Arthroscopy of the Knee Joint
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Arthroscopic knee procedure gained the importance because of its unmatched benefits such as smaller incisions, better view of the joint on the television screen, quicker…
Arthroscopy of the Knee Joint
Arthroscopy is a surgical procedure in which an arthroscope is inserted into a joint. Arthroscopy is a term that comes from two Greek words, arthro-, meaning joint, and -skopein, meaning to examine.
Arthroscopy is performed in a hospital operating room under general anesthetic.
The arthroscope is a small fiber-optic viewing instrument made up of a tiny lens, light source and video camera. The surgical instruments used in arthroscopic surgery are very small (only 3 or 4 mm in diameter), but appear much larger when viewed through an arthroscope.
The television camera attached to the arthroscope displays the image of the joint on a television screen, allowing the surgeon to look, for example, throughout the knee-at cartilage and ligaments, and under the kneecap. The surgeon can determine the amount or type of injury, and then repair or correct the problem, if it is necessary.
The surgeon makes two small incisions (about 1/4 of an inch), around the joint area. Each incision is called a portal. These incisions result in very small scars which in many cases are unnoticeable.
In one portal, the arthroscope is inserted to view the knee joint. Along with the arthroscope, a sterile solution is pumped to the joint which expands the knee joint, giving the surgeon a clear view and room to work. The sterile solution is regulated by a drainage needle for the amount of fluid in the joint during the procedure.
With the images from the arthroscope as a guide, the surgeon can look for any pathology or anomaly. The large image on the television screen allows the surgeon to see the joint directly and to determine the extent of the injuries and then to perform the particular surgical procedure if necessary.
The other portal is used for the insertion of surgical instruments. A surgical instrument is used to probe various parts within the joint to determine the extent of the problem. If the surgeon sees an opportunity to treat a problem, a variety of surgical instruments can be inserted through this portal. After treating the problem, the portals (incisions) are closed by suturing or by tape. Arthroscopy is much less traumatic to the muscles, ligaments, and tissues than the traditional method of surgically opening the knee with long incisions (arthrotomy).
You will wake up in the recovery room and then be transferred back to the ward
- A bandage will be around the operated knee
- Once you are recovered, your drip will be removed and you will be shown a number of exercises to do.
- Your surgeon will see you prior to discharge and explain the findings of the operation and what was done during surgery.
- Pain medication will be provided and should be taken as directed
- You can remove the bandage in 24 hours and place waterproof dressings (provided) over the wounds
- It is NORMAL for the knee to swell after the surgery. Elevating the leg when you are seated and placing Ice-Packs on the knee will help to reduce swelling. (Ice packs on for 20 min 3-4 times a day until swelling has reduced)
- You are able to drive and return to work when comfortable unless otherwise instructed
- Please make an appointment 7-10 days after surgery to monitor your progress and remove the 2 stitches in your knee.
Why is arthroscopy necessary?
Diagnosing joint injuries and disease begins with a thorough medical history, physical examination, and usually X-rays. Additional tests such as an MRI, or CT scan may be needed. Through the arthroscope, a final diagnosis is made which may be more accurate than through “open” surgery or from X-ray studies.
What are the joints that can be viewed with an Arthroscope?
Although the inside of nearly all joints can be viewed with an arthroscope, six joints are most frequently examined with this instrument. These include the knee, shoulder, elbow, ankle, hip, and wrist. As engineers make advances in electronic technology and orthopaedic surgeons develop new techniques, other joints may be treated more frequently in the future.
What are the conditions that can be treated by arthroscopy?
Some problems associated with arthritis also can be treated. Several disorders are treated with a combination of arthroscopic and standard surgery.
Diseases and injuries can damage bones, cartilage, ligaments, muscles, and tendons. Some of the most frequent conditions found during arthroscopic examinations of joints are:
- Inflammation: Synovitis – inflamed lining (synovium) in knee, shoulder, elbow, wrist, or ankle.
- Injury – acute and chronic
Shoulder – rotator cuff tendon tears, impingement syndrome, and recurrent dislocations
Knee – meniscal (cartilage) tears, chondromalacia (wearing or injury of cartilage cushion), and anterior cruciate ligament tears with instability.
Wrist – carpal tunnel syndrome
- Loose bodies of bone and/or cartilage – knee, shoulder, elbow, ankle, or wrist
What are the possible risks & complications?
General Anesthetic risks are extremely rare. Occasionally patients have some discomfort in the throat as a result of the tube that supplies oxygen and other gasses. Please discuss with the Anesthetist if you have any specific concerns. Risks specifically related to the surgery. Risks related to Arthroscopic knee surgery include:
- Post-operative bleeding
- Deep Vein Thrombosis (DVT)
- Numbness to part of the skin near the incisions
- Injury to vessels, nerves and a chronic pain syndrome
- Progression of the disease process
The risks and complications of arthroscopic knee surgery are extremely small. One must however bear in mind that occasionally there is more damage in the knee than was initially thought and that may affect the recovery time. In addition, if the cartilage in the knee is partly worn out then arthroscopic surgery has about a 65% chance of improving symptoms in the short to medium term but more definitive surgery may be required in the future. In general, arthroscopic surgery does not improve knees that have well established osteoarthritis.
What are the advantages?
Although arthroscopic surgery has received a lot of public attention because it is used to treat well-known athletes, it is an extremely valuable tool for all orthopaedic patients and is generally easier on the patient than “open” surgery. Most patients have their arthroscopic surgery as outpatients and are home several hours after the surgery.
Recovery after arthroscopy
The small puncture wounds take several days to heal. The operative dressing can usually be removed the morning after surgery and adhesive strips can be applied to cover the small healing incisions.
Although the puncture wounds are small and pain in the joint that underwent arthroscopy is minimal, it takes several weeks for the joint to maximally recover. A specific activity and rehabilitation program may be suggested to speed your recover and protect future joint function.
It is not unusual for patients to go back to work or school or resume daily activities within a few days. Athletes and others who are in good physical condition may in some cases return to athletic activities within a few weeks.
Remember, though, that people who have arthroscopy can have many different diagnoses and preexisting conditions, so each patient’s arthroscopic surgery is unique to that person. Recovery time will reflect that individuality.