Orthopedics focuses on the musculoskeletal system. Learn about the diagnosis, treatment, and rehabilitation of bone, joint, ligament, and muscle conditions.

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Injury and Causes

The application of minimally invasive techniques covers a vast spectrum of orthopedic injuries and conditions. These range from acute sports injuries occurring in healthy athletes to degenerative conditions affecting the aging population. The common thread is that the pathology is located within a joint or deep structure that can be accessed without disrupting the surrounding healthy tissue.

Causes for these conditions vary from traumatic events to repetitive microtrauma and genetic predisposition. Understanding the underlying cause is essential for planning the surgical approach. A traumatic tear in a young person requires a different strategy than a degenerative tear in an older adult, even if both are treated arthroscopically.

Minimally invasive surgery is particularly well suited for intra articular pathology, where the damage is contained inside the joint capsule. It is also increasingly used for extra articular conditions like tendonitis and nerve compression.

  • Acute sports trauma and ligament ruptures
  • Chronic degenerative joint disease
  • Repetitive overuse syndromes
  • Nerve compression and entrapment
  • Intra articular fractures and loose bodies
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Meniscal and Labral Pathology

ORTHOPEDIC

The meniscus in the knee and the labrum in the shoulder and hip are cartilage structures that act as shock absorbers and stabilizers. They are frequently injured during twisting motions or direct impact.

Because these structures have a poor blood supply, they often do not heal on their own. The loose flaps of tissue can get caught in the joint, causing locking and pain. Minimally invasive surgery is ideal for trimming (meniscectomy) or repairing these delicate structures without cutting through the major stabilizing muscles.

  • Mechanical symptoms like locking and catching
  • Traumatic twisting injuries in athletes
  • Degenerative horizontal cleavage tears
  • Labral detachments causing instability (Bankart)
  • SLAP lesions in overhead athletes
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Rotator Cuff Disease

ORTHOPEDIC

The rotator cuff is a group of tendons that stabilize the shoulder. Tears can occur from acute trauma or, more commonly, from age related wear and tear. Bone spurs on the acromion bone above the tendons can rub and fray the cuff, a condition known as impingement.

Arthroscopic repair allows the surgeon to remove the bone spurs and reattach the torn tendon to the bone using small suture anchors. This avoids detaching the large deltoid muscle, which was necessary in open surgery and required a painful, lengthy recovery.

  • Age related degeneration and hypovascularity
  • Subacromial impingement from bone spurs
  • Acute traumatic avulsion injuries
  • Chronic repetitive overhead activity
  • Calcific tendonitis deposits

Femoroacetabular Impingement (FAI)

FAI is a condition where the bones of the hip joint are misshapen. The ball (cam) or the socket (pincer) has extra bone that rubs against each other during movement. This friction damages the labrum and the articular cartilage.

Hip arthroscopy allows the surgeon to reshape the bone and repair the labrum through tiny incisions. This preserves the hip joint and delays the onset of arthritis. It is a condition often seen in young, active adults with groin pain.

  • Cam deformities on the femoral neck
  • Pincer deformities on the acetabular rim
  • Labral tears resulting from mechanical conflict
  • Limitation in hip flexion and internal rotation
  • Premature cartilage delamination
ORTHOPEDIC

Ligamentous Instability (ACL)

The Anterior Cruciate Ligament (ACL) in the knee is crucial for rotational stability. Tears usually occur from non contact pivoting injuries. Because the ACL is deep inside the knee joint, it cannot heal on its own.

Arthroscopic reconstruction involves replacing the torn ligament with a graft. The surgeon drills tunnels in the bone and threads the new ligament through, securing it with screws or buttons. This is done entirely through portals, preserving the knee capsule and extensor mechanism.

  • Rotational instability and pivoting episodes
  • Non contact deceleration injuries
  • Associated meniscal and cartilage damage
  • Multi ligamentous knee trauma
  • Revision of failed prior reconstructions

Articular Cartilage Defects

Focal defects in the smooth cartilage lining the joint act like potholes. They can be caused by trauma or osteochondritis dissecans (a condition where bone dies and cartilage separates). If left untreated, these defects can expand and lead to widespread arthritis.

Minimally invasive techniques like microfracture (poking holes to stimulate stem cells) or cell transplantation (MACI) can be performed arthroscopically. These procedures aim to regenerate cartilage and resurface the defect before it degrades the whole joint.

  • Traumatic shearing of cartilage surfaces
  • Osteochondritis Dissecans (OCD) lesions
  • Focal defects causing localized pain
  • Loose bodies floating in the joint space
  • Early delamination of the articular surface

Spinal Compression and Disc Herniation

Minimally invasive spine surgery (MISS) treats conditions like herniated discs and spinal stenosis. A herniated disc occurs when the soft center of the disc pushes out and compresses a nerve root, causing sciatica.

Using tubular retractors and endoscopes, surgeons can remove the herniated portion of the disc without stripping the large back muscles off the spine. This significantly reduces post operative back pain and allows for faster mobilization.

  • Radiculopathy from nerve root compression
  • Herniated nucleus pulposus
  • Spinal stenosis causing claudication
  • Spondylolisthesis requiring stabilization
  • Synovial cysts compressing neural elements

Carpal and Cubital Tunnel Syndrome

Nerve compression syndromes are common overuse injuries. Carpal tunnel affects the median nerve at the wrist, while cubital tunnel affects the ulnar nerve at the elbow. The tight ligaments forming the roof of these tunnels compress the nerve.

Endoscopic release involves inserting a small camera into the tunnel and cutting the ligament from the inside. This avoids a large incision on the palm or elbow, reducing scar tenderness and allowing for a quicker return to gripping activities.

  • Compression of the median or ulnar nerve
  • Paresthesias and muscle weakness
  • Repetitive strain and ergonomic factors
  • Hypertrophy of the transverse carpal ligament
  • Double crush phenomenon

Hallux Valgus (Bunions)

Bunions are a complex deformity of the big toe joint involving bone and soft tissue. Traditional surgery involves long incisions and significant swelling.

Minimally invasive bunion surgery uses high speed burrs inserted through tiny skin nicks to cut and shift the bone. The correction is held with screws placed percutaneously. This technique preserves the blood supply to the bone and reduces swelling and stiffness.

  • Valgus deviation of the great toe
  • Painful medial eminence (bump)
  • Difficulty with shoe wear
  • Metatarsalgia and transfer lesions
  • Cosmetic deformity and toe crowding

Achilles Tendon Rupture

The Achilles tendon is the strongest tendon in the body and is prone to rupture in “weekend warriors.” Open repair carries a high risk of wound healing problems due to poor skin blood supply in the area.

Percutaneous or mini open repair techniques use specialized jigs to pass sutures through the tendon via tiny holes. This secures the tendon ends together without opening the skin over the rupture site, drastically reducing wound complications.

  • Acute rupture during push off activities
  • Gap in tendon continuity
  • Weakness in plantarflexion
  • High risk of wound complications with open repair
  • Retraction of tendon ends

Early Degenerative Joint Disease

While total joint replacement is for end stage arthritis, minimally invasive procedures can bridge the gap for early disease. Removing bone spurs, cleaning out loose debris, and releasing tight capsules can improve motion and reduce pain in arthritic joints.

This “cleanup” or debridement is palliative but can provide relief for years. It is particularly useful in the elbow and ankle, where joint replacement options are less reliable than in the hip or knee.

  • Mechanical impingement from osteophytes
  • Synovitis and inflammatory pain
  • Loose bodies causing locking
  • Capsular contracture limiting motion
  • Preservation of native joint biology

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FREQUENTLY ASKED QUESTIONS

What is a loose body

A loose body is a fragment of bone or cartilage that has broken off and is floating freely inside the joint space. It acts like a pebble in a shoe, causing pain, swelling, and mechanical locking when it gets caught between the moving parts of the joint.

The outer third of the meniscus has a blood supply and can sometimes heal on its own with rest. However, the inner two thirds are avascular (no blood supply) and typically do not heal. If a tear in this zone causes symptoms, minimally invasive surgery is usually needed to trim the unstable flap.

Bone spurs on the acromion (the roof of the shoulder) narrow the space where the rotator cuff tendons live. When you lift your arm, the spurs rub against the tendons, causing friction, inflammation (bursitis), and eventually tearing of the tendon.

Yes, it is considered very safe. By using tubes to dilate the muscles rather than cutting them, there is less bleeding and less risk of infection. However, it requires a surgeon with specialized training, as the viewing area is much smaller than in open surgery.

Bunion surgery has a reputation for being painful, but modern minimally invasive techniques have changed this. Because there is less soft tissue damage and the bone is stabilized immediately with internal screws, post operative pain is significantly reduced compared to traditional methods.

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