Surgeries Performed by Dr. Domb
Arthroscopic Repair of the Knee
Arthroscopic knee surgery incorporates the use of small poke-hole incisions (portals) around the joint, and the use of a specialized camera (arthroscope) among other specified arthroscopic surgical instruments. The goal of arthroscopic surgery is to repair and restore the joint to optimal strength, while maintaining range of motion. Due to the minimally invasive nature of the arthroscopic technique, damage to surrounding muscles, ligaments, tendons, nerves and blood vessels is significantly reduced. Risk of infection, post-operative pain and rehabilitation are also decreased compared to the traditional open-technique. Knee arthroscopy can accomplish both diagnostic and therapeutic results.
All knee arthroscopy patients can expect to be involved in physical therapy after surgery to strengthen and condition their knee and return to sports in peak condition.
ACL repair and reconstruction:
- ACL surgery involves the removal of damaged ligament fragments and replacement of the ligament with either the patient's own soft tissue or tissue from a cadaver; known as an autograft or an allograft respectively. ACL surgery may either be performed as an outpatient, or inpatient procedure with an overnight hospital stay.
- Recovery After an ACL reconstruction, patients can expect to bear weight as tolerated without a brace as long as there were no other injuries to the knee requiring additional surgical intervention. They may use crutches for the initial days of recovery to regain stability during ambulation. The patient will also use a continuous passive motion machine daily to prevent stiffness postoperatively.
Meniscus repair and Meniscectomy:
- Large meniscal tears and tears that fail to improve with conservative measures may require surgery. Surgery for a torn meniscus is an outpatient, arthroscopic procedure. The goal of the surgical procedure is conserve as much of the meniscus as possible. If the torn portion of the meniscus is removed from the knee, it is referred to as a partial meniscectomy. If the meniscus if can be repaired, the torn edges of the meniscus will be reattached with sutures or tacks.
- Recovery After a meniscectomy, a patient can expect to bear weight as tolerated and expect to not wear a brace, unless they have experienced an additional injury.After a meniscal repair, a patient can expect to have restricted weight bearing and use crutches for 2-6 weeks. This protects the repair during the early healing phases.
Recurrent Patellar Dislocation Surgical Repair:
- Patella, or kneecap, dislocations can occur with extremes of knee pivoting and rotation. Generally this involves the patella slipping laterally, or to the outside of the knee. After the first dislocation, conservative measures are pursued including rest, bracing, physical therapy and anti-inflammatories. A severe dislocation causes disruption of the medial patellofemoral ligaments, which act to stabilize the patella. If this injury becomes recurrent and the patient has continued instability of the knee, arthroscopic surgical intervention may be necessary to repair the Medial Patellofemoral Ligament.
- Recovery After a MPFL reconstruction, the patient can expect to have restricted weight bearing and crutches for approximately 6 weeks. Patients can also expect to be in a knee brace for approximately 6 weeks.
Other Knee Surgeries
Quadriceps or Patellar Tendon Rupture Repair:
- Severe traumatic injuries can cause rupture to the quadriceps or patellar tendon. Quad tendon ruptures are more common in patients over 40 years old, while the majority of patellar tendon ruptures are seen in patients younger than 40 years old. As the extensor mechanism of the knee has been disrupted, patients generally have severe difficulty bearing weight on the leg or holding the leg straight. Severe tears will require open surgical intervention for repair.
- Recovery After a quadriceps or patellar tendon reconstruction, the patient can expect to have restricted weight bearing and crutches for approximately 6 weeks. Patients can also expect to be in a knee brace for approximately 6 weeks.
- All knee tendon repair patients can expect to be involved in physical therapy after surgery to strengthen and condition their knee and return to sports in peak condition.
Microfracture of the Knee
The smooth movement of the knee is attributed to articular cartilage, a smooth tissue that lines the bones of the joint, acting as a shock absorber and reducing friction when the bones glide over each other. Wear and tear and injury of the cartilage can lead to pain and impaired function. Since it is a complex avascular tissue and has no blood supply, it is unable to repair itself. Microfracture is a procedure performed to repair damaged knee cartilage by drilling small holes into the knee joint to create a new blood supply and stimulate new cartilage growth.
Microfracture is performed under local, spinal or general anesthesia. A small incision is made on your knee to insert an arthroscope, a narrow tube with a tiny camera at its end that enables clear visualization of the inside of your joint. Another incision is made through which specially designed instruments are inserted. Your surgeon prepares the area by removing any damaged cartilage. Multiple tiny holes called microfractures are then made into the subchondral bone (below the cartilage) with a sharp tool called an awl. This helps to bring blood supply from the deeper more vascular bone to the surface tissues. This technique creates a nourishing environment for tissue regeneration by using the body’s natural healing abilities to form new cartilage.
Following microfracture, your surgeon will recommend physical therapy to help restore motion of the operative joint. Immediately after the surgery, most patients can begin physical therapy with a continuous passive motion machine or CPM. You will be instructed on using crutches to avoid weight bearing activities for a few days. You will be allowed to return to sports or other intense activities 4 months after surgery.