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Arthroscopy is used to diagnose several different problems with the knee joint. Arthroscopy is also used to repair the ligaments of a joint. There are some risks to the procedure, but the outlook, for most patients, is good. Recovery time and prognosis depend on the severity of the knee problem and the complexity of the procedure required.
Preparing for the procedure
The doctor or surgeon will advise the patient on how to prepare for the operation. You also need to refrain from eating 6-12 hours before the operation. The doctor may also prescribe pain medication to help prevent any discomfort that the patient may experience after surgery.
An orthopedist may recommend that a patient’s family doctor assess their general health prior to surgery. The doctor will determine if there are any problems that may interfere with the procedure. If a patient has certain health risks, they may need a more extensive evaluation before surgery.
To assist in planning the procedure, the orthopedic surgeon may order preoperative examinations. These may include blood tests or an electrocardiogram (ECG).
If the patient is generally healthy, knee arthroscopy will most likely be performed as an outpatient treatment. This means that the patient does not need to stay overnight in the hospital.
Be sure to tell the orthopedic surgeon about any medications or supplements the patient is taking. He may have to stop taking some of them before surgery.
Before the operation, the anesthetist will talk to the patient. Knee arthroscopy can be performed under regional, local, or general anesthesia.
Arthroscopy procedure
The doctor makes anesthesia before the procedure. It can be: local (relieves the sensitivity of only the knee), regional (relieves sensitivity from the belt), general (during this anesthesia, the patient is unconscious). If the patient is awake, he will be able to observe the progress of the procedure on the monitor.
The surgeon begins the operation by making several small incisions in the knee. Saline will then be pumped up to expand the knee. This facilitates the work of the surgeon inside the joint. The arthroscope is inserted into one of the incisions and the surgeon will view the joint cavity with an attached camera. The surgeon can see the images produced by the camera on a monitor in the operating room. When a doctor detects a problem in a joint, they may insert small instruments into the incisions to help correct the problem. After surgery, the surgeon removes saline from the joint and closes the cuts with sutures.
Anatomy of the knee joint
The knee joint is the largest joint in the human body and one of the most complex. The bones that make up the knee include the lower end of the femur, the upper end of the tibia (lower leg), and the patella. Other important structures that make up the knee joint include the following.
Articular cartilage. The ends of the femur and lower leg and the back of the patella are covered with articular cartilage. This slippery substance helps the kneecaps of the knee slide smoothly towards each other when a person bends or straightens the leg.
Synovial membrane. The knee joint is surrounded by a thin lining called the synovium. It releases a fluid that has the ability to lubricate cartilage and reduce friction during movement.
Meniscus. The two wedge-shaped pieces of cartilage act as “shock absorbers” for the femur and lower leg. Unlike articular cartilage, the meniscus is tough and elastic, which helps cushion and stabilize the joint.
Ligaments. Bones are connected to other bones by ligaments. The four main ligaments in the knee act like strong ropes to hold the bones together and keep the knee stable. There are two collateral ligaments on either side of the knee. The two cruciate ligaments are located inside the knee joint. They cross each other to form an “X” with the anterior cruciate ligament in front and the posterior cruciate ligament in the back.
Indications for arthroscopy
A doctor may recommend knee arthroscopy if a patient has a painful condition that does not respond to non-surgical treatment.
Non-surgical treatment includes rest, physical therapy, pills, or injectable forms of drugs that can help reduce inflammation.
Knee arthroscopy can greatly relieve the pain of many problems that damage cartilage surfaces and other soft tissues surrounding the joint. Common arthroscopic procedures for the knee include:
- removal or repair of a torn meniscus;
- reconstruction of a torn anterior cruciate ligament;
- removal of synovial inflamed tissue;
- trimming of damaged articular cartilage;
- removal of loose fragments of bone or cartilage;
- treatment of problems with the kneecap;
- treatment of knee sepsis (infection).
A doctor may recommend that a patient undergo knee arthroscopy if they experience knee pain. Arthroscopy is sometimes performed in cases where a pain syndrome has already been diagnosed, but this diagnostic method is required to help establish a definitive diagnosis. Arthroscopy is a useful diagnostic method that doctors use to confirm the source of pain in the knee, and this method, in some cases, can solve the problem.
Knee arthroscopy diagnoses and treats the following knee injuries:
- torn anterior or posterior cruciate ligaments;
- torn meniscus (cartilage between the bones in the knee)
- dislocation of the patella;
- loose pieces of torn cartilage in a joint;
- removal of Baker’s cyst;
- fracture of the bones of the joint.
Procedure algorithm
As soon as the patient goes to the operating room, he will be given anesthesia. To prevent infection during the procedure, the skin on the knee will be cleaned. The leg will be covered with surgical tissue, which will expose the prepared incision site. At this stage, a positioning device is sometimes placed on the leg to help stabilize the knee during the arthroscopic procedure.
To begin the procedure, the surgeon will make several small incisions in the knee. A sterile solution will be used to fill the knee joint. This helps the orthopedic surgeon to see the structures inside the knee clearly and in great detail.
The first task of the surgeon is to correctly diagnose the problem. The doctor will insert the arthroscope during the procedure and use the image projected on the screen to guide him. If surgery is required, the surgeon will insert tiny instruments through other small incisions.
Specialized tools are used for tasks such as cutting, gripping and repairing the meniscus. In many cases, special devices are used to secure the stitches into the bone.
Most knee arthroscopy procedures last less than an hour. The duration of the operation will depend on the results and the treatment needed. The surgeon may close each incision with a suture and then cover the knee with a soft bandage.
Risks of the procedure
There are some risks that can occur after any type of surgery, although they are quite rare. Every operation comes with risks in the form of heavy bleeding during the operation, infection, difficulty breathing after anesthesia, allergic reactions to anesthesia or other drugs that were administered during the operation.
There are also risks associated with knee arthroscopy itself, including:
- the occurrence of bleeding in the knee joint;
- clot formation;
- the occurrence of an infectious process in the joint;
- damage to the ligaments, cartilage, menisci, nerves and blood vessels of the knee.
The complication rate after arthroscopic surgery is very low. If complications arise, they are usually minor and easily treated.
The result of the procedure
Many people return to full, unrestricted activities after arthroscopy. Recovery will depend on the type of damage that was present in the knee.
If the patient has not had a ligament reconstruction, they will be able to return to most physical activities in 6-8 weeks, or sometimes much sooner. You may need a higher effectiveness of exposure for a longer time. If the job involves hard work, it may take longer before returning to work.
For some people, lifestyle changes are necessary to protect the joint. An example would be going from a high impact (eg running) to a low impact (eg swimming or cycling). Sometimes damage to the knee joint can be severe enough that it cannot be completely repaired with surgery.
Recovery after the procedure
The patient leaves the hospital with a bandage covering his knee. Keep the incisions clean and dry. Your surgeon will tell you when to shower or bathe and when to change your dressing. The patient will need to return to the doctor a few days later to check progress, review surgical results, and begin a postoperative treatment program.
Most knee arthroscopy patients require crutches or other assistance. The surgeon will tell you when it is safe to put weight on the leg. In addition to medications to relieve pain, a doctor may also recommend pain relievers such as acetylsalicylic acid to reduce the risk of blood clots.
This operation is not very invasive. For most patients, the procedure takes less than an hour depending on the specific procedure.
It is likely that the patient will return home the same day after surgery for further recovery. You can use an ice pack on your knee. Ice helps reduce swelling and minimize pain. At home, relatives should be asked to take care of the patient, at least after the operation on the first day, since movements in the joint must be avoided. You should try to lift your leg and put ice on it for a day or two to reduce swelling and pain.
The doctor will give the patient an exercise regimen to help restore the knee, or recommend seeing a physical therapist so that the patient can use the knee fully and normally. Exercise is essential to help restore a full range of motion and strengthen muscles. With due care, the prognosis after this procedure will be positive.
While recovery from knee arthroscopy is faster than from traditional open knee surgery, it is important to follow your doctor’s instructions accurately and carefully after returning home.
Rehabilitation exercises
You need to exercise your knee regularly for a few weeks after surgery. This will restore movement and strengthen the leg and knee muscles. Working with a physical therapist can help the patient achieve the best possible recovery.
Therapeutic exercises will play an important role in how quickly the patient recovers. A formal physical therapy program can improve the outcome.