Orthopedic and Joint Replacement Surgeon Dr. Manamohan a/l Chandrarajan’s Proficiency in Knee Extensor Realignment

Dr. Manamohan a/l Chandrarajan is a very famous and best Orthopaedic Surgeon in Malaysia. At present, he is working at Gleneagles Hospital Medini Johar. With experience of more than 23 years, he specializes in the treatment of joint disorders, hand & microsurgery. His qualification includes MBBS from Manipal University, FRCS from Royal College of Surgeons of Ireland, Masters in Ortho from the National University of Singapore, and MS Ortho from University Kebangsaan  Malaysia. He is well-versed in English, Malay, and Tamil languages.

Knee Extensor Realignment

Patellar malalignment is a common and lead to chondromalacia at an early age with osteoarthritis of the patella with the load of the side hand of the patella. This is aggravated by increased body weight especially considering that patellar lading is at least 4 times body weight with the conditioning of diurnal living. Patellar malalignment can be caused by several factors including a muscular imbalance of the quadriceps and is generally aggravated by an increased quadriceps angle (please see delineation) which mechanically increases the load of the side patella. The normal tibiofemoral angle contributes to load and because of generally wider hips in women, this condition is more common in women. Patellar load is more frequently associated with conditioning which includes high patellofemoral loads similar to climbing, cross-country handling, jumping, and squinching.


·         Swelling and lateral anterior knee pain

·         Cracking

·         Popping or grating that is palpable and audible with the motion of the knee.

·         The knee becomes more arthritic

·         Stiffness while sitting or reduced activities.

·         Weather ache

·         Debris from the cartilage resulting in knee inflammation


·         History and physical examination.

·         Plain x-ray examination

·         CT scan or MRI when meniscal or ligament pathology is suspected


 When conservative treatment including medium quadriceps strengthening, an anti-inflammatory drug, weight reduction (if necessary), and patellar bracing has failed to drop symptoms adequately, realignment of the extensor medium may be considered. This is generally performed in youngish cases lower than 40 times of age. This is primarily because, with arthritis present, there's lower dependable enhancement with extensor realignment. Multiple factors need to be considered which include Case age, weight, underpinning arthritic changes, ligament or meniscal injuries, exertion position, and return to sports. Conservative measures previous to surgical intervention include medium quadriceps strengthening as outlined in my chondromalacia composition.

Orthopedic Surgery

Surgical intervention is the only option after conservative measures have been exhausted. Side release arthroscopically is generally by itself, of little value and only results in significant enhancement when the patella has significant side cock previous to surgery and a fairly normal quadriceps angle. In trouble to lower the quadriceps angle and homogenize lading on the patella, tibial excrescence transposition can be accepted. This is generally combined with an arthroscopic side release which allows the patella to polarize indeed without dramatic cock previous to surgery. This is generally performed with a quadriceps angle over 20 ° previous to surgery. To ameliorate the safety of the procedure, it's better to leave the tibial excrescence attached distally. The tibial excrescence is undercut and fraudulent medially using a small gash just medium to the tibial excrescence. Obsession of the tibial excrescence in this position is generally fulfilled with a single screw. This is countersunk to avoid elevation and generally, the screw can be left without junking. Sometimes, the patella rides much advanced than it should, and the patella exits the femoral groove with full extension. In this case, distal transposition could also be necessary. This is generally fulfilled with 2 screws because of the more concern for solid obsession before mending has passed. In both cases, significant bone mending generally has passed by 6 weeks following surgery. During this, the case remains full weight-bearing but utilizes a dependent brace locked in extension for ambulation only.


For more details regarding the procedure and aftercare contact Dr. Manmohan a/l Chandrarajan, one of the esteemed doctors from Malaysia. You can see him at Gleneagles Hospital Medini Johor.

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