The joint specialist

The joint specialist Dr. Biju pankappilly - Shoulder ,knee and sports injury specialist Joint pains can affect our daily activities. It causes pain, stiffness, and swelling.

Multiple studies have shown that long standing or chronic pains can lead to depression which inturn can affect all corners of our lives. The key is proper early diagnosis and timely pathology directed treatment. A joint is where two or more bones come together, like the knee, hip, elbow, or shoulder. Joints can be damaged by many types of injuries or diseases, including

Arthritis - inflammation

of a joint. Over time, the joint can become severely damaged. Bursitis - inflammation of a fluid-filled sac that cushions the joint
Dislocations - injuries that force the ends of the bones out of position
Ligament injuries including tears and sprains subsequent to trauma or sports injuries

A stich in time says nine! Why ruin our lives when there is always a solution to the pain. Dr.Biju Pankappilly is a specialist in joint replacement surgery, arthroscopy and sports injuries. He has been trained at some of the pioneers centers in the United states, France, and India.

Acromio clavicualr joint Injuries!!!Arthroscopic assisted reduction and stabilisation of an Acromio clavicular joint dis...
06/04/2020

Acromio clavicualr joint Injuries!!!
Arthroscopic assisted reduction and stabilisation of an Acromio clavicular joint dislocation!

Its minimally invasive , less postoperative pain and faster recovery from the injury!

06/04/2020

Acromio clavicular joint (AC joint) Injuries are relatively common. They are more common in men and contact atheletes especially those taking parting rugby, hockey and wrestling. They can also occur following an accidental fall onto the outstretched hand or when an object falls directly over the shoulder.
Most of the injuries are treated conservatively with sling and medications. But one may have to resort to surgical management for the treatment of High grade injuries affecting the Acromio clavicular joint.
Here is a video of an arthroscopic assisted reduction and fixation of Acromio clavicular joint dislocation with augmentation with Semitendinosis autograft . The patient was a 28 year old professional footballer who sustained an injury during a match . The Autograft was added as a biological augment to aid in the healing of the torn Coraco clavicular ligaments and to add strength to the construct holding the AC joint reduction.
He had a partial articular surface thickness tear of the supraspinatus tendon which was also addressed during the time of arthoscopy.

Cartilage injuries- cartilage defects if not addressed on time can lead to increased pain , early onset of osteoarthriti...
19/07/2019

Cartilage injuries- cartilage defects if not addressed on time can lead to increased pain , early onset of osteoarthritis and can be a career ending factor for most of the Sportsmen!
A a young footballer had come to me recently with a complete tear of the Acl ,the posterior root of the medial Meniscus and a osteochondral Defect!
During the time of arthroscopy a full thickness osteochondral defect was seen over the weight bearing portion of the medial femoral condyle ! In this case the defect was well appreciated on the Mri scan! Many a times they are detected at the time of arthroscopy only.
This was managed by arthroscopic Acl reconstruction , reattachment of the posterior root of the medial meniscus and implantation of a three dimensional Matrix which mimics the osteocartilaginous tissue on to the defect! This in course of time will transform into a hyaline like cartilage structure!
Hopefully he will get back to his favourite sport in few months time!

28/09/2018

Loose bodies can be a cause of pain in the joints. They are commonly seen within the knee joints and elbows. Patients usually complaints of recurrent locking of the joints with pain. They float around inside the joint and very often can be palapated under the skin.
Here is a video showing arthroscopic removal of mutiple loose bodies from the posterior compartment of an elbow joint in an active individual in his late 40s

20/11/2017

Microfracture for Cartilage defects!

Cartilage injuries can be devastating and can put an end to ones sporting career, if not diagnosed and treated in a timely fashion. They cannot be seen on X-rays and requires a high resolution Mri scan preferably in a 7 tesla or atleast a 1.5 tesla machine with a dedicated knee coil.

Many a times the cartilage injuries are recognised during the time of arthroscopy for the treatment of some other pathologies like ligament ruptures and if left unattended can lead to increased wear and tear inside the joint leading to early arthritis.
Cartilage does not grow back as they are devoid of direct blood supply . There are various techniques available to regrow them. One of the oldest and simplest methods practiced world wide is Microfracture- making holes in the underlying bone at the defect site bringing new blood supply containing stemcells. The resultant blood clot transforms into a new cartilage material .

The technique is recommended for only smaller cartilage defects of less than 2 cm in size. The early results of micro fracture are good but it lacks consistency and the pain can recur after 3-5 years owing to the breakdown of the repair material. To improve the consistency of the repaired tissue, the specialists have started to augment the repair with biological scaffolds, bone marrow aspirates, platelet rich plasma injections and hyaluronic acid injections .

Larger cartilage defects warrants for autologous chondrocyte implantation , auto or allograft transplantation to the defect site.

Here is a video demonstrating the micro fracture technique for a cartilage defect in the knee augmented with a bone marrow aspirate injection into the knee after the procedure.

03/07/2017

Arthroscopic management of a Bony Bankarts Lesion

Shoulder dislocation results in tear of the soft tissue structures ( Capsule and the Labrum) around the shoulder joint. During unfortunate incidents like a fall on an abducted shoulder the dislocation may result in the fracture of the glenoid ( socket) !
Its called a Bony bankarts lesion . Here is a video showing arthroscopic reduction of the fractured fragment along with the capsulo-Labral complex back to its position in a 19 year old basket ball player who sustained the injury during one of the games !

18/02/2017

Meniscal Root Tears!

The medial and lateral meniscus play an important role in maintaining the knee function . About 40 to 70% of the load across the joint is absorbed by the menisci. Any injury to these structures can increase the stress across the articulating surfaces resulting in accelerated cartilage wear leading to irreversible arthritic changes in the knee joint.

By definition, Meniscal roots are the site of attachment of the meniscus to the underlying bone.There is a root attachment in the front (anterior root) and back (Posterior root). In majority of the cases its the body of the meniscus that is torn and can be repaired easily using various techniques, few of which i have posted earlier. On the contrary Meniscal root tears are not very common and easily missed on MRI scans if not properly looked into . The repair techniqies are a bit more challenging! Posterior root tears are most common.

A person with posterior root tear experiences sharp pain during deep flexion of the knee.

Here is a video showing an arthroscopic technique for the reattachment of the torn posterior root of the medial meniscus to the bone using sutures and a titanium button through a transosseous tibial tunnel !

Total shoulder replacementThe shoulder is a ball and socket joint. When arthritis sets in , the cartilage layer covering...
11/01/2017

Total shoulder replacement
The shoulder is a ball and socket joint. When arthritis sets in , the cartilage layer covering the articulating surfaces of bones forming the joint gets eroded resulting in pain and stiffness in the joint. The day today routine activities may become difficult.
Total shoulder replacement is the viable option to get you rid of the symptoms !
Although total shoulder replacement is less common than knee or hip joint replacement, it is just as successful in improving the quality of your life.
The images attached are the pre and post operative images of an arthritic shoulder in a 60 year old active man!

14/11/2016

Arthroscopic release in a Frozen shoulder!!
I would like to share with you a video showing arthroscopic treatment in a patient with recalcitrant Frozen shoulder !
Inspite of prolonged conservative treatment in the form of analgesics, intraarticular steroid injections and physio, the patient had persistent pain and severe restriction of movements in the shoulder depriving her from doing day to day activities!
In the video you can see the severely inflamed tissues inside the shoulder joint ( they look dark red in colour) and the use of a shaver and radio frequency ablation probe to excise them. Special punches are used to incise the tight capsule ( the membrane around the joint)to increase the space inside the shoulder and improve the movements!
Do pay attention to the severely restricted shoulder movements prior to the start of the Key hole surgery and the gain in range of movements immediately after the procedure!

Frozen ShoulderStiff shoulder commonly called Frozen shoulder is a very common ailment affecting our society. It affect...
07/11/2016

Frozen Shoulder
Stiff shoulder commonly called Frozen shoulder is a very common ailment affecting our society. It affects the quality of life owing to the pain and stiffness in the shoulder making it very difficult to perform even the day today routine activities.
Night pain can affect your sleep. One may find it hard to get along with the sporting activities. These limitations affects the quality of ones life which inturn can affect you not only physically but also mentally.
It’s very common among the diabetic population. The reason behind it still remains unknown. Stiffness can develop due to prolonged immobilization of the joint following fractures and post surgical interventions in and around the shoulder. In many instances the disabilitating condition may develop without any reason.

During the early phase of the disease a combination of analgesics and a well directed physiotherapy programme both at home and at the clinic can help in reducing the symptoms. But unfortunately very rarely do I get patients during the early phase with mild symptoms. Mostly they come handicapped after a course of massage with marked reduction in movements and severe pain . In this situation analgesics alone will not work. A steroid injection into the shoulder by a specialist along with painkillers and physio may be effective in about 80% of the patients. They reduce inflammation inside the joint and thus relieves pain and help in restoring the motion.

In a small percentage of the patients lacking improvement with injections, and physio within 5-6 months time I do advise arthroscopic release of the tight structures inside the joint. Through a key hole surgery the inside of the joint can be visualized and the inflamed tissues inside the joint can be excised and the tight membrane can be released to increase the space and one can achieve full movements postoperatively.

Frozen shoulder is a common entity in our society and a timely diagnosis along with a well - directed treatment protocol will help you improve the quality of your precious life and get you moving!

28/09/2016

Recurrent shoulder dislocation !

Here is a video of a Latarjet procedure performed on a professional volleyball player who had been dislocating his shoulder since the last 4 months! He has had over 10 episodes of recurrent anterior dislocations since his initial injury while playing! There was a moderate amount of glenoid bone loss and a bony procedure was an ideal option especially in this guy involved in Contact sports!
In the video you can see the osteotomy of the coracoid bone and its transfer on to the anterior surface of the glenoid (the socket) and fixation with two screws and a plate!

Address

NMC Royal Hospital Sharjah
Sharjah
457

Telephone

+97165619999

Website

Alerts

Be the first to know and let us send you an email when The joint specialist posts news and promotions. Your email address will not be used for any other purpose, and you can unsubscribe at any time.

Shortcuts

Share

Category