One of the most common orthopedic surgeries is meniscus injury repair. This part of the body can be damaged by prolonged, excessive use or sudden sideward movements. Therefore, it can affect not only athletes, but also physical workers and its incidence is increased in those with congenital knee and lower limb disorders (e.g., knock-knee., bowleg, loose knee). If you have difficulty bending your knee, it is sensitive to pressure, or is already painful and any sound can be heard from the knee joint during movement, you are most likely facing injury to your meniscus and in most cases need surgery as soon as possible.
20-30 years ago, when the rupture of the meniscus could only be treated by having to open the joint, the entire cartilage ring was removed. These patients developed such a degree of joint wear after 10–15 years that only knee replacement could help alleviate their complaints.
However, with the spread of the arthroscopic minimally invasive technique, we endeavor to excise only the smallest part with the damage. Unfortunately, biomechanical research proves that removing 30 percent of cartilage can already cause severe wear and tear. Most often, however, tissue of this size must be excised so that no free-moving part remains inside the joint, which can also cause articular inflammation and pain.
The latest arthroscopic surgical techniques and meniscus re-suture procedures can further reduce the size of the cartilage ring removed. This new trend was brought to light by the principle of protecting the meniscus. Of course, these interventions also result in increased surgical time, special instrumentation, and in many cases, prolonged rehabilitation.
Occasionally, the outer crescent-shaped cartilage of the knee is damaged in an accident, but even in childhood. The cause of the latter lesion may be a congenital disorder where the meniscus is not crescent-shaped but disc-shaped. When squatting, the enlarged cartilage causes a painful click on the lateral side of the joint. Its treatment is similar to that of internal meniscus injuries; we operate on the injured part of the body with an arthroscopic technique.
Emineo was among the first in the country to implant of a synthetic meniscus cartilage scaffold. In the short- 30 to 60.minute arthroscopic surgery, the missing piece of the meniscus is replaced with a synthetic sponge scaffold and the implant is impregnated with stem cell suspension to transform into a perfect cartilage ring.
But why is this good for the patient?
The complete restoration of the anatomy and biomechanics of the knee joint, if possible, can stop the premature aging and wear of the joint. Our principle is not to take it out, but to keep every piece of the joint for as long as possible! Our private hospital represents this principle in the interests of patients.
Articular cartilage is normally a solid and smooth material withstanding even intense strain. However, active lifestyle and elderly age may lead to injuries and damage of the articular cartilage surfaces. At Emineo Private Hospital, we place special emphasis on the most accurate reconstruction and healing of joint surfaces and with the techniques listed below, we try to avoid or delay the costly knee replacement surgery.
What techniques do we have?
- Mosaicplasty: a method of treating a circumscribed cartilage surface deficiency, performed by arthroscopic technique without opening the joint. In this surgical procedure lasting for approximately 1.5 hours, a bone cylinder covered with healthy cartilage is removed from the surface of the joint that is not loaded and implanted in the cartilage-deficient areas. The implanted cartilage-bone cylinders are then incorporated and after six months, the cartilage covering the joint may appear intact. However, this can only be applied when replacing small areas.
Why is this beneficial for the patient? Because the transplant is done from the same joint. With a well-developed surgical technique, we can achieve good joint reconstruction.
- Microfracture: Worn areas of the cartilage surface are treated with an arthroscopic technique. During the surgery that lasts 1 hour, the damaged, detached cartilage surface is removed to the bleeding bone base, and then a small hole is drilled in the bone base. The new secondary cartilage surface grows from these holes. The surface area of the hole depends on the size of the area to be treated. In layman’s terms, this method is like when road pits are repaired in the spring.
Why is this beneficial for the patient? We can treat even larger areas of joint wear with this method.
The disadvantage is that in the cartilage surface deficient area, we can only grow a scarred cartilage surface with this method. Experience shows that after two to five years, wear and tear clinical complaints may intensify again.
- Stem cell treatment from the pelvic blades: during the arthroscopic surgery that lasts approximately 2 hours, damaged or worn cartilage surfaces are removed. By centrifuging the stem cell suspension (10-15 ml) obtained from the pelvic blade with a hypodermic needle and passing it through a special filter system to the stripped area, 4-8 ml of stem cell-rich fluid is obtained, which is injected into the injured area to achieve secondary cartilage formation.Why is this beneficial for the patient? The filtrate rich in stem cells is created from the patient’s own material. The procedure can be repeated several times.
- Chondrofiller treatment: A unique method in Hungary, during which we remove damaged worn cartilage surfaces by an arthroscopic surgery lasting for 1 to 1.5 hour. A hyaline cartilage material made of rat tails by biotechnological method is injected onto this surface and when it hardens, it becomes jelly-like. Meanwhile, an own hyaline cartilage surface builds up under the artificial surface 6 to 12 months which can be verified by MRI. The technology was developed in Germany and is one of the most modern procedures these days. The methodology was mastered by our doctors from the German manufacturer and the built-in implant is always ordered directly from the factory for each patient.
Why is this beneficial for the patient? It can also be used for significant cartilage abrasion diseases and even the cartilage surface of the patella can be replaced. Hyaline cartilage is formed, which is not a secondary fibrous cartilage. It can be performed as part of a one-day surgical procedure. It has roughly the same load bearing as before the injury.
- Synthetic cartilage and bone surface framework implantation: In case of larger articular cartilage surface or bone surface defects, the damaged area is cleaned and refreshed, a synthetic tissue is implanted, which is impregnated with stem cells, glued to the affected area to form a loadable cartilage surface. The duration of the surgery is 2 hours.
Why is this beneficial for the patient? Larger, deep cartilage ulcers up to 8 cm2 can be treated with this technique and thus premature prosthesis implantation can be delayed.
Duration of surgery: 0.5 to 2 hours depending on the technique
Cartilage wear can occur in any of our joints, but it is most commonly seen in the knees, hips, hands, feet, and shoulder joints, as these are the most frequently and heavily loaded joints. If the “Cartilage surface preservation program” described above can no longer be considered, the physician may, in agreement with the patient, choose from the options of the following surgical program. In determining our surgical program, the degree of joint wear, the patient’s age, the patient’s general activity, and the need for sports exertion were taken into account.
- Axis correction surgeries around the knee: At Emineo Private Hospital, we cure the deformity verified by a loaded entire lower limb radiograph with a minimally invasive method and an overnight hospital stay. That is, from a small incision, a correction is made with an opening or closing wedge, which is fixed with a plate, and the duration of the surgery is 1 to 1.5 hours. After six weeks of crutching, bony remodeling occurs.Why is this beneficial for the patient? By eliminating the deformity of the legs (e.g. knock-knees or bowlegs), the uniform load on the joints can be restored, thus eliminating the stress on some areas and the possibility of rapid wear.
- Knee replacement with custom-made template: If knee replacement is the only solution for the patient, the most important questions concerning the surgical procedure include how long after the appearance of the complaints should it be performed, what surgical procedure is applied and the quality of the implanted prosthesis. At Emineo Private Hospital, knee wear patients are offered knee replacement surgery using a custom-made template (PSI). The difference is perhaps best demonstrated by the example of clothes: if traditional prostheses were off-the-shelf clothes, then a prosthesis with a custom-made template would be a tailor’s garment made for our size and physical structure.In our institution, our patients undergo a full lower limb MRI scan before knee replacement surgery. Based on this scan, the world’s leading prosthesis manufacturer creates a custom-made template in its factory in Germany, which is placed on the patient’s bones making up the knee joint, and the bony surface of the prosthesis is created with minimal bone loss and the determination of the most accurate planes. The surgery takes 1 or 2 hours.Why is this beneficial for the patient? Because with this technique, which is considered the most modern today, knee replacement surgery takes less time, bone loss is decreased, the risk of complications is lower, and rehabilitation is faster. A few hours after the knee replacement surgery the patient is able to walk to the toilet. Since no drains are inserted into the bone, there is no significant blood loss and the pain is also less. The patient can leave our private hospital 2 to 3 days after surgery and continue rehabilitation but already in their own home.
- Térdtáji tengelykorrekciós műtétek: Terheléses, teljes alsó végtagi röntgenfelvétellel igazol tengely deformitás az Emineo Magánkórházban egy éjszakás bent tartózkodással tudjuk gyógyítani minimál invazív módszerrel. Azaz kis feltárásból nyitó vagy záró ékkel korrekciót végzünk, melyet lemezzel rögzítünk, melynek időtartama 1-1,5 óra. Hat hét mankózást követően a csontos átépülés bekövetkezik.
Miért előnyös ez a betegnek? A láb deformitását megszüntetve (pl. X vagy O láb) az ízületek egyenletes terhelése visszaállítható megszüntetve ezzel egyes területek kiemelt terhelését és gyors elkopásának lehetőségét.
The professional team of Emineo Private Hospital is committed to mapping the causes of anterior knee pain and developing targeted, personalized treatment programs. If physiotherapy (“core training”) as a first line treatment is unsuccessful and the patient agrees, a surgical plan is set up based on biomechanical principles.
What surgical techniques are used?
- In case of abnormal patellar ligament axis: the bone area where the tendon inserts is relocated in several planes. From a small skin incision of 3 cm, the bony insertion is rotated and the desired position is fixed.
- In case of patellar dislocations, we reconstruct the rupture of the medial stabilizing ligament which was previously confirmed by MRI. In case of major elongation, ligamentoplasty is performed.
- In the case of a scarred and shrinked patellar ligament, the stabilizing ligament is released arthroscopically (capsular incision).
- If anterior knee pain is caused by a shallow kneecap trough, we help our patients by raising the wall of the trough.
- Cartilage surface diseases are treated according to the Cartilage Surface Program.
Combinations of these surgical techniques are elaborated during the preparation of the individualized program. The length of the surgeries is between 1 and 2 hours.
Why is this beneficial for the patient?
By the non-symptomatic treatment of anterior knee pain, we can permanently cure this pain syndrome.
A leggyakoribb sérülés a combcsontot és a lábszárcsontot összekötő elülső keresztszalag-szakadás. A keresztszalag pótlására többfajta műtét létezik, a legújabb a kétköteges, úgynevezett double-boundle technika. Ebben az esetben az elülső keresztszalagot nem egy kötegként kezelik, hanem két kötegként pótolják azt. Lényegében két furatot helyeznek a lábszárba, kettőt pedig a combcsontba, és ezen keresztül áthúzzuk a térdet tartó inakat. Dr. Knoll Zsolt Ph.D. Magyarországon az elsők között alkalmazta ezt a fajta szalagpótlást és már több száz sikeres műtétet hajtott végre.
Ezzel a modern anatómiai rekonstrukcióval olyan mértékben felgyorsul a rehabilitációs időszak, hogy a műtét után három héttel a páciensek már autót tudnak vezetni. Az egész eljárás összesen kb. két hét kiesést jelent a munkahelyről. A legnagyobb előnye pedig, hogy kórházban mindössze egy napot kell eltölteni!
The knee is one of the most vulnerable parts of our body, carrying a heavy load and performing complex movements, especially under heavy strain during so-called rotational sports. Football, basketball, handball, squash, skiing and tennis are also forms of movement in which knee injuries are common. The most common injuries requiring surgical intervention is meniscus tear followed by anterior cruciate ligament tear, however, the method chosen to repair these damages makes a difference.
At Emineo Private Hospital, led by Dr. Zsolt Knoll PhD, one of the country’s most renowned knee specialists, we recommend individualized cruciate ligament replacement. The number of such procedures is increasing worldwide and we are also experiencing this trend in our private hospital. In addition, more and more young and older active patients are present with knee instability. However, a teenage soccer player needs one thing, a handball player needs another, a top athlete needs a different procedure, a lady in her forties who is injured on the ski slope is different again, and active man in her sixties who plays sports every day needs yet another solution. These diverse needs have led us to devise a strategy for individualized cruciate ligament therapy in the field of knee surgery at Emineo Private Hospital.
There are several types of surgery to replace cruciate ligaments, the latest being the double-boundle technique. In this case, the anterior cruciate ligament is not treated as one bundle but is replaced as two bundles. Dr.Zsolt Knoll PhD, one of the leaders and founders of Emineo Private Hospital, was one of the first in Hungary to use this type of ligament repair and has already performed hundreds of successful surgeries.
During the surgery that lasts 1 to 1.5 hours, targeted drill holes are made at the origin and insertion of the anterior cruciate ligament in the knee joint and the tendons fixing the knee are drawn through these holes. Dr.Zsolt Knoll, PhD was one of the first in Hungary to use this type of ligament repair and has already performed hundreds of successful surgeries.
Customized design is reflected in the type of tendon and the rehabilitation program used for the next step in the healing process. The choice between single-channel and double-bundle techniques are made based on the thickness of the tendon that we want to use for replacement. However, the type of tendon used for cruciate ligament replacement depends on many things (patient’s gender, type of sports activity, possible patellar disease, and patient’s age) and it can be Hamstring, thigh extensor tendon, patellar tendon, synthetic ligament, or iliotibial ligament.
At Emineo Private Hospital, the success of our program is ensured not only by the selection of the most suitable type of surgery for the patient concerned, but also, to a similar extent, by the selection of the most suitable rehabilitation. Our experiences so far indicate that with customized method, 92% of Emineo Private Hospital’s patients could return to active life and sports in the same quality as before injury.
Why is this beneficial for the patient? With this modern anatomical reconstruction, the rehabilitation period is accelerated to such an extent that three weeks after surgery, patients can already drive a car. The whole procedure takes approximately two weeks off work. And the biggest advantage is that the patient only has to spend one day at Emineo Private Hospital!
Cruciate ligament repair for children
In our private hospital, cruciate ligament repair surgery has also become available for children whose growth plates have not yet been closed. In such cases, knee surgery is performed with the patient’s own tendon, but without violating the growth zones.
Why is this beneficial for the patient? Surgery is also recommended for children because cruciate ligament injury is often followed by other associated injuries due to the instability of the knee joint. These associated injuries will later be precursors to knee wear and tear.
During the short intervention lasting for 30 to 60 minutes, in case of isolated medial collateral ligament instability, the compact bone stock is punctured from 4 to 5 small skin incisions along the path of the ligament. The inflicted small hemorrhages result in scarring and shortening of the collateral ligament.
Why is this beneficial for the patient?
This procedure is performed on an outpatient basis in Emineo, so the patient can walk out in a knee brace after a few hours.
Cysts and other associated abnormalities are removed by an arthroscopic or open approach during a surgery that lasts approximately 1 hour. If the size of the cyst is larger and there is not opening toward the joint, the fluid-filled expanded structure is removed from an incision on the skin surface. In many cases, the patient is advised to use crutches until suture collection that is planned after 10-12 days.
Why is this beneficial for the patient?
These interventions are performed at Emineo Private Hospital on an outpatient basis or with an overnight stay.
Cartilage or fibrous free bodies are often detected in the knee joint. Their origin is variable, some of them broke off from the cartilage covering the articular surface, others from the meniscus, or loose cartilage may develop as a result of a disease of the internal membrane of the joint leading to pathological cartilage production. Free bodies migrating in the joint can become pinched between the bones, that may cause lightning-like pain and locked knee. At Emineo Private Hospital, cartilage pieces are removed using a state-of-the-art arthroscopic procedure during a rapid surgery lasting 30 to 60 minutes.
Why is this beneficial for the patient?
Due to the arthroscopic technique, with a small intervention and minimal load on the body, the unpleasant sharp pains disappear in a short time and the patient can live a fuller life again.
The internal articular membrane covering the inner surface of the knee joint may thicken, become inflamed, overgrow for known or unknown reasons, resulting in swollen joint with restricted function. It is treated in our private hospital by eradicating the triggering inflammatory focus, administering an anti-inflammatory drug, or draining articular fluid (puncture). If these do not help, the overdeveloped membrane is removed using a special shaver during a short arthroscopy (articular keyhole surgery) lasting for 30 to 60 minutes. This long-standing knee surgery makes it possible to analyze the excised pieces by histological examination and to find the most effective cure.