual basis. Dr Shepard enjoys spending time with each patient weighing the risks and benefits of all the surgery options with each patient. With each knee reconstruction comes a consideration of graft type, surgery type, anesthesia, pain control, number of tunnels, time off of work / school, time off of sport, and a rehabilitation timeline. Only with a thorough understanding of the risks and benefits of the different surgical techniques can we find the right surgery for you.
ACL with Patellar Tendon Autograft - 5 years after surgery in a Division I NCAA athlete
This patient is a 38 year old female who was hit by a car 3 years ago and suffered tears of her ACL, PCL, and MCL. Her initial reconstruction consisted of a MCL reconstruction with an Achilles Allograft and a PCL reconstruction with an Achilles Allograft. Now that her multiple fractures and injuries have healed, she now seeks an ACL reconstruction for return to sports. Her PCL graft appears well incorporated and her knee is stable to posterior and valgus stresses.
PCL graft 4 years after surgery
This is a 35 year old female 4 years out from her PCL reconstruction. She had been hit by a car and underwent MCL and PCL reconstruction. The video shows the well incorporated PCL graft 4 years after surgery.
Normal Anatomy of the Knee Joint
How does the Knee joint work?
Find out more in this web based movie.
Arthroscopy of the knee joint.
Arthroscopy is a surgical procedure in which an arthroscope is inserted into a joint. Arthroscopy is a term that comes from two Greek words, arthro-, meaning joint, and -skopein, meaning to examine.
The benefits of arthroscopy involve smaller incisions, faster healing, a more rapid recovery, and less scarring. Arthroscopic surgical procedures are often performed on an outpatient basis and the patient is able to return home on the same day.
Find out more about Knee Arthroscopy from the following links.
Interactive Movie
Text version
Patient Info handout
Anterior Cruciate Ligament ACL reconstruction
The anterior cruciate ligament is one of the major stabilizing ligaments in the knee. It is a strong rope like structure located in the centre of the knee running from the femur to the tibia. When this ligament tears unfortunately it doesn't heal and often leads to the feeling of instability in the knee.
ACL reconstruction is a commonly performed surgical procedure and with recent advances in arthroscopic surgery can now be performed with minimal incisions and low complication rates.
