What is Arthroscopy?

Arthroscopy (also called arthroscopic surgery, KEY HOLE SURGERY) is a minimally invasive surgical procedure in which an examination and treatment of damage of the interior of a joint is performed using an arthroscope, a type of endoscope that is inserted into the joint through a small incision.

The advantage of arthroscopy over traditional open surgery is that the joint dose not have to be opened up fully. Instead, only two small incisions are made- one for the arthroscope and one for the surgical instruments to be used in the knee cavity. This reduces recovery time and may increase the rate of surgical success due to less trauma to the connective tissue. It is specially useful for professional athletes, who frequently injure knee joints and require fast healing time. There is also less scarring, because of the smaller incisions.

The surgical instruments used are smaller than traditional instruments. Surgeons view the joint area on a video monitor, and can diagnose and repair torn joint tissue, such as ligaments and menisci or cartilage.

It is technically possible to do an arthroscopic examination of almost every joint in the human body. The joints that are most commonly examined and treated by arthroscopy are the knee, shoulder, elbow, wrist, ankle, foot, and hip.

What is done in Knee Arthroscopy?

A pencil – sized instrument called an arthroscope is inserted into the knee joint without any open cut or incision. Fluid is then inserted into the joint to allow the surgeon to thoroughly examine the interior of your knee and determine the source of your problem. During the procedure, the surgeon also can insert surgical instruments through other small pin holes in your knee to repair damaged tissues and cartilage or remove loose pieces.

Arthroscopy is one of the most common orthopedic procedures. During the procedure, which is performed under epidural anesthesia, with the patient awake, the inside of the joint is examined for damaged tissue. The commonest types of arthroscopic surgery include trimming or repair of a torn meniscus (cartilage), ligament reconstruction, removal of loose debris, and trimming damaged surface cartilage.

Symptoms are swelling, persistent pain, catching, giving-way, bucking and loss of confidence in your knee. Arthroscopies are performed on patients between the ages of 18 and 60.

Arthroscopy is much less traumatic to the muscles, ligaments, and tissues than surgically opening the knee with long incisions. The benefits of arthroscopy are faster healing, quicker recovery and smaller.

Orthropaedic Surgeon might use this procedure to diagnose or treat:

• A torn meniscal cartilage
• Loose fragments of bone or cartilage
• Damaged joint surfaces or softening of the particular cartilage known as chondromalacia
• Inflammation of the synovial membrane, such as rheumatoid or gouty arthritis.
• Abnormal alignment or instability of the knee cap
• Torn ligaments including the anterior and posterior cruciate ligaments.

It is usually possible to go back to physical activities or sports after around three weeks. The orthopedic surgeon will provide more advice about this in each individual case

Understanding the Knee

The knee is a hinged joint made up of three bones held firmly together by ligaments that stabilize the joint.

The bones that meet at the knee are the upper leg bone (the femur), the lower leg bone (the tibia) and the knee cap (the patella). The bones inside the joint are lined by a smooth protective layer called articular cartilage, which allows the bones to glide smoothly upon each other. In arthritis, this smooth lining becomes damaged.

Ligaments

Ligaments are dense structures of connective tissue that fasten bone to bone and stabilize the knee.

Inside the knee joint are two major ligaments.

• The anterior cruciate ligament (ACL)
• The posterior cruciate ligament (PCL)
  

These cross in the center of the knee (that’s why they’re called cruciate ligaments) and control the backward and forward motion of the knee. The ACL is frequently injured in severe twisting injuries of the knee.

Two other major ligaments are actually located outside the knee joint, on the outer and inner side of the leg. They act to stabilize the knee’s sideways motion. The ligament on the inner side of the knee is called the medial collateral ligament or MCL (medial means inner side). The ligament on the outer side of the knee is the lateral collateral ligament or LCL (lateral means outer side).

The patellar ligament (the ligament of the knee cap) connects the lower part of the patella to the upper part of the tibia, specially to the bony prominence one can feel on the lower leg bone (the tibia). The central one-third of this ligament is the most commonly used graft source in reconstructing a torn ACL.

Meniscus

The meniscus is a half moon – shaped structure placed between the weight – bearing bone ends in the knee. There are two menisci in each knee, one on the inner side called the “medial meniscus” and one on the outer side called the “leteral meniscus.”

The two menisci act as shock absorbers within the knee and also spread the weight load.

The meniscus is a type of cartilage, trough it is different than the cartilage that lines the bones.

The menisci may be torn during twisting movements of the knee.

TYPES OF KNEE INJURY:

Meniscal injury

These are the most common knee injuries. The menisci are two pads of fibrocartilage on either side of the knee that act as cushions or shock absorbers. They also help distribute the weight load inside the knee.

Most tears of the meniscus result from a sudden twisting movement of the knee, as often occurs in sports injuries. As the knee bends and twists, the meniscus may be pinched between the bones. This is often accompanied by a “popping” sensation. The knee is likely to swell a few hours after the injury.

The tear may occur along the inner edge of the meniscus, or, less commonly, along the outer edge. There may be just a small torn “flap” of the meniscus, or a longer so-called “bucket-handle” tear, which is a tear along the length of the meniscus. Such a tear may cause the knee joint to “lock” meaning that the leg cannot be straightened.

The menisci may be also become damaged and torn as part of normal wear and tear within the knee joint as we age.

All types of meniscal tears can be treated by arthroscopy. Because the inner part of the meniscus has no blood supply, a tear along the inner part will not heal. Treatment, therefore, involves trimming away the torn piece of the meniscus. This is done with miniature motorized instruments inserted through a tiny incision on the side of the knee.

Meniscal injuries along the outer edge of the knee may be repaired rather than removed because the blood supply to this part of the meniscus is better, giving an improved chance of healing.

Ligament Injury

The cruciate ligaments restrict both the forward and backward motion of the knee and its rotation. They may be torn by sudden twisting motions of the knee beyond its normal range.

Not all cruciate ligament injuries need to be reconstructed; it depends on your age, level of activity, type of activity, and what you expect from your knee. A frank discussion with your doctor will help both of you determine whether surgery would be beneficial.

• If you enjoy active sports, it would be appropriate to have surgery.
• If you have a sedentary – type job and are not active in your leisure time, you may not require surgery.

Always, a simple repair by suturing the torn ligament together again is not effective. A successful repair involves completely replacing the torn ligament.

Ligament reconstruction is most commonly performed utilizing the patella tendon graft. The orthopedic surgeon takes the central strip of the patella tendon and roots this through the knee through tunnels drilled in the tibia and femur. This creates a new ligament to replace the torn one.

This method requires an extra skin incision ( about 2 inches in length ) to harvest the tendons to be used.

Loose Bodies Within The Knee

A traumatic incident to the knee can cause a fragment of cartilage, or a fragment of bone attached to cartilage, to come loose and float around the joint. This condition may result from “osteochondritis” (OCD).

Depending on the size of the fragment and whether it is still attached , the orthopedic surgeon may decide to reattach it or remove it entirely. The surgeon can perform either using the arthroscope.

A number of arthritic conditions may also cause loose bodies inside the knee.

Chondromalacia Of The Patella

This is a condition in which the cartilage surface lining the kneecap softens, sometimes to the point where the articular surface cracks, giving it an irregular surface. This may lead to discomfort felt in the knee, particularly when going up and down steps.

If the problem does not respond to medication or physical therapy, some surgeons elect to smooth the rough areas of the kneecap using arthroscopic surgery.

Osteoarthritis

As we get older, our joints, including the knee, may suffer from wear and tear that can cause pain and discomfort. If medication can’t control the discomfort, your surgeon may use arthroscopy to shave and smooth the roughened surfaces of the bone and trim any damage to the meniscus.

Clearing out the debris often helps reduce the pain of arthritis for a period of time. This is a significantly less traumatic procedure than a total knee replacement, which may ultimately be required if the pain and discomfort osteoarthritis becomes severe.

An Orthopedic Surgeon might use this procedure to diagnose or treat:

• A torn meniscal cartilage.
• Loose fragments of bone or cartilage.
• Damaged joint surface or softening of the articular cartilage known as chondromalacia.
• Inflammation of the synovial membrane, such as rheumatoid or gouty arthritis.
• Abnormal alignment or instability of the knee cap.
• Torn ligaments including the anterior and posterior cruciate ligaments.

It is usually possible to go back to physical activities or sports after around three weeks. The orthopedic surgeon will provide more advice about this in each individual case.

Frequently Asked Questions

Here are some frequently asked questions related to arthroscopy of the knee.

what type of knee problems can arthroscopy help?

Arthroscopy may help relieve problems of persistent pain, catching, or swelling in your knee due to meniscal tears, cruciate ligament injuries or loose bodies in the knee.

why is my knee prone to injury?

There are many soft tissue components to the knee, making it vulnerable for various types of injuries. The knee is the largest joint in the body, and one of the most easily injured.

What’s the advantage to having local instead of general anesthesia?

While the risk of problems with any type of anesthesia is small, there are fewer risks associated with local anesthesia than with general. In addition, local anesthesia is less expensive than general, and recovery in most cases is quicker.

My doctor told me I’ve injured my cruciate ligament. Does this mean I have to have surgery?

Not all cruciate ligament injuries need to be reconstructed. You need to discuss with your doctor your lifestyle and level of activity. If you have s sedentary-type job and are not active in your leisure time, you may not require surgery.

Do knee injuries from playing sports happen only to professional athletes?

Unfortunately, knee injuries during sports can happen to anyone. A casual game of soccer can turn into a painful and debilitating injury for someone whose body is unprepared for athletics. Knee injuries can happen during an impromptu volleyball game at your company picnic, when your are heading out to the ski slopes on your first free weekend in a while, or even while playing a game of catch with your children.

How much physical therapy will I need after the ACL reconstruction?

One of the main priorities after ACL reconstruction is to regain the knee range of motion. This along with establishing a good strengthening program is usually best done two to three times per week for the first four to six weeks. Because many insurance policies will not cover this many visits to the therapist, an independent home program may need to be instructed earlier. Compliance in performing the exercises in and out of the clinic is the key.

I like to snow and water ski. can I still do these activities after ACL reconstruction?

Unless the surgeon advises otherwise, most people return to enjoying both of these sports with the use of a brace. However, remember every individual injury is different. Following the recommendations of the surgeon is of utmost importance