The musculoskeletal system, a complex network of bones, joints, muscles, tendons, and ligaments, is responsible for the body’s form, stability, and movement. When this system is compromised by trauma, chronic disease, or degenerative wear, a variety of medical and surgical procedures are used to restore function and relieve pain. These interventions range from minimally invasive diagnostic tools to extensive joint replacement surgeries.
Restoring Severely Damaged Joints
Severe joint damage, often caused by advanced osteoarthritis or rheumatoid arthritis, requires arthroplasty, or joint replacement surgery. This involves removing the damaged joint surfaces and replacing them with artificial implants (prostheses) made of metal, plastic, or ceramic components. Hip and knee arthroplasties are the most frequently performed, as these joints endure high weight-bearing stress.
Total joint replacement involves resurfacing both sides of the joint. A partial replacement (hemiarthroplasty) addresses only one damaged surface, such as the femoral head or a single compartment of the knee. Shoulder replacement is also common, performed either as an anatomic replacement or a reverse replacement for patients with significant rotator cuff damage. These procedures alleviate chronic pain and restore motion.
Stabilizing Acute Trauma
Acute traumatic injuries, particularly fractures, necessitate interventions focused on realigning and stabilizing the bony segments to promote proper healing. Non-surgical methods, such as casts, splints, or braces, are employed for simple, non-displaced fractures to hold the fragments externally. More complex injuries, like displaced or comminuted fractures, often require surgery.
Open Reduction Internal Fixation (ORIF) is a common surgical approach. An incision is made to manually realign the bone fragments (open reduction), which are then held securely in place with internal hardware (internal fixation) such as metal plates, screws, rods, or pins. For long bones, an intramedullary rod may be inserted down the central canal. External fixation, involving pins connected to a stabilizing bar outside the skin, may be temporarily used for severely unstable fractures.
Repairing Ligaments and Tendons
Procedures in this category focus on restoring the integrity of soft connective tissues that provide joint stability and muscle-to-bone connection. Ligament reconstruction is frequently performed for tears to the anterior cruciate ligament (ACL) in the knee, often utilizing a graft to replace the damaged structure.
Graft Types
The graft can be an autograft, tissue harvested from the patient’s own body, such as the patellar or hamstring tendon. Alternatively, an allograft, tissue sourced from a cadaver donor, offers the advantage of shorter surgical time and no secondary harvest site pain.
Repairing torn tendons, such as the rotator cuff in the shoulder, involves reattaching the tendon to the bone using strong sutures anchored by specialized devices. These suture anchors, often made of bioabsorbable material, are secured into the bone to hold the tendon close to the bone surface, allowing for biological healing. For large Achilles tendon ruptures, direct repair may be augmented with a tendon transfer or a free tendon graft to bridge a significant gap.
Diagnostic and Targeted Interventions
Some musculoskeletal procedures are less invasive and are primarily used for diagnosis or highly localized treatment. Arthroscopy is a procedure where a miniature camera is inserted into a joint through a small incision, allowing the surgeon to visualize the interior structures on a monitor. This technique is used for both diagnosis and minor surgical tasks, such as removing loose bodies, smoothing frayed cartilage, or repairing simple meniscal tears.
Biopsies involve taking a small sample of tissue, such as bone or muscle, for laboratory analysis. Image-guided techniques, often using CT scans or ultrasound, allow precise needle guidance to collect the sample. This procedure is crucial for diagnosing conditions like bone tumors, soft tissue masses, or specific muscle disorders. Non-surgical therapeutic injections are also common, delivering medications like corticosteroids or hyaluronic acid directly into the joint space to reduce inflammation or improve lubrication.