Orthopedic Surgery | Sports Medicine | Westwood | Hackensack Orthopedic Services | Westwood | Hackensack Orthopedic Surgeons Westwood | Dr. Michael L. Gross MD | Dr. James C. Natalicchio MD | Dr. Steven Weinfeld MD | Hackensack Specialties Physical Therapy | Sports Rehabilitation | Westwood | Hackensack Patient Information Orthopedic Care | Westwood | Hackensack Orthopedic Services | Westwood | Hackensack The Active Center for Health & Wellness Active Orthopaedics & Sports Medicine - Westwood Office: 390 Old Hook Rd. | Westwood, NJ 07675 | Tel: 201.358.0707
   
 

Specialties - Knee


Knee Arthroscopy


What is knee arthroscopy?

Knee arthroscopy is a procedure in which the doctor examines your knee with an instrument called an arthroscope. An arthroscope is a tube with a light on the end that is inserted in your knee and projects an image of the inside of your knee onto a TV monitor. The arthroscope is about the diameter of a pencil.

This procedure is used to diagnose the cause of pain, swelling, tenderness, or weakness in your knee.

What happens during the procedure?

The doctor will give you a general, regional, or local anesthetic. A general anesthetic will relax your muscles and make you feel as if you are in a deep sleep. Both local and regional anesthetics numb part of the body while you remain awake. All three types of anesthesia should keep you from feeling pain during the operation.

The doctor will then insert the arthroscope, a tube containing a saltwater solution, and a probe instrument into the lower part of your knee. He will then inject fluid into the knee.

Your doctor may find loose material in the knee, or a tear in the cartilage or ligaments. Sometimes the doctor can repair the tears and remove loose pieces of cartilage using small instruments and the arthroscope. If the problem cannot be fixed by this procedure, the doctor may recommend open knee surgery.

After the procedure the doctor will close the small openings with one or two stitches or sticky tape.

Click Here to view an animated overview of the procedure.

For additional information visit: AAOS Online Services Fact Sheet - Knee Arthroscopy

Knee Arthroscopy | ACL Reconstruction | Knee Replacement Surgery | Westwood | Hackensack | New Jersey


ACL Reconstruction


What is the ACL?

Knee Arthroscopy | ACL Reconstruction | Knee Replacement Surgery | Westwood | Hackensack | New JerseyThe anterior cruciate ligament (ACL) is a stabilizing ligament that connects your thighbone (femur) to the shinbone (tibia). Ligaments are tough, non-stretchable fibers that hold your bones together.

When it is torn, the anterior cruciate ligament (ACL) unravels like a braided rope and does not heal on its own. Fortunately, reconstruction surgery can help many people recover their full function after an ACL tear.

What happens during the procedure?

Surgical treatment of the torn ACL usually involves an arthroscopic surgical reconstruction of the injured ligament. Although a number of different types of tissue have been utilized to reconstruct the ACL, the most common type of ACL reconstruction involves harvesting the central third of the patellar tendon with a bone block at each end of the tendon graft. Many patients may benefit from allograft, which is a donor tissue from a cadaver. Often as strong as the patient’s own tissue, this graft is suitable for the demands of certain patients. Allografts allow for less scarring, faster surgery, and a quicker return to normal daily activities such as work or school.

The remaining tendon is then repaired. After harvesting the tissue, drill guides are used to place holes into the tibia (bone below the knee) and femur (bone above the knee). By placing the drill holes at the attachment sites of the original ligament, when the graft is pulled through the drill hole and into the knee, it will be placed in the same position as the original ACL.

After pulling the graft through the drill holes and into the joint to replace the torn ACL, the graft is then held in place with bioabsorbable screws or metallic screws.

After a period of rehabilitation and sports training, most patients enjoy a successful return to full activities.

Click Here to view an animated overview of the procedure.

For additional information visit: AAOS Online Services Fact Sheet - ACL Injury: Does It Require Surgery?

Knee Arthroscopy | ACL Reconstruction | Knee Replacement Surgery | Westwood | Hackensack | New Jersey


Meniscus Surgery (including repair and meniscectomy)


A torn meniscus is a common injury often caused by forcefully twisting or rotating the knee. It can also be a result of degenerative changes in older adults. A meniscus tear can be repaired through arthroscopic surgery.

How does a meniscus tear happen?

The menisci are C-shaped pieces of tough cartilage that rest on either side of the knee, between the thigh bone and shin bone. They help to distribute body weight across the knee so it can be properly supported by the bones in the leg, and also provide stability to the knee joint. A meniscus tear is common after a traumatic injury, and most frequently occurs when the knee joint is bent and the knee is then twisted. Torn menisci are common in athletes and older adults whose cartilage may have worn away.

A torn meniscus causes pain and swelling, and may also be accompanied by a frequently locking joint and the inability to completely straighten the knee. Some people experience a popping or clicking sensation within the knee as well.

How is a meniscus tear treated?

Treatment for a meniscus tear often begins with conservative methods such as rest, ice or over-the-counter medication. If these treatments are not effective and symptoms continue, patients may benefit from meniscus surgery. Partial meniscectomy and arthroscopic meniscus repair are procedures in which the torn segment of the meniscus is removed, or if possible, the torn edges are sutured together, which allows them to heal properly. Some patients may require a full meniscectomy, a surgical procedure in which the entire meniscus is removed. The extent of your surgery depends on the location and severity of the meniscus tear.

Recovery from meniscectomy is often rapid, with most patients returning to fully activity after two to six weeks. With several weeks of immobilization and crutches, followed by physical therapy, most patients recover well from these procedures. The majority of patients undergo partial meniscectomy, but unfortunately, less than 10% of tears are actually repairable.

Click Here to view an animated overview of the procedure.

For additional information visit: AAOS Online Services Fact Sheet - Meniscal Transplant Surgery

Knee Arthroscopy | ACL Reconstruction | Knee Replacement Surgery | Westwood | Hackensack | New Jersey


Patella Procedures


What is the patella?

The patella, commonly known as the kneecap, is one of three bones that make up the knee joint and increases the leverage of the joint, allowing for a stronger extension of the leg. The patella can become irritated or injured from prolonged sitting, overuse, malalignment or instability. Like any other bone in the body, the patella can also fracture, which may involve a single crack or shattering into several pieces.

Some of the common conditions associated with the patella include:

  • Chondromalacia Patellae (runner’s knee)
  • Prepatellar Bursitis (housemaid’s knee)
  • Patellar Subluxation/Dislocation (unstable kneecap)

How are patella problems treated?

Many patella injuries can be treated through nonsurgical treatments such as physical therapy, braces, orthotics, anti-inflammatory medication and icing. Some patients may need surgery to correct their patella conditions, although it is usually considered a last resort for patients who have not had success with nonsurgical methods.

Surgery for patella problems is most often used to correct malalignment in patellas that subluxate or dislocate. Surgical options depend on the cause of the malalignment, and may include arthroscopic lateral release, to loosen tight lateral structures, medial repair and reconstruction to tighten medial tissues, or osteotomy to cut and realign the bone to improve tracking within the groove. When necessary, these procedures carry a high rate of success and often allow for a return to full activity.

Knee Arthroscopy | ACL Reconstruction | Knee Replacement Surgery | Westwood | Hackensack | New Jersey


Total Knee Replacement


Symptoms

The symptoms of a degenerative knee joint usually begin as pain while bearing weight on the affected knee. You may limp and the knee may become swollen with fluid. The degeneration can lead to a reduction in the range of motion of the affected knee - the knee bends less than normal and may lose the ability to completely straighten out. Bone spurs will usually develop and can be seen on X-ray. Finally, as the condition becomes worse, the pain may be present all the time and may even keep you awake at night.

Diagnosis

The diagnosis of a degenerative knee starts with a complete history and physical examination by your doctor. X-rays will be required to determine the extent of the degenerative process and may suggest a cause for the degeneration. Other tests may be required if there is reason to believe that other conditions are contributing to the degenerative process. Blood tests may be required to rule out systemic arthritis (such as Rheumatoid Arthritis) or infection in the knee.

Knee Replacement Surgery

In knee replacement surgery, the damaged bone and cartilage are replaced with metal and plastic surfaces that are shaped to restore knee movement and function. The new artificial knee is called a prosthesis.The prosthesis is generally composed of two metal pieces fitted onto the ends of the tibia (shin bone) and the femur (thigh bone) and a plastic piece inserted between them to act as a bearing. Stainless steel, cobalt or chrome alloys or titanium may be used for these components. Durable, wear resistant polyethylene (plastic) is used for the bearing. A plastic bone cement may be used to anchor the prosthesis into the bone. Some joint replacements also can be implanted without cement when the prosthesis is designed to fit and lock onto the bone directly.

Click Here to view an animated overview of the procedure.

For additional information visit: AAOS Online Services Fact Sheet - Total Knee Replacement

Knee Arthroscopy | ACL Reconstruction | Knee Replacement Surgery | Westwood | Hackensack | New Jersey


Unicondylar Knee Replacement


What is unicondylar knee replacement?

Also known as unicompartmental knee replacement, unicondylar knee replacement is a less invasive alternative to a total knee replacement. This procedure is designed to replace only the portions of the knee most damaged by arthritis, leaving the healthier portions intact and letting patients benefit from less scarring, shorter recovery times and a fuller range of motion.

This procedure is commonly performed on younger, more active patients who do not wish to undergo a total knee replacement yet, or for patients whose arthritis is localized in one specific area of the knee.

What happens during the procedure?

During a unicondylar knee replacement, your doctor will make a small incision in the front of the knee or wherever the damaged area is. Small pieces of bone are then removed from the damaged area of the femur and tibia, and are then replaced by metal prosthetics. The metal pieces are separated by a plastic insert that allows for smooth, fluid motion of the joint after surgery.

Depending on where the damage is, the inner or outer parts of the knee can remain untouched during this procedure, resulting in less bone loss and a greater range of motion. After a unicondylar knee replacement, many patients fully recover within a month and are still able to partake in low impact sports and other activities.

Knee Arthroscopy | ACL Reconstruction | Knee Replacement Surgery | Westwood | Hackensack | New Jersey

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