Procedures Offered

George Tselentakis Carries Out A Wide Variety Of Knee Surgery Procedures

Cartlidage Lesions Repair

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Computer Assisted Surgery

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Arthroscopy

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Arthroscopic Menisectomy

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Arthroscopic Lateral Release

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Microfracture

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Chondroplasty

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Total Knee Replacement

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Unicompartmental Knee Replacement

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ACL Reconstruction

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PLC Reconstruction

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MPFL (Medial Patellofemoral Ligament) Reconstruction

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Medial Collateral Ligament

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Multiple Ligament Reconstruction

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ACI (Autologous Chondrocyte Reimplantation) Osteotomies

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Osteochondritis Dissecans (OCD)

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Meniscal Tear

Menisci are semicircular cartilages present in the knee.  They are interposed between the femur and tibia (bones of the leg forming the knee joint); one on the inner aspect and one on the outer.

The menisci have a very important function in the knee. They help to evenly distribute the pressures on the knee.They act as shock-absorbers. They help in stabilizing the knee and also have a minor role in helping nourishment of the knee cartilage.

Meniscal tears can either result due to sporting injuries or due to wear and tear in the menisci which make them soft. Meniscal tears cause pain and clicking in the knee. They can also cause mild instability and if severe can cause to knee to be locked.

The tears are assessed by thorough clinical examination utilizing special tests. MRI scanning confirms the diagnosis and further delineates the severity of the tear.  In certain cases with very high index of clinical suspicion, arthroscopy is resorted to for both diagnosis and treatment.

Some of the meniscal tears are amenable to non surgical treatment and resolve with physiotherapy and activity modification. If the tears are complex, they require surgical intervention in the form of arthroscopy (Keyhole surgery). They are treated by either repairing the meniscus or resecting the torn edges (partial menisectomy). If a repair is carried out the patient may have restrictions on weight bearing. The surgery is followed by a brief outpatient physiotherapy.

Meniscal Cysts

These form as a result of exudation of synovial fluid into tears of the meniscus, usually seen in degenerative tears. Treatment is aimed at management of the tears and achieved athroscopically. Rarely the cysts may be large and may require open surgery for complete resolution.

Articular Cartlidge Lesions

Articular cartilage is the tough smooth tissue which covers the ends of bones forming joints. Due to the smoothness and the presence of joint fluid (synovial fluid) they provide an almost frictionless movement at the joint surface. This helps to reduce the effort needed to move the joint.

The cartilage can be damaged due to trauma and sporting injuries. It can also be damaged due to a selective wear and tear process. In children the cartilage lesion can occur secondary to a minor trauma due to condition called osteochondritis dessicans (literally meaning ‘drying up of the cartilage’).

The cartilage can be damaged due to trauma and sporting injuries. It can also be damaged due to a selective wear and tear process. In children the cartilage lesion can occur secondary to a minor trauma due to condition called osteochondritis dessicans (literally meaning ‘drying up of the cartilage’).

The assessment includes examination followed by further MRI imaging. Quite often arthroscopy is required to precisely diagnose the severity of damage.

These are difficult problems to treat and there are multiple treatment methods which are still relatively recent. They can all be grouped together as cartilage regeneration procedures.

These are difficult problems to treat and there are multiple treatment methods which are still relatively recent. They can all be grouped together as cartilage regeneration procedures.

Cruciate Ligament Injury

There are two cruciate ligaments in the knee. The anterior running from the front of the knee to the back; and the posterior cruciate running from back to front. They appear to be crossing each other when seen from the front, hence the name. These ligaments are very important stabilizers of the knee. The cruciates are very strong ligaments and can withstand huge amounts of load before rupturing.

They are damaged due to sporting accidents and other high energy trauma. Sports requiring pivoting on the knee - like football, skiing, rugby, etc - are the usual culprits.

Cruciates are vascular structures. Cruciate injury presents with as a painful swollen knee due to bleeding in the joint. Subsequently the patient is left with a weak knee which gives way even with normal activities. It becomes difficult to participate in sports. Since the knee becomes unstable other structures in the knee remain at risk of further trauma.

Management involves examination and imaging with MRI scan. Depending on the findings the cruciate ligament injury can be treated non-surgically with specific rehabilitation or surgical reconstruction.

Our choice of reconstruction is the all arthroscopic technique using hamstring tendon from the same leg. This allows us to rehabilitate patients early and graft site has minimal morbidity.

Collateral Ligament Injury

These are strong ligaments on either side of the knee, the medial collateral ligament(MCL) lying on the inner aspect and the lateral collateral ligament (LCL) lying on the outer aspect. They provide stabilization in sideways stress in the knee.

The MCL is one of the most commonly injured ligaments and is a predominant sporting injury; though it can be injured in other trauma as well. The LCL is less commonly involved in isolation and is usually in association with other ligament injuries.  The ligaments are sprained as a result of forced stretching of the ligaments. There may be other injuries in the knee that need meticulous evaluation.

Clinical examination remains the mainstay for diagnosing these injuries. Further imaging is important in estimating the severity and to identify any other damage to the knee. MRI scanning is very useful tool in assessment.

The MCL injuries can be classified into 3 grades according to the extent of damage. Treatment is planned on the grade of injury and after assessing other factors like concomitant injury to other stabilizing structures.

Less severe injuries of the MCL are managed non-surgically in a hinged knee brace with controlled early mobilization protocol. Severe injuries are treated with repair of the ligament or reconstruction. The LCL injuries, if isolated, can be treated non-surgically.

Other Ligament Injuries

Some other important ligaments in the knee are the postrolateral ligament complex and the posteromedial ligament complex. These are anatomically complex structures which can be injured as a result of high energy trauma. These are often associated with knee dislocations. These injuries cause instability symptoms and are managed surgically with reconstruction. The procedure is quite complex and requires use of multiple ligament/tendon grafts.

Medial patelofemoral ligament is a structure which helps to keep the patella (kneecap) to track congruently in the trochlear notch. It is injured after patella dislocation. Reconstruction of this ligament is done to help instability and recurrent dislocation of the patello- femoral joint.

Arthritis

This is a condition where the articular cartilage in the knee gets destroyed. There may be a cause for the destruction as found in inflammatory arthritis like rheumatoid arthritis, psoriatic arthritis, sero-negative arthritis, ankylosing spondylitis, etc. Other causes for arthritis are infection (septic arthritis) and trauma (post-traumatic arthritis).

But a majority of arthritis has no precise etiology and this is termed as osteoarthritis. It is a result of age related degenerative process. With age the articular cartilage starts to become softer and this leads to accelerated damage to the cartilage with weight bearing. Subsequently the bone just under the cartilage hardens; aprocess called sclerosis. As the cartilage is gradually lost the knee becomes slightly unstable and this leads to formation of osteophytes and stiffening of the knee.

Arthritis causes painful joints. It restricts movements. The pain is activity related in the early stages but can gradually be a constant feature. The pain and stiffness causes significant limitation to the function and hence is a major factor affecting quality of life. In later stages the involved joint deforms.

When the arthritis is in the early stages treatment is directed towards managing pain. This includes lifestyle modification to avoid impact exercises, physiotherapy to improve muscle strength and co-ordination and analgesics as required.

The next step can be surgical procedures like realignment osteotomy and cartilage debridement. At this stage the arthritis is usually affecting only partial area of the joint and treatment is aimed to offload the painful area and weight bear the relatively normal area.  

In advanced stages the joint is not salvageable and joint replacement is the treatment option.

Partial joint replacement is the procedure where only the arthritic area of the joint is replaced, and the normal area left intact. This helps to preserve more structures in the knee and gives patients a better propiocetion. Total joint replacement involves replacing the entire joint. It helps to completely relive the pain and improve mobility.

Osteochondritis Dessicans (OCD)

It is the loss of blood supply to a part of bone just adjacent to the cartilage with associated cartilage involvement seen most commonly in the knee but can be found in other joints of the body as well. The most common site is the lateral portion of the medial femoral condyle. It can be secondary to repetitive trauma but an acute injury may or may not be present.

Affects adolescents with a growing skeleton, but can be rarely seen in adults.

Knee pain and locking in the knee are the main features of this condition.

The knee can get swollen especially after sports or increased activity.

Clinical examination and radiological assessment usually gives a provisional diagnosis.

MRI scan is helpful in confirming the diagnosis as well as quantifying the severity and healing potential of the lesion.

A bone scan may be sometimes required to know about the vascularity of the area.

Prognosis is better in adolescents and therefore the goal of treatment is to obtain lesion healing before physeal closure (skeletal maturity). Factors considered before treatment are age of patient, size of the fragment, stability of the fragment

Non operative treatment involves anti inflammatory medication, restricted weight bearing if the knee is irritable and avoidance of all impact loading activities. This is quite successful in children 12 years and younger with a small stable fragment.

Operative treatment is generally required in the older children (12 years and older). The various surgical options available are:

* Drilling through the fragment is a treatment if the overlying cartilage is intact.

* Reduction and fixation of the fragment is used if the fragment is unstable. This can be achieved using screws or pins.

* If the lesion is large and unstable other methods like chondroplasty, microfracture, autologous chondrocyte implantation can be used.

Baker's Cyst

This is a cystic fluid filled swelling in the back of the knee. It is a generic term applied to all swellings in the area irrespective of their etiology.

Commonly a Bakers Cyst is caused due to increased joint fluid which protrudes out through a capsular extension in the back of the knee. This happens in osteoarthritis and other arthritis.

A Cyst can also form due to a tear in the posterior part of the meniscus which allows extravasation of the fluid.

It is also sometimes found to be a result of an enlarged semimembranosus bursa (a fluid filled lubrication sac below the semimembranosus muscle.

The Baker’s Cyst itself rarely causes symptoms but the underlying pathology like arthritis, meniscal tear etc can cause pain. The cyst - if large - can cause restriction to movements because of the size. Rarely, the cyst may rupture and cause calf pain due to fluid extravasation.

Clinical examination is usually sufficient to diagnose this condition. Most diagnostic imaging modalities are directed towards finding the cause of the cyst. MRI scanning is preferred due to its high sensitivity and specificity. In case of a cyst rupture Doppler scanning is required to differentiate it from deep vein thrombosis (blood clots in the leg).

Treatment is directed at treating the cause.

More often a non-surgical treatment is adopted.

If the swelling is large and causing symptoms due to size, aspiration is tried, though re-filling of the cyst is quite common.

Surgery is usually the last resort as recurrence rate is high after this surgery.

Bursitis

Bursae are fluid filled sacs made of synovial tissue (which is similar to tissue lining the joints).

These are helpful in lubricating various areas around the knee. They lie between tendons and bones to ease movements. There are number of bursae around the knee like Pre patellar bursa, Infra patellar bursa, Pes anserinus bursa, Semi-membranosus bursa, etc.

Inflammation of these bursae is termed bursitis, it caused due to overuse.  It is often seen in people who have to kneel to do their occupation. They can sometimes be infected and form an abscess.

Bursitis causes swelling and pain in the joint. It has to be differentiated from infection in the knee joint. If the bursa is infected it can cause general symptoms like fever, malaise, etc.

Treatment for inflamed bursae is non-surgical. Rest and anti-inflammatory medication is advised. If the bursa is infected, it needs incision and drainage.

Tendonitis/Tendinopathy Around The Knee

This is a condition where there is pain and decreased function of the tendons around the knee. The name suggests inflammation but there at the molecular level there is absence of any inflammatory cells. The condition affects tendons close to their insertion and may be related to reduced blood supply and degenerative process.

All tendons around the knee can be affected. Commonly the patellar tendon and the quadriceps tendon are involved. It is also seen in the hamstring tendons. Patients present with pain in the region of tendon insertion. The pain is proportional to activity, but may be also present at rest.

It affects the patient’s ability to participate in sports.

Treatment is conservative in most cases. Physiotherapy, stretching and strengthening usually resolve symptoms. The treatment may take long time. Sometimes injection of a steroid and anaesthetic are used to expedite the resolution.

Anterior Knee/Chondromalacia Patellae

This is a general term used to indicate multiple problems affecting  the patello-femoral joint and the entire extensor mechanism. As the name suggests the pain is perceived in the front of the knee. The patella is a bone in the quadriceps tendon which articulates with the trochlea (which is the part of femur shaped like a trough). It is sometimes difficult to identify the exact cause of pain and hence treatment can be quite difficult. The various pathologies that are considered are arthritis of the patello-femoral joint (PFJ), mal-tracking of the PFJ, subluxation/dislocation of the PFJ, dysplasia (abnormal devolopment) of the trochlea, patella tendonitis, quadriceps tendonitis.