RESPECT AND CONSERVATION OF TISSUES, CARTILAGINOUS RECONSTRUCTIONS AND KNEE PROSTHESES WITH ADVANCED PROCEDURES

The knee orthopaedics surgeons of Clinica San Francesco always adopt the philosophy of a progressive and continuous technological development, aimed at reducing operation invasiveness. The arthroscopic approach materializes in a greater respect and conservation of tissues, translating into a smaller painful symptomatology and more rapid rehabilitation times for patient. Most patients start walking again few hours after operation and recover the knee functionality in few weeks.

The unit directed by MD Piergiuseppe Perazzini, one of the best Italian knee surgeons, carries out all main meniscus, ligament and cartilaginous knee arthroscopy operations, resorting even to donor tissues (through the human tissue bank) and biotechnologies (cell cultures, growth factor graft, precursor graft of cartilage/bone cells, mesenchymal cells) for cartilaginous reconstructions.      

Knee arthroscopy

Meniscus, ligament and cartilage operations

At the Clinica San Francesco, every meniscus and knee ligaments reconstructive operation is carried out in arthroscopy, a percutaneous procedure that allows to see and operate within articulation, thanks to a mini video camera and small tools introduced by minuscule incisions. The procedures change according to the type of patient and specific clinic case.

In most cases, for reconstruction of anterior or posterior cruciate ligament, the double knee flexor tendons (autologous transplantation) are used, but even the patellar and quadriceps tendon graft, the donor tendons (by human tissue bank) and, in selected cases, artificial tendons.

For the treatment of complications connected to meniscus, the approach is to protect as much as possible the structures, sacrificing only irrecoverable parts of them and suturing them when is possible or substituting with meniscus prostheses or donor menisci.

For treatment of cartilaginous injuries the options are various and aimed at fixing the specific existing damage. It ranges from autologous osteocartilaginous grafts (of same patient) to heterologous ones and cell cultures (carried out in laboratory, starting from sampling of patient’s cartilage fragment with subsequent graft on damaged area), till the associated (or not) microfractures and growth factors and mesenchymal cells.

Patellofemoral surgery

In this ambit are treated the diseases of articulation malfunctioning derivated from trauma or defective constitutional alignment. The used procedures range from levigation of weared out surfaces (endoscopic shaving), to microfractures, cartilage transplantation, articular balancing (lateral release, endoscopic plicatures of inner alar) until the reconstruction of medial patellofemoral ligament (with various procedures). The proximal and/or distal realignment of extensor apparatus is reserved for cases featuring important defects of patella flow.

Knee replacement surgery

Anallergic prostheses and solutions for patients with prosthetic failure history

At the Clinica San Francesco are carried out operations of knee partial or total replacement surgery, using anallergic arthroprostheses for metal allergic patients (as, in spite of hip prostheses, the knee ones, in femoral component, are realized with a metal alloy containing nickel, chrome and cobalt that are metals to which more frequently the contact allergies develop. The prosthetic designs are various and similarly the type of fixation (strengthened, not strengthened, hybrid).

The prosthetic application procedures are various: the traditional (using precomposed incision masks on the basis of a postoperative radiologic study), the experienced (turning to a intraoperative system that can provide detailed information on the components positioning) and the robotic (partial or unicompartimental and total implants applied with Mako Rio Robot system). The choice of implant type and application procedure is done on the basis of shared criteria and guidelines, trying to give the patient the best solution for his/her specific problem.

The revision surgery of prosthetic failures represents an ample area of work, extremely difficult, technically complicated, using prosthetic models and different procedures depending on cases, and turning to also to donor transplantations in failures with important destruction of bone tissue.

Both infections (with the support of infectious disease specialists) and mobilizations are treated with very satisfactory results. This is a sector in progressive expansion owing to the growing number of implants and length of average life.

Finally the traumatologic field uses procedures and instruments allowing the reconstruction of damaged structures and the functional recovery as quickly as possible.

Postoperative antalgic treatment

In postsurgical phase the patient is followed by an anesthetist who takes care of prevention and treatment of prosthetic painful symptomatology, turning to the most innovative procedures (selective block of nervous branch, peridural tubes, continuous administration of analgesic minidoses, et cetera) and the use of state of the art drugs.