To coin a football phrase it’s squeaky bum time, I have two pieces of coursework due next week, dissertation due on the 14th May, then it’s exams and then around about the 4th June its all over. If only I could fast-forward a month…. Despite the pressing deadlines I was fortunate to be able to spend some time with one of the master class presenters at this years Society of Sports Therapists Student Conference Dr Ian McDermott. I spent Friday morning at the London Bridge Hospital where I observed an ACL reconstruction and a high tibial osteotomy. The ACL reconstruction is a relatively straightforward procedure now and estimates suggest that in the US approximately 100,000 ACL reconstructions are carried out each year. Dr McDermott carries out in the region of 40-50 each year. To see what i'm talking about have a look at this video - not exactly the same technique but it uses an allograft and is a quite similar albeit shortened view of what I saw.
High Tibial Osteotomy
The high tibial osteotomy on the other hand is not a routine procedure. The osteotomy is essentially the breaking and realigning of the tibia in order reduce the effect of osteoarthritis on one side of the knee. During the arthroscopy the surgeon will assess the state of the articular surgery on the affected side of the knee, and possibly carry out drilling or microfracture to the affected cartilage in an attempt to stimulate cartilage regrowth.
Normal Cartilage (left) Cartilage damage (middle) and cartilage drilling (right)
When the arthroscopy is finished the remainder of the operation is carried out with a portable x ray machine, so everyone in the operating theater is required to lead lined aprons - lets face it none of us want to have our bits frazzled. The tibia is then drilled and a fragment of bone removed so that the tibial plateau can be realigned, it is then fixed in place with a wedge replacing the removed bone. That makes it sound remarkably simple - it wasn't. The thing that surprised me most about both operations was the heavy duty tools that were used and also the force required for elements of each procedure.
It was a great experience being able to view both operations and it gives me a better understanding of the surgical procedures involved which in the future will help shape they way I rehabilitate patients. Thanks to Ian McDermott and his team for making it a great day. If you get a chance to view some surgery I'd highly recommend it.
None of the photo's or x-rays of the operation are from my visit.
www.fitforsportclinic.com
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