Knee arthroscopy – indications, preparation and course. Knee arthroscopy effects

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Knee arthroscopy is a modern, endoscopic diagnostic and therapeutic method. It allows the doctor to view the affected joint from the inside, while performing surgical procedures to eliminate or alleviate the troublesome symptoms. The arthroscopic procedure can be performed on virtually any human joint, but the most common is arthroscopy of the knee.

Joints and their functions

Thanks to the joints, we can move and perform all activities, from the simplest to the more complicated. The fact is that without joints, a person is not able to function properly, work, play – just live. Diseases of the joints not only impair our daily functioning, making us disabled, but also cause unbearable pain. Therefore, in order to stay healthy and be able to fully enjoy life – you should take care of it and, if necessary, treat it.

Among the reasons that may disrupt the proper functioning of the joints, we can distinguish:

1. excessive stress leading to stiff joints,
2. obesity,
3. staying in a sitting position for a long time (e.g. sedentary work),
4. injuries.

Injuries and injuries usually occur while practicing some sport, such as cycling, playing football, running or skiing. Joint contusion can exclude the patient from both family and professional life for a long time.

See also: Pain in the knee. How to heal?

Types of arthroscopy

One of the most common treatments used to treat joints is arthroscopy. Depending on the pond to be treated, there are several types of it.

1. Hip arthroscopy
2. Arthroscopy of the knee
3. Bark arthroscopy,
4. Elbow arthroscopy,
5. Hip arthroscopy,
6. Wrist arthroscopy.

What is Knee Arthroscopy?

Knee arthroscopy is a minimally invasive diagnostic and therapeutic method of the inside of the joints. Thanks to it, the doctor can carefully examine the diseased joints from the inside, and at the same time perform a procedure aimed at alleviating the symptoms. Joints can be treated from all sides simultaneously. The advantage of arthroscopy is the shorter hospital stay and a lower rate of complications after the procedure.

In addition, thanks to arthroscopy, it is possible to carefully examine even the tightest places in the joint, which cannot be treated with the traditional method (open incision). During the knee treatment, a few small point incisions are made, and then a microcam and tools are inserted. The procedure is characterized by the absence of blood, and thanks to small incisions, postoperative ailments are associated only with treatment.

Arthroscopy should be performed under sterile conditions, in the room and operating room, and with the use of spinal anesthesia. The procedure itself takes about 2-3 hours.

Knee arthroscopy – indications

Among the knee conditions currently treated with arthroscopy are:

1. acute traumatic changes causing a “blockade of the knee”, ie the inability to perform proper movements in the joint as a result of blocking it by a free piece of tissue, combined with acute pain and swelling; examples are dislocated articular fractures, meniscus tears or tears;
2. traumatic lesions causing instability of the knee joint, e.g. rupture or rupture of the cruciate ligament;
3. post-traumatic or post-inflammatory changes such as rupture, meniscal dissection, synovial fold hypertrophy;
4. advanced degenerative changes in articular cartilage called chonodromalacia;
5. the presence of a foreign body in the joint,
6. RA, i.e. rheumatoid arthritis,
7. the presence of periarticular cysts,
8. cancer that develops in the joints,
9. joint swelling and chronic joint pain,

Knee arthroscopy – preparation for the procedure

Before arthroscopy, X-ray examinations are performed as standard. If necessary, an electromagnetic resonance imaging (MRI of joints and bones) can also be done. Before the procedure, the patient should undergo an orthopedic consultation.

The physician must interview the patient to determine if the patient qualifies for the procedure (if there are problems such as heart failure, emphysema, diabetes or high blood pressure, these should be minimized for surgery). You should also not forget to inform your doctor about the medications you take before the procedure. A specialist may find that it will be necessary to stop taking certain medications that hinder blood clotting, such as aspirin, ibuprofen, naproxen or other narcotic drugs.

In addition, the doctor must be informed about the amount of alcohol consumed by the patient, especially when talking about large amounts and especially within the two weeks before the procedure. The same applies to smokers, as it is advisable to stop smoking or at least reduce the amount as nicotine may slow the healing of wounds. It should be added that you should also inform your doctor about any inflammation in your body.

Also read: 10 most expensive diagnostic tests

Knee arthroscopy – course

On the very day of the procedure, it is recommended not to take any food or liquids for 6 to 12 hours before the procedure.

Arthroscopy allows you to:

1. removal of a foreign body from the joint,
2. smoothing the articular cartilage,
3. removal of a damaged or sutured meniscus;
4. removal of synovial hyperplasia or a synovial fold,
5. rinsing the knee joint,
6. reconstruction of the anterior cruciate ligament.

Before the arthroscopic procedure is performed, a standard X-ray examination is performed. Occasionally, you may need additional MRI.

The arthroscopic procedure is much less invasive compared to the former arthrotomy (i.e. the operation consisting in opening the joint). The surgeon makes a few centimeter incisions through which a camera and special tools for laparoscopic procedures are inserted into the joint cavity, which are controlled by the doctor from the outside. The monitor screen shows an enlarged image of the structures of the knee joint. The patient is placed in a lying or sitting position, depending on the operated joint.

The skin around the examined joint is carefully covered with sterile scarves and the skin itself is disinfected. Often, a pressure band is put on the skin above the examined joint, otherwise known as the so-called Esmarch’s headband. Its task is to cause ischemia to rule out bleeding during colonoscopy of the joint that could interfere with visibility.

During the procedure (as mentioned above), the surgeon may, depending on the needs, suture or remove a damaged meniscus, fuse bone fragments, remove damaged articular cartilage, reconstruct cruciate ligaments and perform many other treatments. Knee arthroscopy is usually performed under spinal anesthesia, i.e. the patient remains conscious but is under anesthesia from the waist down.

Knee arthroscopy – advantages of the procedure

Knee arthroscopy is a procedure that does not require the total opening of the knee joint, as it is relatively non-invasive. Painless incisions are made during the procedure, and the scars after the procedure are small. All this means that the patient is discharged home on the same day on which the procedure was performed or on the following day.

It should also be added that specialists perform knee arthroscopy because it is much more accurate than other imaging methods and gives the opportunity to assess the functioning of the joint during movement.

Also read: Ligament – characteristics, functions and most common injuries

Knee arthroscopy – rehabilitation after surgery

When it comes to rehabilitation after knee arthroscopy, this is it is extremely important that the patient strictly follow the instructions of the orthopedist. The key is to unburden the operated leg, even for several weeks. This involves moving with elbow crutches (it may be a good idea to learn crutches before performing the procedure).

After the procedure, the patient cannot exert himself, but it does not completely exclude physical exertion. It is also very important that after the knee arthroscopy, the patient starts exercising under the supervision of a physiotherapist, and the purpose of these exercises is to strengthen and stretch the muscles, as well as improve the stabilization of the joint. Recovery time may take up to 6 weeks, and full recovery takes about 12 weeks. However, it should be noted that the time it takes for the patient to recover depends on individual factors.

It is extremely important to follow your doctor’s instructions as this may protect you from complications following arthroscopy. It is worth mentioning that after the procedure, the most common symptoms are swelling, hematomas and pain. Occasionally, however, deep vein thrombosis or bacterial infections may occur. This may result from too early loading of the operated joints.

Read more about it: Rehabilitation after arthroscopy

Knee arthroscopy – complications after the procedure

Knee arthroscopy is an operation with a low risk of complications, among the most common complications after arthroscopy of the knee include: intra-articular hematomas, chronic exudates, local infection, limitation of joint mobility, nerve damage, articular cartilage damage, venous thrombosis, pulmonary embolism.

It should be added that there is a flu in people who are at greater risk of complications after knee arthroscopy. These are people suffering from diabetes, suffering from heart diseases, varicose veins of the lower limbs, immunosuppressed or taking immunosuppressive drugs, with pathogenic bacteria in the throat, nose, urinary tract, tooth decay.

There are also some very rare complications that affect only about 1% of people undergoing this surgery. These complications include:

Infections – it can occur in the area of ​​incisions, where it is considered a superficial infection, or in the knee joint, where it is a more serious, deeper infection. When an infection does develop, additional surgery may be necessary to clear it up. The presence of bacteria in the knee joint can cause significant damage to the joint cartilage, so it is imperative to urgently treat any suspected infection. If the infection is only in the superficial area around the incision, sometimes antibiotics alone will be sufficient to treat the infection. When the infection is deeper in the knee joint, additional surgery in addition to antibiotics is usually required.

Blood clot Blood clots can occur in anyone, but are more common in people with certain risk factors for developing a blood clot. One of the risk factors for developing a blood clot is leg surgery with prolonged immobilization. For this reason, it is important to follow your doctor’s instructions and move your limb as much as possible to maintain blood flow to the limb and prevent blood clots from forming. Additional precautions may be necessary for people with other risk factors (including smoking, oral contraceptives, bleeding disorders, etc.).

It must be borne in mind that in the case of a procedure such as knee arthroscopy, it is important to quickly start rehabilitation of the knee joint. You should also take the time to choose the best specialist possible.

Also read: Knee joint prosthesis

Knee arthroscopy – exercises after the procedure

After having knee arthroscopy, it’s important to begin knee exercises immediately to restore strength and full range of motion. The starting exercises should be light-weight and focus on gently strengthening the muscles surrounding the knee and increasing the range of motion in the joints. As always, it should be discussed with your orthopedic surgeon before beginning any exercise program.

After the procedure, the patient should expect gentle stretching while exercising with the knee, but should not feel pain. Any activity that causes you significant discomfort must be stopped immediately. It’s also a good idea to ice and lift your leg after exercising to reduce the increase in swelling.

The following exercises are suitable for immediate rehabilitation following arthroscopy.

Quadriceps exercise

For this exercise, lie on your back on a flat surface. Place a rolled up towel under the knee between it and the bed surface. Tighten the muscles of your upper thigh and try to push the back of your knee off the ground. This will straighten your knee. Make your knee as straight as possible and hold this position for five seconds. Repeat the exercise several times.

Exercise for hamstrings

Hamstrings help to bend the knee, and maintaining their strength is important after knee arthroscopy.

Lie on your back with your knees bent 10 to 15 degrees. Without moving your leg, press your heel to the floor as if you were trying to bend your knee but the ground prevents movement. This will cause the hamstring muscles in the back of your thigh to contract. You should stay in this position for five seconds and then repeat the exercise a few times.

An exercise for the muscles of the buttocks

Buttock exercises are a great way to develop hip function and help with blood flow to the legs and hips after surgery.

For this exercise, lie on your back with your knees bent 10 to 15 degrees. Now squeeze your buttock muscles as if to stop bloating. You should stay in this position for five seconds and then repeat the exercise a few times.

Leg muscles exercise

The exercise involves lifting straight legs and is important as it can help improve the work of your hip and knee muscles while protecting your knee.

For this exercise, lie on your back on a flat surface. Bend the knee of your uninvolved leg (the one that has not been operated on) at a 90-degree angle with the foot flat on the surface. Now keep the involved leg straight, without bending the knee. Slowly raise the affected leg to a height of about 15 cm (flexing the muscles of the front thighs). Maintain this position for five seconds and then slowly lower your leg onto the bed. Repeat the exercise a few times. Remember that the knee of the elevated leg should remain straight throughout the exercise. The focus should be on lifting using the muscles in front of the hip joint.

After knee arthroscopy, consult your doctor and physical therapist and then begin your knee exercises to help you return to normal activity levels quickly and safely.

Knee arthroscopy – treatment results

Most knee arthroscopy is performed on older adults because of degenerative diseases such as osteoarthritis. The incidence of osteoarthritis of the knee, which may be associated with wear of the meniscus, and also of the cartilage that lines the bone, increases with age. Most people aged 50 and over suffer from osteoarthritis and about a quarter from meniscuses.

Many people with osteoarthritis or a ruptured meniscus also experience knee pain. This led to the belief that osteoarthritis or a tearing of the meniscus was causing pain. But these changes are also common in those who feel no pain at all. The menisci usually lack nerves, so they cannot be felt unless a large tear occurs, often resulting from severe trauma. In fact, most people with a torn meniscus don’t experience knee pain.

Many studies have now shown that the outcomes of arthroscopic osteoarthritis and degenerative meniscus surgery are no better than those of placebo (sham) surgery or other treatments (such as exercise therapy). A recent summary of these studies stated “a recommendation against the use of arthroscopy in almost all patients with osteoarthritis of the knee” (osteoarthritis and meniscal degeneration) and that “further studies are unlikely to change this recommendation.”

Many surgeons believe that the presence of mechanical symptoms (this concept is not clearly defined but includes pain and unusual sensations such as clicking or locking) when moving the joint can be treated with arthroscopy. However, studies have also shown that arthroscopy does not provide better results than artificial surgery in treating mechanical symptoms. Sometimes the meniscus can be broken so badly that it folds over itself, blocking the knee and limiting the ability to straighten the knee. This is a relatively rare type of meniscus, and if symptoms persist, a torn part of the meniscus can be removed arthroscopically.

Knee pain from osteoarthritis often fluctuates in severity, and patients seek treatment when the pain is greatest. This means that any treatment given during this time will be more effective than it really is. Therefore, comparative studies, especially placebo studies, are important as they show the real effects of treatment.

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