Monday, February 20th, 2012
This is a 40s female who presented with progressive and disabling anterior knee pain . Her condition had been getting progressively worse to the extent that she was no longer able to participate in even routine activities without having substantial discomfort followed by swelling. She had undergone prior surgery for the knee and recently had a second procedure done which was a lateral release and micro fracture. She was scheduled to have the same procedure performed for the opposite knee however since she had not gotten acceptable pain relief came to see us for a second opinion.
We made a diagnosis of advanced osteoarthritis of the patellafemoral compartment and based on the advanced nature and pattern of the cartilage loss recommended a resurfacing procedure for effective and durable pain relief. Arthrosurface implants were used for the resurfacing ( image 1,2). Note the implants and how they are surgically implanted to match the complex curved geometry of the knee. She achieved an excellent result from the procedure with no further symptoms of pain or swelling.
The following video is at her most recent visit to schedule the identical procedure for the opposite knee. The video shows the cosmetic incision as well as restoration of full knee motion (video).
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Thursday, February 2nd, 2012
This is a 17 year old female who sustained an injury to her left knee while playing Lacross. Her MRI showed a tear of the ACL. Image 1 torn ACL. Image 2 After torn ACL was derided. Image 3 you can see the new ACL graft now in place.
Tuesday, January 24th, 2012
Image 1 and 2 show a postop knee only 6 days from the surgical procedure. The muscles are not disrupted during the procedure and therefore the patient has achieved active functional range of motion almost immediately after the operation.
Image 3 shows a minimal incision which is barely noticeable after it heals. Image 4 shows that the patient is less then a week from surgery and is able to stand and walk independently. He is taking only occasional pain medication and has already started physical therapy.
Tuesday, January 24th, 2012
This is a 28yo man that sustained a traumatic injury to his knee. He underwent initial arthroscopic surgery in 2001 by another surgeon at which time he was noted to have damaged the cartilage surface of his knee. He continued to have pain and swelling in the knee.
A repeat arthroscopic surgery performed by Dr. Montalbano in 2007 showed 2 full thickness cartilage defects in the femoral condyle.
He underwent Autologous Chondrocyte Implantation. This is a procedure by which a small cartilage biopsy is taken from the joint and is sent to a specialized facility in Mass. where the cartilage cells are proliferated.
As a second stage procedure the cells are transplanted into the defects (Image 1) which are covered with a collagen patch (Image 1) The transplanted cartilage cells (chondrocytes) will eventially produce matrix and the cartilage defects will be filled in with new cartilage tissue. A second look arthroscopic procedure shows the cartilage defects have healed (Image 2,3,4)
Tuesday, January 24th, 2012
This woman came to our office complaining of bilateral knee pain and also complaining of a progressive bow-legged deformity and difficulty waking. She was diagnosed with osteoarthritis and elected to undergo reconstructive joint surgery.
The procedures were done in a staged fashion with the left knee being done first followed by the right knee 1 year after the first surgery. 2 months following her second surgery she has restoration of normal alignment and motion (image 1,2) as well as nice cosmetic result utilizing a small incision and muscle sparing approach (image 3).
Also notice how the appearance of the incision fades with time when comparing the left knee which is 1 year old vs. the right knee which is only 2 months old (image 4). In this video you can see how she walks in the office with no pain, restored alignment of her legs and normal strength and motion at 1 yr postop left knee and 2 months postop right knee. (Video)
Tuesday, January 24th, 2012
Image 1 and 2 demonstrate a reconstruction of the medial compartment of the knee using a mobile bearing. The remaining 2/3rds of the knee remains natural.
Image 3 – 2 weeks postoperative; is full weight bearing and walking with a cane; the procedure is done through a minimally invasive 3 inch incision and discharge was within 23 hours of the procedure.
Image 4 and 5 – 2 weeks postoperative; has regained functional range of motion.
Monday, December 19th, 2011
This is a case of a fifty-something yo female who presented to us after sustaining a knee injury. Her xrays were normal (image 1,2). She underwent an arthroscopic procedure and was found to have a cartilage defect on the medial femoral condyle (image 3). A micro fracture procedure was performed.
1 year after the procedure she continued to have knee pain. A second look arthroscopy showed healing of the cartilage defect with fibrocartilage (image 4), however the quality of the tissue was poor and when stressed using a blunt probe cracked easily (image 5).
The reconstruction that was done was a resurfacing implant (Arthrosurface). This implant was used to reconstruct the medial femoral condyle by filling the cartilage defect as opposed to doing a more traditional procedure – total knee replacement (image 6,7).
One of the many advantages of this procedure is that the surface of the knee can be reconstructed with the removal of very little adjacent tissue during preparation of the bone. Also , the procedure is done through a minimally invasive exposure, is ambulatory and immediately weight bearing. Also, the kinematics of the knee are not changed as a result of the procedure and there are no anticipated limitation in regard to activities – run, jump, twist etc.
This is a wonderful reconstructive option for appropriately selected knees and a much better option then knee replacement for limited cartilage loss.
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Monday, December 19th, 2011
This was a twenty-something girl that sustained a fracture of her knee-tibia plateau- after sustaining a fall. She was seen in the ER after the accident and then came to us for treatment. A CT scan of the knee shows the depressed fracture of the lateral plateau in addition to fractures lines that separate the medial condyle from the main segment ( Images 1,2). The treatment was surgical and included open reduction of the fracture utilizing simultaneous radiographic and arthroscopic guidance to elevate the depressed segment and achieve an anatomic reduction of the fracture line inside the joint (image 3).
Following reduction of the fracture the fragments and bone graft were held in place using a peri-articular locking plate and screws (image 4,5). To minimize the length of the surgical scar the plate and screws was applied percutaneously. The plate was slid down the leg underneath the muscle through the incision at the knee and the screws were placed through tiny incisions in the skin and blunt dissection through the muscle.
This technique of plate application (MIPO) is an advanced technique for fracture surgery and has the advantages of improved cosmetic result (image 6) as well as less pain and a quicker recovery after surgery. This patient did very well after surgery and has returned to all of her activities without pain. She recovered quickly and regained full motion of her knee (image 7).
Tuesday, December 6th, 2011
This patient had a total knee replacement done on her left side by another surgeon (note the length of the incision highlighted with a purple marker- the incision extends from her mid thigh to well below the knee and measures over 10 inches in length). She then had a total knee replacement done on the right side by Dr Montalbano using a minimally invasive technique (note the length of Dr Montalbano’s incision which is just over the front of the knee and only 4 inches in length). This minimally invasive technique which does not require detachment of the muscle allows for not only a much more cosmetic result but a much faster recovery after surgery with much less discomfort.
Tuesday, December 6th, 2011
This is a woman who presented with severe persistent knee pain that had substantially reduced her functional abilities and dramatically reduced her quality of life.
Note on the preoperative X-ray (image 1,2) the arthritic changes including joint space loss and osteophyte formation (bone spurs). Following the surgery (image 3,4) x-rays show implants that have restored the joint with normal alignment Note the ultra-small incision size, in this patient 3.5 inches (image 5). The overall result is a satisfied patient (image 6).
Dr Montalbano uses a minimally invasive surgical technique to perform the procedure whereby the muscles around the knee are maintained. This is a special technique that is not utilized by many surgeons. The advantages of this technique include less post-surgical pain, a much faster and complete recovery after surgery.
