The cost of all related investigations needed before the surgery.
The cost of Surgery including the cost of surgeon’s fee and OT.
The cost of all consumable and disposables used for the treatment in OT.
The cost of the room stays of the patient and 1 attendant including all meals as per the hospital menu.
The cost of pre surgical and post-surgical Physiotherapy / Dietetic consult during the entire hospital stay.
In room wi fi and free internet.
Needful concierge services.
Overstay more than package days,
Any other Specialty Consultations,
What is Arthroscopic Meniscectomy Partial/Subtotal?
An arthroscopic meniscectomy is a procedure to remove some or all of a meniscus from the tibio-femoral joint of the knee using arthroscopic (keyhole) surgery. The procedure can be a complete meniscectomy where the meniscus and the meniscal rim is removed or partial where only a section of the meniscus is removed. This may vary from a minor trimming of a frayed edge to anything short of removing the rim. This procedure often carried out as an outpatient in a one-day clinic and is performed when a meniscal tear is too large to be corrected by a surgical repair of the meniscus. Where non-operative therapy provides some degree of symptom relief over the long-term, these benefits may become increasingly ineffective as the affected meniscus degenerates over time. In such cases, partial arthroscopic meniscectomy can be more effective in improving patient quality of life.
Joint line tenderness and effusion.
Complaints of 'clicking', 'locking' and 'giving way' are common.
Functionally unstable knee.
Symptoms are frequently more intense by flexing and loading the knee, with activities such as squatting and kneeling being poorly tolerated because of stiffness and pain
Joint line tenderness has been reported to be the best common test for meniscal injury.
Mcmurray's test is positive if an audible pop or a snap is heard at the joint line whilst flexing and rotating the patient's knee.
Appley's test is performed with the patient prone, then hyper-flexing the knee and rotating the tibial plateau on the femoral condyles.
Steinman's test is performed on a supine patient by bringing the knee into flexion and rotation.
Ege's Test is performed with the patient squatting. A positive result is an audible and palpable click heard/felt over the area of the meniscus tear. The patient's feet are turned outwards to detect a medial meniscus tear, and turned inwards to detect a lateral meniscus tear.
MRI: has a crucial role in patients with combined injuries and the assessment of the meniscal surfaces. Abnormal findings are graded I to IV.
Grade I: Discrete central degeneration - an intra-meniscal lesion of increased signal without connection to the articular surface.
Grade II: Extensive central degeneration – a larger intra-meniscal area of increased signal intensity, again without connection to the articular surface. May be horizontal or linear in orientation.
Grade III: Meniscal tear - increased intra-meniscal signal intensity with contour disruption of articular surface. May be associated with displacement of meniscal fragments or superficial step formation.
The presence of tears in the red area versus the white areas of the meniscus is crucial as long term positive prognosis for the repair of tears is only good within the vascularised red areas.
Need of Surgery
This decision is based on several factors such as age, co-morbidities, compliance, tear characteristics (location of the tear, age and pattern of the tear) and whether the tear is stable or unstable. Where the tear is deemed to be unstable surgery is necessary. Degenerative or non-degenerative tears which are asymptomatic or stable are treated non-surgically, but treated surgically in symptomatic cases. It has then to be determined whether a meniscal repair or a meniscectomy is appropriate. Where none of the normal surgical treatments are appropriate total meniscectomy is the option. The factors taken in consideration are:
the clinical evaluation
the exact type, location, and extent of the meniscal tear
Small, degenerative meniscal tears are often treated conservatively with rest, reducing load bearing on the joint through activity modification and treating with physical therapy. Where a non-surgical approach is taken it is essential that a good level of strength is achieved and maintained in the affected leg and activities requiring pivoting or sudden changes of direction are avoided. If the tear is large, in a low vascularised region or if conservative management fails to alleviate the associated pain and joint dysfunction then surgery is the next step.
Two small incisions are made in the anterior region of the knee below the patella. A camera is inserted through one of the incisions so that the surgeon can see the inside of the knee joint on a monitor. The other incision is used to place a tool into the joint that will clip and remove the torn piece of cartilage. While the camera is inside the joint the surgeon uses this opportunity to examine the rest of the knee to make sure it is otherwise healthy.
Physical Therapy Management
Neuromuscular electrical stimulation (NMES) causes muscle contraction by applying transcutaneous current to terminal branches of the motoneuron. In subjects with knee osteoarthritis, NMES can increase quadriceps strength and improve functional performance, and has been found to be as effective as exercise therapy. NMES has also a beneficial effect on muscle mass. Other benefits of the therapy are a reduction in postoperative muscle atrophy with exercise rehabilitation.
Meniscectomy is a safe procedure even in older patients. However, regardless of age, patients with an increased comorbidity and those with a history of smoking are at increased risk of adverse events and/or readmission after the procedure.
After meniscectomy rehabilitation protocol can be aggressive, because the knee joint anatomical structures should not be overly protected during the healing phase. The rehabilitative treatment consists of ice-ultrasound therapy, friction massage, joint mobilization, calf raises, steps-ups, extensor exercise and cycling.Treatment under water cannot begin until the wounds have properly closed in order to prevent increased risk of infection. In the first week after surgery rehabilitation treatment consists of a progressive loading with crutches. Early objectives after surgery are: control of pain and swelling, maximum knee range of motion (ROM) and a full weight bearing walking. There is no load limitation, with weight bearing being as tolerated by the patient. In the subsequent 3 weeks the goal is to normalize gait and to increase knee ROM, led by the patient’s tolerance. Intensive muscle strengthening, proprioceptive and balance exercises are carried out around the third week. Return to sport/activities is recommended only when the quadriceps’ muscle strength is at least 80% of the contralateral limb. Competitive level sport is, however, not recommended until muscle strength in the affected limb is at least 90%. Patients generally return to work after 1 to 2 weeks, to sporting activities after 3 to 6 week and to competition after 5 to 8 weeks.
Phase 1: The Acute Phase (1-10 days post-op) Goals are to decrease inflammation, restore the range of motion and the neuromuscular re-education of the quadriceps. Recommended exercises in the first phase are: long arc quadriceps, short arc quadriceps, hamstring curls (open chain exercises), cycling and leg presses (Closed chain exercises).
Phase 2: The Subacute Phase (10 days-4 weeks post-op) Goals are to restore muscle strength and endurance, to re-establish full and pain free ROM, a gradual return to functional activities and to minimise normal gait deviations.
Phase 3: The Advanced Activity Phase (4-7 weeks post-op) The goals of the final phase are to enhance muscle strength and endurance, maintain full ROM and a return to sports or full functional activities. This phase is based on progression to dynamic single leg stance, plyometrics, running, and sport specific training.
Recovery will take about four to six weeks, depending on the surgical approach used. The recovery period following arthroscopic surgery is usually shorter than that for open surgery. Other factors that affect recovery time include: type of meniscectomy (total or partial).
With a partial meniscectomy, crutches may be needed until you can walk without limping. With a proper rehabilitation program, you can usually expect to resume sports within four to six weeks after the surgery.
Arthroscopic partial meniscectomy normally takes about between 20 and 40 minutes to perform, and usually you will be able to leave the hospital the same day. General anesthesia is typically used for this type of surgery, though in some cases a spinal or epidural anesthetic is used.
Most clients will begin a return to running program around the 8-12 week mark after their meniscus surgery. This provides a fair amount of time for swelling reduction, quadriceps and hip strength, and progression and training for normal walking mechanics.
A moderate tear can cause pain at the side or center of your knee. Swelling slowly gets worse over 2 or 3 days. This may make your knee feel stiff and limit how you can bend your knee, but walking is usually possible.
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