We can help you recover from injuries faster and at the same time help prevent re-injury whether you are a professional athlete or a active person.

Common injuries treated

  • Meniscal injuries in the knee
  • Anterior Cruciate Ligament reconstruction
  • Posterior Cruciate Ligament reconstruction
  • MPFL reconstruction and Patellar realignment for instability
  • Use of Orthobiologics like PRP (Platelet-rich plasma) chronic tendinopathy pain and early arthritis
  • Shoulder Rotator cuff repair
  • Shoulder surgery for instability/ recurrent dislocation/ Bankart lesion
  • Shoulder pain from impingement

Anterior Cruciate Ligament Injuries

One of the most common knee injuries is an anterior cruciate ligament sprain or tear. If you have injured your anterior cruciate ligament, you may require surgery to regain full function of your knee. This will depend on several factors, such as the severity of your injury and your activity level.

Anatomy

Three bones meet to form your knee joint: your thighbone (femur), shinbone (tibia), and kneecap (patella). Your kneecap sits in front of the joint to provide some protection. Bones are connected to other bones by ligaments. There are four primary ligaments in your knee. They act like strong ropes to hold the bones together and keep your knee stable.

Collateral Ligaments

These are found on the sides of your knee. The medial collateral ligament is on the inside and the lateral collateral ligament is on the outside. They control the sideways motion of your knee and brace it against unusual movement.

Cruciate Ligaments

These are found inside your knee joint. They cross each other to form an "X" with the anterior cruciate ligament in front and the posterior cruciate ligament in back. The cruciate ligaments control the back and forth motion of your knee. The anterior cruciate ligament runs diagonally in the middle of the knee. It prevents the tibia from sliding out in front of the femur, as well as provides rotational stability to the knee.

Description

About half of all injuries to the anterior cruciate ligament occur along with damage to other structures in the knee, such as articular cartilage, meniscus, or other ligaments.Injured ligaments are considered "sprains" and are graded on a severity scale.

  • Grade 1 Sprains. The ligament is mildly damaged in a Grade 1 Sprain. It has been slightly stretched, but is still able to help keep the knee joint stable.
  • Grade 2 Sprains. A Grade 2 Sprain stretches the ligament to the point where it becomes loose. This is often referred to as a partial tear of the ligament.
  • Grade 3 Sprains. This type of sprain is most commonly referred to as a complete tear of the ligament. The ligament has been split into two pieces, and the knee joint is unstable.

Partial tears of the anterior cruciate ligament are rare; most ACL injuries

are complete or near complete tears.

Cause

The anterior cruciate ligament can be injured in several ways:

  • Changing direction rapidly
  • Stopping suddenly
  • Slowing down while running
  • Landing from a jump incorrectly
  • Direct contact or collision, such as a football tackle

Several studies have shown that female athletes have a higher incidence of ACL injury than male athletes in certain sports. It has been proposed that this is due to differences in physical conditioning, muscular strength, and neuromuscular control. Other suggested causes include differences in pelvis and lower extremity (leg) alignment, increased looseness in ligaments, and the effects of Oestrogen on ligament properties.

Symptoms

When you injure your anterior cruciate ligament, you might hear a "popping" noise and you may feel your knee give out from under you. Other typical symptoms include:

  • Pain with swelling. Within 24 hours, your knee will swell. If ignored, the swelling and pain may resolve on its own. However, if you attempt to return to sports, your knee will probably be unstable and you risk causing further damage to the cushioning cartilage (meniscus) of your knee.
  • Loss of full range of motion
  • Tenderness along the joint line
  • Discomfort while walking

Doctor Examination

Physical Examination and Patient History

During your first visit, your doctor will talk to you about your symptoms and medical history. During the physical examination, your doctor will check all the structures of your injured knee, and compare them to your non-injured knee. Most ligament injuries can be diagnosed with a thorough physical examination of the knee.

Imaging Tests

Other tests which may help your doctor confirm your diagnosis include:

X-rays

Although they will not show any injury to your anterior cruciate ligament, x-rays can show whether the injury is associated with a broken bone.

Magnetic resonance imaging (MRI) scan

This study creates better images of soft tissues like the anterior cruciate ligament. However, an MRI is usually not required to make the diagnosis of a torn ACL.

Treatment

Treatment for an ACL tear will vary depending upon the patient's individual needs. For example, the young athlete involved in agility sports will most likely require surgery to safely return to sports. The less active, usually older, individual may be able to return to a quieter lifestyle without surgery.

Nonsurgical Treatment

A torn ACL will not heal without surgery. But nonsurgical treatment may be effective for patients who are elderly or have a very low activity level. If the overall stability of the knee is intact, your doctor may recommend simple, nonsurgical options.

Bracing

Your doctor may recommend a brace to protect your knee from instability. To further protect your knee, you may be given crutches to keep you from putting weight on your leg.

Physical therapy

As the swelling goes down, a careful rehabilitation program is started. Specific exercises will restore function to your knee and strengthen the leg muscles that support it.

Surgical Treatment

Rebuilding the ligament.

Most ACL tears cannot be sutured (stitched) back together. To surgically repair the ACL and restore knee stability, the ligament must be reconstructed. Your doctor will replace your torn ligament with a tissue graft. This graft acts as a scaffolding for a new ligament to grow on. Grafts can be obtained from several sources. Often they are taken from the patellar tendon, which runs between the kneecap and the shinbone. Hamstring tendons at the back of the thigh are a common source of grafts. Sometimes a quadriceps tendon, which runs from the kneecap into the thigh, is used. Finally, cadaver graft (allograft) can be used. There are advantages and disadvantages to all graft sources. You should discuss graft choices with your own orthopaedic surgeon to help determine which is best for you. Because the regrowth takes time, it may be six months or more before an athlete can return to sports after surgery.

Unless ACL reconstruction is treatment for a combined ligament injury, it is usually not done right away. This delay gives the inflammation a chance to resolve, and allows a return of motion before surgery. Performing an ACL reconstruction too early greatly increases the risk of arthrofibrosis, or scar forming in the joint, which would risk a loss of knee motion.

Rehabilitation

Whether your treatment involves surgery or not, rehabilitation plays a vital role in getting you back to your daily activities. A physical therapy program will help you regain knee strength and motion.

If you have surgery, physical therapy first focuses on returning motion to the joint and surrounding muscles. This is followed by a strengthening program designed to protect the new ligament. This strengthening gradually increases the stress across the ligament. The final phase of rehabilitation is aimed at a functional return tailored for the athlete's sport

Platelet - rich plasma (PRP) Therapy

What is PRP or Platelet Rich Therapy?

Platelet-rich plasma (PRP), is a natural component extracted from one's own blood. Platelets are cells within the blood stream that control the role of healing and scar tissue formation following an injury. They are full of growth factors and cytokines which play a crucial role in joint homeostasis and healing. PRP therapy is emerging as a major player in regenerative therapy for tissue injury.

How is Platelet Rich Plasma Prepared?

Blood is first drawn from a patient with a syringe using sterile technique and then centrifuged (spun) and separated out into three layers. The bottom layer is made up of red blood cells , the middle layer consists of platelets and white blood cells and the top layer is plasma.

The total volume of platelet rich plasma that is collected is approximately 5 milliliters or one teaspoon. Once it is prepared it is stable for up to eight hours, however once it is “activated” it must be used within ten minutes. The PRP is then delivered directly to the area of injury.

What is PRP Used For?

PRP is highly effective in muscle and tendon injuries in the fields of orthopaedics and sports medicine. It is used for injuries of tendons, muscles and ligaments. PRP has been proven to be effective in aiding the healing of tendon tissue, articular cartilage (the material that lines the joint surface) defects and significantly reduce pain and improve function in the conditions mentioned below, however nothing in the world as yet can restore articular cartilage once the damage is too far gone. In severe arthritis PRP can however significantly minimise pain, improve function and allow people to exercise, and reduce their reliance on daily medications and quite harmful continuous NSAID anti-inflammatory use, and through this combined effect protect the joint surface that remains. It's effect for pain relief in arthritis can last 12 months

Common injuries that can be treated with PRP include

  • Tennis elbow (Lateral Epicondylitis)
  • Achilles tendonitis
  • Plantar Fascitis, Patellar Tendonitis
  • Rotator cuff injuries
  • Osteoarthritis

Based on the injury and location, several PRP treatments may be needed and may be as frequent as once a week as the full effect of PRP takes up to seven days. Since the platelet rich plasma promotes inflammation, there will be moderate discomfort after the treatment, yet this will subside with time and acetaminophen (Paracetamol) may be used for pain control.

Bibliography

  • Chang KV, Hung CY, Aliwarga F, Wang TG, Han DS, Chen WS. Comparative effectiveness of platelet-rich plasma injections for treating knee joint cartilage degenerative pathology: a systematic review and meta-analysis. Arch Phys Med Rehabil. 2014 Mar;95(3):562-75.
  • Krogh TP, Bartels EM, Ellingsen T, Stengaard-Pedersen K, Buchbinder R, Fredberg U, Bliddal H, Christensen R. Comparative effectiveness of injection therapies in lateral epicondylitis: a systematic review and network meta-analysis of randomized controlled trials. Am J Sports Med. 2013 Jun;41(6):1435-46.
  • Vetrano M, Castorina A, Vulpiani MC, Baldini R, Pavan A, Ferretti A. Platelet-rich plasma versus focused shock waves in the treatment of jumper's knee in athletes. Am J Sports Med. 2013 Apr;41(4):795-803. Epub 2013 Feb 13.
  • Wetzel RJ, Patel RM, Terry MA. Platelet-rich plasma as an effective treatment for proximal hamstring injuries. Orthopedics. 2013 Jan;36(1):e64-70.
  • Mautner K, Colberg RE, Malanga G, Borg-Stein JP, Harmon KG, Dharamsi AS, Chu S, Homer P. Outcomes after ultrasound-guided platelet-rich plasma injections for chronic tendinopathy: a multicenter, retrospective review. PM R. 2013 Mar;5(3):169-75.
  • Mautner K, Colberg RE, Malanga G, Borg-Stein JP, Harmon KG, Dharamsi AS, Chu S, Homer P. Outcomes after ultrasound-guided platelet-rich plasma injections for chronic tendinopathy: a multicenter, retrospective review. PM R. 2013 Mar;5(3):169-75.