Dr. Ankur Saurav

MBBS (Gold Medalist)
DNB Orthopedics
Diploma in Orthopedics
Fellowship in Arthroplasty (Joint Replacement), Revision Arthroplasty and Arthroscopy (Munich, Germany)
Fellowship in Sports Medicine (ISAKOS: International Society of Arthoscopy, Knee Surgery And Orthopedic Sports Medicine)

My Knee Replacement Guide

PARTIAL/UNI KNEE REPLACEMENT

Written by:
Dr. Ankur Saurav
Orthopedics Surgeon,
Fellowship in Joint Replacement(Germany)
Fellowship in Sports medicine (ISAKOS)

  • Introduction:

    Now world is moving fast in Joint Replacement and specially Knee Replacement. From no Replacement to Total Knee Replacement with lots of restrictions to High mobility Knee Replacement with long durable knees.
    Now we are thinking of preserving ones knee natural structures, with minimally invasive surgery and providing pain relief at the same time with shorter Rehabilitation and Physiotherapy.
    Partial or Uni knee Replacement is a strong step towards it.
  • What is Partial Knee Replacement?:

    Partial knee replacement is a type of knee replacement where we only change the diseased part of knee and rest of the knee is left untouched and also the four main ligaments which supports the knee is left intact(where as in total knee replacement two out of four ligament is removed while surgery).
    Uni/Partial knee replacement has one major limitation that it can't be done in patients having more than one half of the knee damaged due to arthritis.
  • When to go for Partial knee replacement:

    Our knee is made up of 3 compartments,

    usually arthritis(damage of the cartilage) starts in single compartment which gradually spreads to other compartments with time.

    Partial or Uni knee replacement is a

    surgery done in patients having single compartment disease of the knee. In partial knee replacement we resurface the affected compartment with metallic implant thus curing the pain of the patient.
  • Advantage of Partial knee replacement:

    1. It is a minimally invasive surgery, thus patient have a very speedy recovery.

    2. This surgery is unique as in this surgery all four important ligament of the knee is preserved which provide natural stability to the knee. Thus patient had a very natural feel in the knees after this surgery.

    3. Patient can avoid much bigger surgery such as total knee replacement if this is done in time.

    4. Range of movement of knee is excellent and level of activity is good after this surgery compared to total knee replacement.

    5. Revision to total knee if required is much easier in this compared to other corrective osteotomies. called a prosthesis.

  • Indications:

    1. Early arthritis.

    2. Lesser deformity around knee

    3. Good Range of motion

    4.Intact ligaments of knee

    5. Correctable deformity

  • The ideal candidate for Partial Knee Replacement Surgery:

    1.Only single compartment of knee affected i.e medial compartment or lateral compartment

    2. Non inflammatory arthritis

    3.All the conservative management has failed to provide significant pain relief.

    4.Young age individuals with knee arthritis who need to be more active in day to day life.

    5.Old aged patient who are having bothering pain with difficulty in day to day activities and is not relieved by conservative treatment. It is worth not waiting for entire joint to get damaged and partial knee replacement done at this age group will salvage the natural ligament and will also preserve most of your natural bone. Most of the patient will not require total knee replacement in their lifetime after this surgery as it will slow down the wear and tear of your knee joint and will also relieve you from pain.

DOES YOUR KNEE MAKE NOISES ( POPS AND CRACKLINGS)? Lets know why it happens and do you need to worry for that!

Written by:
Dr. Ankur Saurav
Orthopedics Surgeon,
Fellowship in Joint Replacement(Germany)
Fellowship in Sports medicine (ISAKOS)

Everyone among us once in a while experience this Popping and Crackling sounds from our knees. For some it is once in a while but for others it is quite frequent and bothersome. In this article I will try to explain you about the common causes behind this sound produced by your knees and when to seek medical advice.

  • First Let's Understand Our Knee:
    • The knee consists of:

      1. Bones

      2.Cartilage

      3.Meniscus (Cushions)

      4.Ligaments and

      5.Lubricating fluid know as Synovial fluid

      6.All the structures mentioned above are enveloped by a sheet like structure know as SYNOVIUM.

    • The abnormal sounds produced by our knee originate from the interplay between these structures. This may be physiological or pathological
  • Common Causes of Knee Sounds:
    1. 1. Arthritis:
      Erosion of the cartilage and bones of our knee leads to abnormal grinding of the structures of our knee which leads to the production of Crackling sound on the movements of our knee. This sound is almost always associated with pain in your knees and is one the early symptoms of Knee Arthritis.
    2. 2. Injury:
      This may lead to damage to the structures of the knee like Meniscus(Cushion) or knee cap or ligaments and bones which may be the underlying cause of abnormal sounds produced by your knee. This may be associated with pain, laxity or locking of knee depending on the structure involved.
    3. 3.Gas Bubbles:
      With due course of time, small gas filled bubbles can build up in the Synovial fluid. When you move your knees some of these Gas Bubbles may burst producing Crackling sounds. This is usually not associated with pain and is harmless.
    4. 4.Ligaments and Tendons:
      These are the structures which hold your joints in place. Sometimes due to degenerative changes in the bones small bony bumps appear at the edges of knee bones. And on movement of knee these ligaments and tendons snap over these bony bumps and produce clicking sounds. They may or may not be associated with pain.
    5. 5.Maltracking of Patella(Knee Cap):
      When your Knee Cap doesn't move in the described path with the movement of knee then this may lead to production of abnormal sounds. This condition may be present since birth or due to age, injury or life events.
    6. 6.Surgery:
      After Total Knee Replacement your damaged bone surface is replaced by metals and plastic. These are much harder structures than bones and cartilage. Thus on movement of your knees these artificial components of knee replacement produce sounds. This is a very common phenomenon after surgery and shouldn't be worried upon.
  • When to seek medical advice for noises around knee?
    • Whenever your knee noise is associated with

      1. Pain

      2. Laxity or Instability

      3. Locking of the knee while movement

      4. Swelling around the knee

      5. Previous significant injury history to your knee.

      6. Muscle wasting around your knee.

What are the alternatives to Knee Replacement Surgery in a Patient suffering from Knee Osteoarthritis:
A General information

Written by:
Dr. Ankur Saurav
Orthopedics Surgeon,
Fellowship in Joint Replacement(Germany)
Fellowship in Sports medicine (ISAKOS)

Osteoarthritis of knee is a very common problem in old age. But all knee arthritis doesn't require Knee Replacement. Their are multiple options available which can provide moderate to good pain relief in early Osteoarthritis of your knee. Here I will be telling you few of that options.

  1. Physiotherapy: This is the mainstay of conservative treatment in a patient with knee arthritis. A good strong muscles around your knee, greatly off loads your knee and also reduces muscle spasm, thus giving good pain relief. Follow the link to learn exercises for knee arthritis: https://drankursaurav.com/knee-guide/
  2. Weight Loss: Researches show that every 4.5 kg gain in weight increses the chances of knee arthritis by 35%, and on the other hand lossing 4.5 kg of weight reduces 4 times pressure over your knee. Try to keep your BMI less than 25.
  3. Hylarounic Acid Injections : This has shown to delay your progression of knee arthritis and also moderate pain relief. But is effective in Stage 1 or early stage 2 of Arthritis (https://drankursaurav.com/arthirtis/)
  4. Plasma Rich Protein Injections: This has shown to provide some relief when injected in the knee, but long term studies to this is still awaited.
  5. Geniculate Nerve Ablation In this procedure your Geniculate nerves(nerves which supply the knee joint) is ablated by Cold Frequency Ablator. This reduces your Knee pain but has no role in rectifying the disease. Adviced only in those how are not physically fit for Knee replacement surgery.
  6. Arhtroscopic Knee Debridement: Limited role, not very cost effective. Provide pain relief for shorter duration and has no role in modifying the disease process.
  7. Knee Osteotomy: Surgery done in partially damaged knee. Provide very good result and also correct the deformity. Delays the progression of knee Arthritis.
  8. Walking Aids : Their are multiple walking aids available in the market. They off- loads your knee and provide some stability. Few good ones are very expensive.
  9. Medications and Steroids Shots:
    • Pain Killers: This reduces pain but shouldn't be recommend for long term as the patients get addicted to it and also causes multiple serious side effects.
    • Steroids injection in the knee: Reduces pain and inflammation of the knee, but the effect lasts for 2 to 3 months only. It causes accelerated damage to the knee Cartilage if given repeatedly.
    • Topical gel application: Many gel and oils available for local applications over knee. Provide mild pain relief.

PRIMARY TOTAL KNEE REPLACEMENT PROSTHESIS(Implant):
A General information for the Patients.

Written by:
Dr. Ankur Saurav
Orthopedics Surgeon,
Fellowship in Joint Replacement(Germany)
Fellowship in Sports medicine (ISAKOS)

  • Knee prosthesis or commly called as knee implants that is used in total knee replacement can be broadly classified into two types:
    • 1.Implant used in patients undergoing primary(first) total knee replacement.
    • 2. Implant used in patients undergoing Revision(Replaced knee being replaced again) knee replacement.
    Here I will be explaining you only about the implants used in Primary Total Knee Replacement.
  • Total Knee Replacement Prosthesis (Implant) consists of 3 main components:
    • 1. The Femoral Component: The component which attaches to the lower part of your thigh bone.
    • 2. The Tibial component: The Plastic Spacer(Polyethylene): This lies between the femoral and tibial component.

The model below is showing the different components in Knee Replacement:

Fig.1 :Knee model seen from front.

Fig 2: Knee Model seen from side

Your surgeon in his basket has variety of implant types and the one to be used in you depends on lots of factors like:

  1. Your particular Anantomy
  2. Amount of knee deformity
  3. Ligament Stability
  4. Quality of soft tissue around knee
  • Another method of classifying the Knee Replacement Implant is:
    • Type 1: Plastic Component is Fixed to the tibial Component. This implant is also called as Fixed Bearing implants.
    • Type 2: Plastic Component is Rotating on the tibial component. This is also known as Rotating Platform implant.
    • Figure showing Rotation in Rotating platform implant

  • Which type of Implant will be used in a particular patient depends on lots of factor and one the important factor is surgeons experience.
  • ROTATING PLATFORM IMPLANT has some of the theoretical advantages like:
    • 1. It allows small amount of rotation that a normal knee experiences when becoming fully extended.
    • 2. Less shear stress on the top of the plastic, where femoral component bends.
  • There are some disadvantages also in Rotating platform also as it is more dependent on soft tissue, more chances of dislocation and need more expertise from surgeon.
  • I use Rotating Platform implants in young and and active patients.
  • Long term studies show similar survivorship of Rotating platform and fixed bearing Implants.
  • Another category of implants relates to how the Posterior Cruciate Ligament(One the four main ligaments of the knee)is treated during the surgery:
    • 1. Cruciate Retaining(CR): Your Posterior Cruciate Ligament(PCL) is not removed during surgery. This is done if your PCLis healthy and functional. This cuts less bone.
    • 2. Posterior Stabilised(PS) Implant:In this type the PCL is removed and implant has a box and post in the design which stabilize the knee. This cuts more bone than the CR implant.
  • Both these designs have its own advantages and it depends on your surgeon what is he going to use
  • I personally use mostly Posteriorly Stabilized implant as in India we get mostly very deformed and damaged knee in which these PCL is almost nonfunctional.
  • In some of the cases your knee cap(Patella) is also replaced.

Home Exercises Program
For Patients having Knee Arthritis and Knee Replacement Surgery:

Written by:
Dr. Ankur Saurav
Orthopedics Surgeon,
Fellowship in Joint Replacement(Germany)
Fellowship in Sports medicine (ISAKOS)

  • I would like to thank all my patients for encouraging me to write yet another article on your knee care. I received lot of mails and messages from my patients to guide them about the exercises to be done at home for patients suffering from knee arthritis or had Knee Replacement. In this period of lockdown due to COVID-19, many patients are unable to continue their physio sessions as before.
  • This home exercise program demonstrates 18 exercises that can increase knee motion and strength. The program is useful for patients who have knee arthritis and also for patients recovering from knee replacement surgery. They are performed while lying in bed, sitting in a chair and standing. Consistent efforts will produce the best results. You may consider performing the lying down exercises in the morning and evening while in bed, and the sitting and standing exercises during the day. You should exercise your good leg as well. After exercising the knee, consider using an ice pack to control any swelling.
  • A. Knee Exercises While Lying
    in bed or floor
    • Ankle Pumps: Push your foot all the way down, followed by pulling your toes all the way up. Repeat 20 times.
    • Heel Slides: : Bend your knee toward your buttocks by sliding your heel(Try to bring your heels upto the level of of the other knee). Keep the heel on the bed at all times. Next, slide your leg back down flat. Repeat 10-15 times.
    • Straight leg Raises: Tighten your thigh muscles and lift your leg 5 inches off the bed. Keep the knee as straight as possible and tighten your thigh muscles. Hold for 10 seconds then lower the leg. Repeat 10-15 times.
    • Quadriceps Sets:Place a towel under your ankle and keep your leg straight. Slowly tighten the muscles on the front of the thigh. Imagine that you are pushing the knee cap into the bed. Hold for 10 seconds then slowly release the muscles. Repeat 10 times
    • Lying Knee Extension: Move the towel to under your lower thigh. Straighten the knee and lift your foot off the bed. Hold for 10 seconds then lower your foot to the bed. Repeat 10 times.
    • Gluteal Sets: Tighten the buttock muscles by squeezing them together. Hold the squeeze for 10 seconds. Repeat 10 times. Hamstring Sets: Slightly bend your exercising knee, while keeping the other leg flat on the bed. Slowly tighten the muscles on the back of the thigh and hold them contracted for 10 seconds. Repeat 10 times.
  • B. Knee Exercises While Sitting
    In a chair or on a firm couch
    • Knee Extension:Straighten your knee by lifting your ankle as much as you can. Hold the knee straight for 10 seconds then slowly lower the ankle. Repeat 10 times. As you get stronger, use an ankle weight (between one and ten pounds) to increase resistance.
    • Knee Extension with foot stool: : Place your ankle on a stool or another chair. Tighten the front thigh muscles to push the knee toward the floor. Hold for 10 seconds then slowly release muscle tension. Repeat 10 times.
    • Assisted Knee Bend:Bend the knee as much as possible. Cross your legs with the good leg in front. Use your front ankle to push your surgery leg further back. Hold for 10 seconds then release the tension. Repeat 10 times.
    • Adductor Set:Place a towel or ball between your thighs. Squeeze the thighs together and hold for 10 seconds. Repeat 10-15 times.
  • C. Knee Exercises While Standing
    Hold onto a supportive surface
    • Knee Bend: :Bend your surgery knee so that your ankle rises toward the buttock. Hold for 10 seconds. Repeat 10-15 times
    • Terminal Extension: : Start with the knee slightly bent. Gently straighten the knee as much as possible by tightening your thigh muscles. Hold for 10 seconds. Repeat 10-15 times.
    • Heel Raises:Lift both heels off the ground. Hold for 5 seconds. Slowly return the heels to the ground. Repeat 15 times.
    • Toe Raises:Lift the toes off the ground. Hold for 5 seconds. Slowly return the toes to the ground. Repeat 15 times.
    • Hip Flexion:Slowly lift your knee up toward the shoulder while bending the hip. Hold for 5 seconds then slowly bring your foot to the ground. Repeat 10 times
    • Hip Extension: Slowly bring your surgery leg backwards, keeping your knee straight. Hold for 5 seconds. Return your foot to the ground. Repeat 10 times.
    • Hip Abduction: Slowly bring your surgery leg out to the side. Hold your balance for 5 seconds. Return your foot to the ground. Repeat 10 times. Important: All patients should do their exercises as per thier Knee Surgeon advice. Feel free to write to me your questions and feedbacks as they are my driving forces...

Timeline for Recovery- What to expect after Total Knee Replacement.

Written by:
Dr. Ankur Saurav
Orthopedics Surgeon,
Fellowship in Joint Replacement(Germany)
Fellowship in Sports medicine (ISAKOS)

In my previous article I tried to inform you on "WHEN SHOULD I HAVE MY KNEE REPLACED".
THE MORE IGNORANT WE STAY THE MORE IS THE ANXIETY WE FACE. In this article I will again address a very common query and anxiety in my patient that what is the timeline of recovery after my knee replacement surgery.

  • Common questions asked by patients regarding recovery period is:
    • 1. When will I start walking?
    • 2. When will I be going to washroom independently?
    • 3. How long the pain will last?
    • 4. How gradually I should increase my day to day activities?
    • 5. When will I be able to resume my office?
    • 6. When to start driving?
    • 7. How long my knee swelling will be their?

Many such questions are asked by patients regarding their recovery
So lets know, what you are going to experience in different timeline from your knee replacement surgery.

  • Recovery from Knee replacement surgery may be full of challenges along the way. I find that if the Patient knows what to expect after surgery, generally have excellent perspective on their progress and they feel less anxious during their recovery period
  • One should always keep in mind that each body behave in unique manner in healing and thus two individuals can't be compared. But here i will give you the general guidelines about your recovery after your Knee replacement surgery
  • KNEE REPLACEMENT SUPPORT SYSTEM:
  • It is extremely helpful and wise to have strong support network of family and friends during this vital period of recovery. I encourages my patients to collaborate with us for education and encouragement during your recovery process.
  • Feel free to communicate with me on Twitter, Instagram, Facebook, WhatsApp or on Mail me about your queries and issues in post operative period.
  • 1. Period Early after Surgery:
  • The first couple of days after surgery is usually the most uncomfortable period. But with the advancement in the the Pain Management System Modalities, patients can expect to move out of bed and walk with support and braces as early as on the day of surgery.
  • After you get discharge from the hospital, always keep in mind to stay ahead of pain by: i) Applying regular ice, ii) Having adequate rest, iii) Elevation of knee, iv) Judicious use of painkillers.
  • It is not uncommon in some patient to continue taking mild pain killers for 4 to 8 weeks.
  • Ice Packs and Elevation:
  • Your knee will be typically be swollen immediately after surgery and this is quite a common issue to all the patients. The best thing which you can do to reduce the discomfort is to apply ICE and ELEVATE the knee.
  • I recommend my patients a Larger Ice Packs that can drape over the knee. Readymade ice packs are readily available but those who don't find adequate size, for them it is extremely easy to make your own Ice packs.
  • Lets learn how to make your own ice packs.
    • 1. Take one plastic bag of large size with ziplock. You may consider to double up the bag to avoid any leakage.
    • 2. Add 50ml of Hand Rub(70% Isopropyl alcohol) in the bag.
    • 3. Add 150ml of Water to it.
    • 4. Evacuate all the air from the bag before freezing.
    • 5. Place the bag in the freezer for 5 to 6 hours initially.

The advantage of this pack is that it can be easily moulded around your knees. Ice packs should be used frequently while your knee is swollen.

  • 2. Recovery during first 6 weeks:

Patient ambulating early after surgery

  • Common issues in first 6 weeks
  • Trouble :in having a rest full night sleep due to knee swelling, pain and other discomfort.
    #Solution:A good night sleep returns over time. Check with your Physian for any pills needed for sound sleep. Apply braces during sleep to avoid abnormal positioning of knee during sleep and also avoid flexion contractures of knee.
  • Can I travel?
    #Traveling during the first 3 weeks after surgery should be restricted. Apply braces during sleep to avoid abnormal positioning of knee during sleep and also avoid flexion contractures of knee.
  • Your stitches/ Staplers from your knee will be removed between 15 to 20 days from your surgery.
  • By the end of 3rd week the significant pain will fade. Deep aching becomes more prominent rather than sharp pain.
  • You will be doing now much of the Physiotherapy sessions independently and will require less assistance from your therapist.
  • During this period, the knee can still feel quite tight at times. Some days will be better than other.
  • During the first 6 weeks you will need Ice, rest and elevation
  • This is the period when a critical balance is required to be established between increase in activity and rest, ice and elevation
  • It is not unusual for some patients to feel a transient sense of depression during this period. This will definitely get better once your pain subsides, your knee functionality gets better and your sleep patterns begins to return to normal
  • 3. Recovery from 6 to 12 weeks:

" Moons and years passes by and are gone forever but a beautiful moment shimmers through life a ray of light".

  • Now is the time when most of the patient start sensing the positive end result.
  • By this time it is common for patients to have noticed that their knee may Click or Clunk. This sound or sense of instability is caused by some minor motion between the thigh bone prosthesis and the plastic component attached to the shin bone. This is usually normal and may become less noticeable as the patient develop better strength in the knee. This strength is important to develop as this ensures smooth Arc of motion of your knee, thus patient should have strict compliance to their physiotherapy sessions.
  • Now your formalized physiotherapy sessions are about to end with you having more confidence to move outdoors.
  • Patients who have " light duty" job typically return to work between 6 to 12 weeks
  • For some patients, it may take up to 12 weeks to feel as if they are " better than before surgery ".
  • At the end of 12 weeks after surgery there typically will still be some knee discomfort and minor swelling.
  • 4. Recovery after 12 weeks:

" The greener side of the world is awaiting you".

  • After 3 months, many of your routine activities become easier, you typically will feel much more functional than you have in a long time
  • After 6 months most of the healing is completed. Occasional aching or soreness is not uncommon.
  • Between 4 to 6 months many of the patients are back on the driving seat of their car and fully ready to handle their offices.
  • It may take 9 months to 1 year before the sense of stiffness fully resolves.
  • If you still have significant pain, soreness or swelling, then it should be evaluated by your Knee surgeon.
  • Physiotherapy lesson should be your best friend by now as you need to have a good complinance of it along the way.

# Friends feel free to put your queries on my emails, Twitter or WhatsApp.

WHEN SHOULD I HAVE MY KNEE REPLACEMENT?

A Surgeon Perspective
Written by:
Dr. Ankur Saurav
Orthopedics Surgeon,
Fellowship in Joint Replacement(Germany)
Fellowship in Sports medicine (ISAKOS)

This is a very frequent query from my patients in my OPD. Sometimes the answer is straight forward but very oftenly it requires a thoughtful analysis involving multiple intricacies.

Lets do some logical deductions:

Point 1: Your quality of life is severly affected by your knee arthritis and you have tried all conservative methods for sufficient time(pain killers, injection, physiotherapy, braces) to get relief but all went in vain.

Point 2: After evaluation of your xrays and other clinical test by your Knee surgeon you had been diagnosed to have advance knee Arthritis. So That's it! If you fulfill both point 1 and point 2 then its time to go for Knee Replacement. Right?

Yes for many patients these are the two ruling factors. However for many it is much more complex and requires brain storming analysis.
So you known that 1+2 is not equal to Knee Replacement in every patient.

Lets take a tour of decision making from a Surgeon perspective:

  • Do as surgeon I am more inclined to operate? The answer is "NO". So what is our primary concerns?
    • 1. We want your knee Replacement to be very successful in improving your quality of life and significant reduction in pain. This outcome gives us huge satisfaction and pride in our work.
    • 2. We want your recovery to be uneventful and smooth. This doesn't mean that we don't manage complicated patient but it is always better to avoid complications in the first place.

Thus many patients coming to me is not an ideal patient because of multiple different problems like diabetes, stroke, chronic kidney disease, chronic liver disease, heart attack, morbid obesity other joints damaged, chronic low back pain etc etc...

  • As your Knee specialist, I need to decide:
    • 1. That do we want to take that risk with you.
    • 2. Also are you as a patient willing to try to mitigate this risk factors?
    • 3. Even if you tried could you be successful?

The answer to these questions is somtime very complex to find but if our approach is methodical and scientific it is not impossible to reach a conclusion


I explain you with example:

1. Suppose a patient with advance Knee Arthritis leading to severe compromise in day to day activities, is having obesity(BMI >30) and uncontrolled diabetes with stenting done for heart problem, age something between 60 years to 70 years can we do knee Replacement in this patient?

  • The first thing which I assess is your willingness to get rid of your knee pain and your will power towards it, next deduction is based on scientific literature that because of immobility your blood sugar is very tough to be controlled and your obesity will keep on increasing as you are not moving much and thus these two factors can make you seriously ill in future if left unaddressed. So in these patients we must try to operate as this will not only relive the knee pain but also increase his longevity and thanks to morden advances in medical services that we can carefully take this risk. But again their is a caveat many a times you will not choose to operate if medical problems are to alarming and life threatening.
2. One more example: A patient with advanced knee Arthritis with chronic low back pain(due to sever secondary degenerative lumbar spine) and multiple joint pain age 55 years to 70 years, should we operate?

  • Now here I ask my patient "if I fix your knee right know and it felt great, would this significantly improve your life quality? Would you be able to get out of your house and do the activities you are missing presently. Sometimes the answer is "YES" but sometimes they feel that they may not be able to perform well even if knee is corrected(So no knee surgery should be offered in this case straight away).

Thus as a patient you must consider the following:

  • 1. Are you mentally ready to go for major surgery(A patient with great motivation and will power to perform after knee replacement is found to do excellent even after lots of comorbidities)?
  • 2. Do you have a realistic expectation?
  • 3. Do you fully understand the timeline of recovery? I will be writing in my next blogs to help my patients more on above questions

To conclude I tell my patient " You will know when you are ready" and it is wise to do net practice(knowing risks and benefits) before going for a tournament.


Feel free to write to me as I know their are many more you want to know.