Knee Surgeries

One knee, many possible problems – get the right treatment, with Dr. Murtuza Rassiwala, Hakimi Ortho Care

The knee does quite a bit of work. It bears your weight when you walk, is a deep bend when you sit on the floor, twists when you turn on a cricket pitch and absorbs the impact when you go down a stair case. It is one of the most injured and worn out joints in the body because it is used for both weight-bearing as well as twisting and bending.

All knee problems don’t require the same solution. A 19-year-old footballer whose knee buckles after a sudden change of direction needs a very different plan than a 65-year-old whose knee has become painful and bowed over 10 years. This page aims to list all knee procedures offered by Dr. Murtuza Rassiwala, an arthroscopic and orthopedic surgeon in Indore, and how each procedure fits into the larger picture. Use this to get a feel for what your options are likely to be before you come in, and then read the dedicated page for any procedure that applies to you.

Surgery is just one part of knee care. Many knee problems settle down with physiotherapy, a brace, changing activities or medicines and a large part of each consultation is spent deciding whether an operation is needed at all.

Quick answer: Knee surgery at Hakimi Ortho Care, Indore include keyhole (arthroscopic) procedures for ligament, meniscus and cartilage injuries, or partial and total knee replacement for arthritis. Dr Murtuza Rassiwala will only recommend surgery after examination, relevant imaging and discussion of options for non-surgical alternatives.

Knee Surgery at Hakimi Ortho Care at a Glance

How the Knee Works – A Simple Guide

A little knowledge of anatomy is very helpful in understanding what a doctor is telling you, and why he recommends a certain procedure.

• The Bone: Knee has 3 bones. The thigh bone (femur) is above the shin bone (tibia) and the knee cap (patella) slides in a groove on the front of the femur. The fibula is a thinner bone on the outside of the leg . It provides a place for important ligaments to attach but it doesn ‘t bear a lot of weight .
• The Joint Surfaces: Articular cartilage is a smooth, white, low-friction layer a few millimeters thick covering the ends of the femur and tibia and the back of the patella. Articular cartilage has no blood supply of its own and does not heal well when damaged.
• The Meniscus: Between the femur and tibia are two disks of tougher cartilage, shaped like the letter C: on the inside is the medial meniscus, on the outside the lateral meniscus. They function as shock absorbers, spreading the load across the joint and adding stability. Only the outer edge of each meniscus has a good blood supply, and that determines whether a tear can be repaired.
• The ligament: The knee is held together by four major ligaments. The anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) cross in the center of the knee and control backward and forward motion and rotation. The medial collateral ligament (MCL) on the inner side and the lateral collateral ligament (LCL) on the outer side oppose lateral forces. And there are supporting structures that work together with them , in the back corners of the knee . Posterolateral corner .
• The Joint Lining: The synovium is the thin lining of the joint. It secretes synovial fluid, which nourishes the cartilage and lubricates movement. When irritated or diseased it swells and thickens by producing excess fluid.
  The Muscles: As you walk down stairs, the quadriceps at the front of the thigh straighten the knee and control it; the hamstrings at the back bend it and help protect the ACL. Almost any knee condition improves when the muscles around it are strong and well coordinated.

Common Knee Problems Treated

Knee problems are generally divided into injuries, wear-and-tear problems and inflammation problems. Each group tends to produce a recognizable pattern of symptoms.

• Sports and Twisting Injuries: A sudden change in direction, a clumsy landing or a tackle can tear the ACL or meniscus. Patients usually report a pop, rapid swelling in a matter of hours, and an inability to continue playing. Weeks later, the knee may feel unstable when turning.
• Direct Blows and Road Traffic Accidents: Two wheeler accidents are frequent on Indian roads and often result in knee injury due to a dashboard type blow or fall on a bent knee. These mechanisms are associated with PCL injuries, collateral ligament injuries and fractures.
• Degenerative Meniscus Tears: As you get middle-aged, the meniscus loses its elasticity and can be torn by very small movements such as squatting or getting up from the floor. Many of these tears are related to early arthritis and many are best treated nonoperatively.
• Damage to Cartilage: A specific area of damaged cartilage can occur after an injury, a dislocated kneecap or conditions such as osteochondritis dissecans, causing pain, swelling and sometimes catching.
  Loose Bodies: Loose pieces of cartilage or bone may break off and float in the joint sometimes becoming trapped between surfaces causing sudden locking.
• Arthritis: Osteoarthritis gradually destroys the surfaces of the joint. Rheumatoid and other inflammatory arthritis damage the joint by inflammation of the lining of the joint, the synovium. Advanced arthritis causes pain, stiffness and deformity every day.
• Inflamed Joint Lining: If the swelling continues due to rheumatoid arthritis, pigmented villonodular synovitis or certain other conditions, the diseased synovium may have to be removed.

Warning Signs That Need a Knee Assessment

Some knee pain will settle down with a few days of rest. Other symptoms suggest structural damage and should be checked by an orthopedic surgeon. If you experience any of the following, get assessed:

• Swelling in a few hours after injury, usually from bleeding into the joint from a ligament tear or fracture.
• Knee giving way when walking or turning or on stairs.
• Locking, when the knee becomes stuck and cannot be straightened until it is wiggled free.
• ainful catching or clicking on the inner or outer joint line.
• Can’t put weight on after fall or accident.
• Obvious deformity or change in the shape of the knee.
• Pain that interferes with sleep or persists for more than a few weeks despite rest.
• Stairs, difficulty getting up from a chair or squatting, progressively worse.
• A swollen knee with redness, warmth and fever that needs urgent medical attention to exclude infection.

Early assessment of sports injuries is very important. Repeated giving way of the knee can lead to further damage to the meniscus and cartilage, which may limit future treatment options.

How Knee Problems Are Diagnosed

Never is this step hurried because an accurate diagnosis rules out all that follows.

• Complete History: Questions such as when and how the problem started, where exactly was the knee when the injury happened, did it “pop” or swell right away, what activities now cause trouble are asked by Dr. Rassiwala. If it is long-standing pain he asks about stiffness, nite pain, previous treatment and how far you can walk.
• Physical Examination: Some clinical tests help to know which structure is injured. The ACL is tested with the Lachman and pivot shift tests; PCL injury is suggested by posterior drawer and sag signs; the MCL and LCL are evaluated with stress testing with the knee straight and slightly flexed; and meniscus tear is suspected with joint line tenderness and rotational tests. Kneecap, hip, leg alignment and muscle strength are also tested.
• X-ray (Radiography): X-ray images reveal bones, alignment, fractures, loose bodies with bone, and joint-space narrowing, as seen in arthritis. X-rays standing are better for arthritis because they show the joint under body weight.
  MRI scan: MRI is good at showing up soft tissues such as ligaments, menisci, cartilage, bone bruising and the synovium. It is especially useful after injury and prior to arthroscopic surgery. It is not necessary for every knee problem.
• Other Tests: If infection or inflammatory arthritis is suspected, blood tests may be suggested. Fluid may be removed from an inflamed joint and examined. Complicated fractures or bone defects sometimes need CT scans.

Choosing the Right Treatment – How Decisions Are Made

Several factors influence the recommendation for any knee problem:

• The precise diagnosis, and the presence of multiple structures.
• Age and activity level (sport, occupation, daily routine).
• Symptoms are not just scans – a tear on MRI that causes no trouble may not need surgery.
• Knee stability as repeated giving way can damage other structures.
  – cartilage status, which is the basis for choosing between joint-preserving surgery or replacement.
• Non-surgical treatment already attempted has not been successful.
• General health and fitness for anesthesia.
• Your own goals and preferences once you understand the benefits, risks and recovery demands.

It is reasonable for two patients to get two different advice on the same MRI report. A recreational walker with a partial ACL tear may be fine with physiotherapy, but a competitive kabaddi player with the same injury and repeated instability may be better off with reconstruction.

Non-Surgical Knee Treatment

The first step in treatment is conservative, and for many conditions, this is the only step needed.

• Physical Therapy: Targeted exercises restore movement, rebuild the quadriceps and hamstrings, improve balance and correct movement patterns. Physiotherapy is also important pre and post almost any knee surgery.
• Braces and Supports: Hinged braces protect collateral ligaments while they heal. Unloader braces can reduce pain in patients with unicompartmental knee osteoarthritis. Simple supports may provide confidence during early return to activity.
• Medication: Flares can be helped with careful, appropriate use of pain relievers and anti-inflammatory medicines.
• Injection: Steroid injection can help settle an acutely inflamed arthritic knee. Other injectable options are discussed individually with a clear explanation of what the evidence does and does not support.
• Activity and Weight Changes: Reducing activities with a high impact or deep squat, but developing strength and controlling body weight, decreases the load on painful joints.

Knee Procedures Offered by Dr. Murtuza Rassiwala

The following are descriptions of the individual knee procedures offered at Hakimi Ortho Care. Each procedure has its own detailed page covering the condition, surgical steps, recovery.

• Total Knee Arthroplasty (Total Knee Replacement): Arthritis had eroded the cartilage from most of the knee, so the total knee arthroplasty resurfaces the damaged ends of the femur and tibia – and often the kneecap – with metal and plastic parts. It is considered for patients whose pain, stiffness and deformity continue to impact walking, sleep and independence after well-tried non-surgical care. A big part of the surgery is to fix the bow-legged or knock-kneed alignment that often goes with arthritis.
• Partial Knee Replacement Surgery: Some people have arthritis in only one part of the knee, usually the inside, but the ligaments and the rest of the cartilage are healthy. Partial (unicompartmental) replacement resurfaces only the worn part of these knees. It may seem more natural to some people as it retains more of the patient’s own knee, but careful selection is important as not every arthritic knee qualifies.
• ACL Reconstruction: When completely torn, the anterior cruciate ligament rarely heals on its own. The ACL is replaced by a graft (usually from the patient’s hamstring tendons or patellar tendon) that is placed through small tunnels made in the femur and tibia using an arthroscopic technique. The aim is to provide stability of the knee during turning, pivoting and jumping. Recovery requires a staged rehabilitation process over several months before return to sport.
• PCL Reconstruction: The posterior cruciate ligament is thicker and less commonly injured than the ACL, usually by a direct blow to the front of the shin with the knee bent. Isolated partial PCL injuries often do well with rehabilitation. Complete tears causing symptoms or with a torn PCL and other ligaments are considered for reconstruction.
• MCL Repair/Reconstruction: The medial collateral ligament on the inside of the knee is well supplied with blood and so most injuries to the MCL heal with a hinged brace and physiotherapy. Surgery is considered for severe tears that are still unstable or for injuries with a displaced ligament or combined ligament injuries.
• LCL Reconstruction or Repair: The lateral collateral ligament on the outside of the knee heals less predictably than the MCL, and LCL injuries often involve neighboring structures at the back-outer corner of the knee. Major tears that make the joint unstable outwardly may need to be repaired or reconstructed, sometimes along with cruciate ligament surgery.
• Meniscus Repair or Partial Meniscectomy: If a torn meniscus causes locking or persistent mechanical symptoms, it can be treated arthroscopically. If the tear is in an area of good blood supply and the tissue is healthy, the preferred method is to stitch it (repair) so that it can keep the natural shock absorber of the knee. When repair is not possible, only the torn, unstable portion is trimmed (partial meniscectomy) keeping as much healthy meniscus as possible.
• Diagnostic Knee Arthroscopy: Sometimes the symptoms continue and the diagnosis is still unclear after examination and imaging. In diagnostic arthroscopy, a surgeon can see directly inside a joint through a tiny camera and, in many cases, can treat the problem at the same time.
• Chondroplasty: Chondroplasty is performed using arthroscopic instruments to smooth frayed or unstable edges of damaged articular cartilage. It is used to reduce catching and irritation from loose flaps of cartilage. It does not make the cartilage grow back and is not a treatment for arthritis that has spread.
• Surgery for Cartilage Regeneration: In younger, active patients, techniques that stimulate or restore cartilage may be considered for well-defined areas of cartilage loss. These include marrow stimulation procedures. Other restorative procedures are based on the size and location of the defect.
• Osteochondral Defect Repair: Some injuries injure the cartilage and bone underneath. The goal of osteochondral defect repair is to restore this combined surface, by fixing a loose fragment back into place or by filling the defect, depending on the patient’s age and the size and stability of the lesion.
• Removal of Loose Bodies: Loose fragments of bone or cartilage can cause sudden painful locking. These fragments are removed arthroscopically . When possible , the surgeon also searches for and removes the source of the fragment.
• Synovectomy: In diseases like rheumatoid arthritis or pigmented villonodular synovitis, persistent inflammation and thickening of the joint lining can be treated by removing the diseased synovium, reducing swelling and pain. It is commonly performed arthroscopically and often combined with medical treatment.

Arthroscopic Versus Open Knee Surgery

Many of the above procedures are performed arthroscopically. Knowing the difference helps set expectation.

But the small incisions don’t always mean a short recovery. While meniscus trimming walking may be possible within days, a meniscus repair or ACL reconstruction requires protection and months of rehabilitation as the repaired tissue needs to biologically heal.

What to Expect Around Knee Surgery

Each procedure has its own details, but the general pathway is pretty much the same for most knee surgeries.

• Before Surgery: You will have blood tests and a medical examination to check that you are fit for anesthesia. Some medicines, like blood thinners, may need to be changed on medical advice. Many patients benefit from starting physiotherapy before surgery to reduce swelling, regain full straightening and strengthen the thigh muscles – sometimes called “prehabilitation”. Especially during ligament surgery, a calm, well-moving knee when you walk into the operating room helps you recover.
• Anesthetics: Most knee operations are performed under spinal anesthesia, sometimes with a nerve block for pain relief after the operation. Appropriate cases are done under general anesthesia.
• Inpatient care: Arthroscopic procedures have short stay, sometimes day care or one nite stay depending on procedure and patient. Ligament reconstruction and replacements of the knee usually take a longer stay.
• Post- Surgery: You’ll have pain relief, ice, elevation, early muscle activation and a procedure-specific physiotherapy plan that starts quickly. Others, such as meniscus repair or some cartilage procedures, require crutches and a period of protected weight-bearing. Some procedures allow full weight-bearing immediately.
• Follow Up: Your surgeon can assess progress, adjust the rehabilitation plan and determine when you can drive, work and return to sport by examining the wound, removing stitches and

Rehabilitation – The Other Half of Knee Surgery

Surgery fixes or replaces the damaged structure, but rehabilitation restores the function. The broad stages are:

Timing of each phase differs widely among procedures. You are provided detailed timelines on each procedure page and your plan is tailored to your progress not just the calendar.

Cost of Knee Surgery in Indore

Price of knee surgery depends on the procedure, and can vary quite a bit. The final amount depends on the following:

•  Type of procedure: arthroscopy, ligament reconstruction or joint replacement.
• Used implants, fixation devices and graft materials.
• HOSPITAL & ROOM CATEGORY.
• Number of days in hospital.
• Pre-operative work-ups and medical clearance.
• Post-operative physiotherapy and follow-up care.

After your consultation your diagnosis and treatment plan is confirmed and you are provided with a clear written estimate.

Insurance and Cashless Treatment

Most medically necessary knee surgeries are covered by health insurance policies depending on the policy terms, waiting periods, sub-limits and exclusions. Check with your insurer or TPA to see if they offer cashless treatment at the hospital where the surgery will be performed. The pre-authorisation paperwork can be helped with by the clinic team.

Knee Problems at Different Stages of Life

Different advice can be given for the same symptom for the reason that the most likely cause of knee pain changes with age.

Young People and Teenagers: Sports injuries are the main cause in this group. Common injuries include ACL tears, meniscus tears in younger, healthier tissue, kneecap dislocations and cartilage injuries . Osteochondritis dissecans may occur in adolescents, when a piece of bone and cartilage loses its blood supply and may become separated. Because young meniscus and cartilage tissue has more healing potential and these patients have decades of knee use ahead, joint-preserving surgery – repair rather than removal – is prioritized whenever feasible.
Working Adults in Their Thirties and Forties
Injuries to the ligaments from recreational sport and road accidents are still happening in this population and early cartilage wear is beginning to be seen, particularly in knees with previous injury or an old meniscus removal. Many individuals in this age group have demanding jobs and family responsibilities so the timing of surgery and the length of time away from work become important parts of the discussion.
Middle Age – 50s and Early 60’s: Degenerative meniscus tears and early to moderate osteoarthritis are common entities. It is important for patients in this group to know that arthroscopic “clean-up” of an arthritic knee is generally not recommended solely for the purpose of arthritis pain, as studies have shown limited benefit. Treatment may include exercise-based treatment, weight management, and partial knee replacement or osteotomy (where the arthritis is limited to one compartment).
Older people: The primary concerns become advanced osteoarthritis, deformity and stiffness. If conservative treatment has not helped and your daily life is significantly limited, knee replacement may be an option. Bone strength, balance, fall risk, medical conditions such as diabetes, heart disease and kidney function determine the plan.

Knee Injuries in Popular Sports and Activities

Patterns exist in knee injuries in different sports, and knowing these patterns helps players determine when an injury needs assessment.

• Cricket: Fielders can injure the meniscus or ACL when they dive, stop short or change direction quickly in pursuit of a ball. Fast bowlers often repeatedly “load” the front knee on landing, which over a long season can put stress through the cartilage and tendons.
• Football & Kabaddi: Both involve cutting, pivoting and contact in quick succession. These sports carry a known risk of ACL tears, collateral ligament sprains and meniscus injuries, sometimes at the same time.
• Badminton, Pickleball and Paddle Games:
  On indoor courts, short bursts of lunges and abrupt stops can damage the meniscus, strain the tendons around the knee and, less frequently, tear the ACL. Paddle sports have exploded in popularity among middle-aged adults and many of these players have no conditioning experience.
• Running & Gym Training: Acute tears are not as common as overuse problems like patellar tendon irritation, pain around the kneecap and iliotibial band pain. Bad technique on deep weighted squats can irritate pre-existing cartilage damage.
• Bicycle Accidents: Falling from a scooter or motorcycle can result in a direct blow to the front of the shin or side of the knee, injuring the PCL, collateral ligaments or bone. Always examine these injuries even if the patient can walk as combined ligament injuries are easily missed.

Protecting Your Knees – Practical Prevention

Not all knee problems can be prevented, but there are a few things you can do to decrease the likelihood of injury and reduce the rate of wear.

• Strengthen the thigh and hip muscles with routine exercises. Strong muscles help absorb the load that would otherwise pass through the joint.
• Warm up before sport and work in balance and landing-control drills, which research in sports medicine has shown to help reduce ACL injury risk in athletes.
• Don’t go from zero to 60; build up your training gradually, and avoid intense or unfamiliar sport.
  Wear appropriate footwear for the surface and the sport.
• Keep your body weight healthy. This will lower the stress on your knee during normal daily activities.
• Don’t return to sport too soon after injury; incomplete rehabilitation is a common cause of re-injury.
• Get an early assessment for locking or recurrent giving way rather than playing through it multiple times.

Returning to Daily Life in Indian Homes After Knee Surgery

In many Indian homes, daily chores involve positions that put a lot of stress on the knee. These are things to plan for before any operation.

• Sitting and Crossed-Legged Postures: Deep knee bending is required for floor sitting during meals, prayer or family gatherings. This is usually restricted for a period after surgery to the ligaments or meniscus and then gradually reintroduced depending on healing. Sitting deep on the floor may still be hard or discouraged after knee replacement to protect the implant.
• Toilets: An Indian toilet requires you to do a full squat. For most knee surgeries, a Western-style toilet or portable commode chair is highly recommended for the early recovery period.
• Stairs: Indore many homes have no lifts with stairs. Patients are taught the safe technique before discharge – the stronger leg going up and the operated leg going down.
• Two Wheeler Riding: Scooters and motorcycles require strength and knee control to balance and kick-start. Your surgeon will advise you when it is safe to do this and it is usually later than you will be able to walk independently.
• Religious and Social Commitments: Patients often time surgery around festivals, weddings and pilgrimages. Mentioning these dates at the first visit helps to plan surgery and rehabilitation realistically.

Seeking a Second Opinion

Knee surgery is a major decision, and it’s completely understandable to want a second opinion. Dr. Rassiwala reviews the reports, MRI scans and previous surgical notes, performs a new examination of the knee and informs us if he concurs with the suggested plan or would recommend an alternative. “Bringing in the actual MRI images or CD, not just the written report, allows for a more comprehensive assessment.

You might want to get a second opinion if you are told you need an operation but your symptoms are not very bad, or if you are in continuing pain but have been told that nothing can be done. Either way, a new perspective can help you determine whether the advice applies to your actual circumstances and goals.

Questions Worth Asking at Your Knee Consultation

Patients often leave an appointment with questions they didn’t think to ask. It helps to write them down beforehand. Useful questions might include:

• What is wrong with my knee and what is the source of my symptoms?
• Will this condition improve without surgery and how long do I wait to try non-surgical treatment?
• Will delaying surgery put my knee at risk for further damage?
• What procedure do you recommend and why is it better for me than the other options?
• Will the procedure be performed arthroscopically or with an open incision? How long will I be in hospital?
• When can I walk around unaided, drive, return to work and play sport?
• How much physiotherapy will I need and can I do some of it at home?
  • What are the risks for someone my age and health specifically?
• How much is the treatment going to cost, and will my insurance cover it?

Dr. Rassiwala welcomes these questions and encourages family members to participate, since they often help with recovery at home.

Why Consult Dr. Murtuza Rassiwala for Knee Surgery in Indore

• Arthroscopy & Joint Replacement Training: Dr. Rassiwala did his MBBS from Baroda University (2013) and DNB in Orthopedics from National Board of Examinations (2018). He is also MNAMS, F.I.A.S.M. and F.I.A.J.R. (fellowships). His training in arthroscopy and joint replacement allows him to manage the full range of knee problems from a ligament tear in a young athlete to an arthritic knee in an elderly patient.
• When Possible, Preserve Joint Function: The first is the option to save the knee — repairing a meniscus rather than removing it, or treating a cartilage defect before it becomes arthritis.
• A Simple Reason For Each Option: Patients are shown their imaging, told what is and is not causing their symptoms and given a realistic picture of recovery time and limitations.
• Recovery led by rehabilitation: All treatment regimens include physiotherapy guidance, both before and after surgery.
• Convenient Locations: We have two clinics of Hakimi Ortho Care in Indore where we provide consultation and follow-up visits.

Book Knee Consultation in Indore

Whether your knee problem started suddenly with an injury or developed over years, the first step to the right treatment – surgical or not – is a thorough assessment.

Book your appointment with Dr. Murtuza Rassiwala at Hakimi Ortho Care, 106 Badshah Chambers, Jawahar Marg or 6 Phadnis Colony, Manik Bag Road, Indore. You can call +91-7224888071, 0731-4981538 or 0731-3695285 or Book Online.

Medically reviewed by: Dr. Murtuza Rassiwala, MBBS, DNB (Orthopaedics)