Knee arthroscopy is a type of keyhole surgery, used to look inside and treat the knee joint. Knee arthroscopy is surgery that is done to check for problems, using a tiny camera to see inside your knee. Other medical instruments may also be inserted to repair your knee.
Three different types of anesthesia (pain management) may be used for knee arthroscopy surgery:
Ø Your knee may be numbed with painkilling medicine, and you may be given medicines that relax you. You will stay awake.
Ø Spinal anesthesia. This is also called regional anesthesia. The painkilling medicine is injected into a space in your spine. You will be awake but will not be able to feel anything below your waist.
Ø General anesthesia. You will be unconscious and unable to feel pain.
A cuff-like device that inflates may be used around your thigh to help control bleeding during knee arthroscopy.
The surgeon will make 2 or 3 small incisions (cuts) around your knee. Saltwater (saline) will be pumped into your knee to open up the space.
A narrow tube with a tiny camera on the end will be inserted through one of the incisions. The camera is attached to a video monitor in the operating room. The surgeon looks at the monitor to see the inside of your knee. In some operating rooms, the patient can also watch the surgery on the monitor, if they want to.
The surgeon will look around your knee for problems. The surgeon may put other medical instruments inside your knee through the other small incisions. The surgeon will then repair or remove the problem in your knee.
Your care will be adapted to meet your individual needs and may differ from what is described here. So it's important that you follow your surgeon's advice. At the end of your surgery, the saline will be drained from your knee. The surgeon will close your incisions with sutures (stitches) and cover them with a dressing. Many surgeons take pictures of the procedure from the video monitor so that afterward you can see what was found and what was done.
If you have persistent pain, catching, or swelling in your knee, a procedure known as arthroscopy may help relieve these problems.
Arthroscopy allows an orthopaedic surgeon to diagnose and treat knee disorders by providing a clear view of the inside of the knee with small incisions, utilizing a pencil-sized instrument called an arthroscope. The scope contains optic fibers that transmit an image of your knee through a small camera to a television monitor. The TV image allows 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 incisions in your knee to remove or repair damaged tissues.
Modern or contemporary arthroscopy of the knee was first performed in the late 1960s. With improvements of arthroscopes and higher-resolution cameras, the procedure has become highly effective for both the accurate diagnosis and proper treatment of knee problems. Today, arthroscopy is one of the most common orthopaedic procedures in the United Kingdom.
Whether you have just begun exploring treatment options for your problem knee or have already decided, with your orthopaedic surgeon, to have an arthroscopy, this information will help you understand more about this procedure.
How the Normal Knee Works
The knee is the largest joint in the body, and one of the most easily injured. It is made up of the lower end of the thigh bone (femur), the upper end of the shin bone (tibia), and the knee cap (patella), which slides in a groove on the end of the femur. Four bands of tissue, the anterior and posterior cruciate ligaments, and the medial and lateral collateral ligaments connect the femur and the tibia and provide joint stability. Strong thigh muscles give the knee strength and mobility.
The surfaces where the femur, tibia and patella touch are covered with articular cartilage, a smooth substance that cushions the bones and enables them to glide freely. Semicircular rings of tough fibrous-cartilage tissue called the lateral and medial menisci act as shock absorbers and stabilizers.
The bones of the knee are surrounded by a thin, smooth tissue capsule lined by a thin synovial membrane which releases a special fluid that lubricates the knee, reducing friction to nearly zero in a healthy knee.
Knee Problems
Normally, all parts of the knee work together in harmony. But sports, work injuries, arthritis, or weakening of the tissues with age can cause wear and inflammation, resulting in pain and diminished knee function.Arthroscopy can be used to diagnose and treat many of these problems:
* Torn meniscal cartilage.
* Loose fragments of bone or cartilage.
* Damaged joint surfaces 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 kneecap.
* Torn ligaments including the anterior and posterior cruciate ligaments.
By providing a clear picture of the knee, arthroscopy can also help the orthopaedic surgeon decide whether other types of reconstructive surgery would be beneficial.
Why the Procedure is Performed
Ø Arthroscopy may be recommended for these knee problems:
Ø A torn meniscus. Meniscus is cartilage that cushions the space between the bones in the knee. Surgery is done to repair or remove it.
Ø A torn or damaged anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL)
Ø Inflamed or damaged lining of the joint. This lining is called the synovium.
Ø Misalignment of the kneecap (patella). Misalignment puts the kneecap out of position.
Ø Small pieces of broken cartilage in the knee joint
Ø Removal of Baker's cyst -- a swelling behind the knee that is filled with fluid. Sometimes this occurs when there is inflammation (soreness and pain) from other causes, like arthritis.
Some fractures of the bones of the knee
Risks
The risks for any anesthesia are:
· Allergic reactions to medicines
· Breathing problems
The risks for any surgery are:
· Bleeding
· Infection
Additional risks for this surgery include:
· Bleeding into the knee joint
· Damage to the cartilage, meniscus, or ligaments in the knee
· Blood clot in the leg
· Injury to a blood vessel or nerve
· Infection in the knee joint
· Knee stiffness
Before the Procedure
Always tell your doctor or nurse what drugs you are taking, even drugs, supplements, or herbs you bought without a prescription.
During the 2 weeks before your surgery:
· You may be asked to stop taking drugs that make it harder for your blood to clot. These include aspirin, ibuprofen (Advil, Motrin), naproxen (Naprosyn, Aleve), and other drugs.
· Ask your doctor which drugs you should still take on the day of your surgery.
· Tell your doctor if you have been drinking a lot of alcohol, more than 1 or 2 drinks a day.
· If you smoke, try to stop. Ask your doctor for help. Smoking can slow down wound and bone healing.
· Always let your doctor know about any cold, flu, fever, herpes breakout, or other illness you may have before your surgery.
On the day of your surgery:
· You will usually be asked not to drink or eat anything for 6 to 12 hours before the procedure.
· Take your drugs your doctor told you to take with a small sip of water.
· Your doctor or nurse will tell you when to arrive at the hospital.
After the Procedure
After the surgery, you will have an ace bandage on your knee over the incision dressing. Most people go home the same day they have surgery. Your doctor will give you an exercise program to follow.
Outlook (Prognosis)
Whether or not you have a full recovery after knee arthroscopy depends on what type of problem was treated.
Problems such as a torn meniscus, broken cartilage, Baker's cyst, and problems with the synovium are usually fixed easily. Many patients remain active after these surgeries.
Recovery from simple procedures is usually fast. You may need to use crutches for a while so that you do not put weight on your knee and to control pain. This will depend on what kind of surgery you had. Your doctor may also prescribe pain medicine.
Recovering from more complicated procedures will take longer. When anything in your knee is repaired or rebuilt, you may not be able to walk without crutches or a knee brace for several weeks. Full recovery may take several months to a year.
If you also have arthritis in your knee, you will still have arthritis symptoms after surgery to repair other damage to your knee.
About knee injuries
The most common knee injuries are:
· a sprain - one or more ligaments is overstretched through twisting or pulling; the ligament may be torn or ruptured
· a strain - a tendon or muscle is overstretched
· damage to the cartilage in your knee - the cartilage is a crescent-shaped disc called a meniscus, that acts as a 'shock absorber' in your knee
· overuse - this is most common in people who run
Ligaments connect one bone to another. The ligaments outside your knee joint are called the medial collateral ligament and the lateral collateral ligament. They provide your knee with stability and limit the amount it can move from side to side.
- The medial collateral ligament is on the inner side of your knee and is taut when your leg is straight. It's a strong ligament but can be sprained or completely ruptured (torn) if you twist your straightened leg at the same time as being knocked sideways, for example, when being tackled in rugby.
- The lateral collateral ligament is like a thin, strong cord that runs on the outer side of your knee connecting the bottom of your thigh bone to the top of your fibula (one of the bones in your lower leg). It's not usually damaged on its own, but you may need to have it repaired if you have damaged other ligaments.
· Medial and lateral collateral ligament injuries may be classed as follows:
- Grade 1 is a sprain with no tearing of the ligament
- Grade 2 is a partial tear of the ligament
- Grade 3 is a complete tear of the ligament
The ligaments inside your knee joint are called the anterior cruciate ligament and the posterior cruciate ligament. Cruciate means in the form of a cross - the anterior cruciate ligament crosses over in front of the posterior cruciate ligament. These ligaments provide stability to your knee, when it is in different positions, particularly in the forward and backward movements of the knee joint.
The other soft tissues around your knee can also be injured. Soft tissue means any tissue in your body that isn't bone.
If you play a sport that involves twisting your upper leg while your foot is planted on the floor, you may tear the cartilage in your knee. The cartilage becomes worn down (degenerates) as you get older, making it easier to tear even after a very minor injury.
Overuse of your knee can also result in tearing a patellar tendon. Your patellar tendon connects your kneecap (patella) to your thigh muscle.
Symptoms of knee injuries
The symptoms for most ligament injuries will be similar, no matter which one has been damaged. These may include:
· Pain
· Swelling
· Instability - you may feel like your knee is giving way or that it's locking
You may feel a popping or snapping sensation at the time of the injury, or even hear a popping sound. You may also find that you can't stand properly on the affected leg, or put your full weight on it.
You won't feel any direct pain if you injure the cartilage in your knee, but you may have some pain or discomfort from the swelling that follows an injury. Pain may develop on either the inside or outside of your knee joint (depending on which knee you have damaged the cartilage) and you may see some swelling.
If you have any of these symptoms, visit your GP or physiotherapist for advice.
Causes of knee injuries
You may injure your knee if:
It receives an impact or is moved beyond its usual range of movement, for example if you have a fall or land awkwardly
· you play a sport that combines running, jumping and stopping with quick changes of direction, such as football
· you have a condition such as osteoarthritis or gout, or are very overweight
· your knees hit the dashboard in a car accident - posterior cruciate ligament damage is sometimes called the 'dashboard injury' as this is often how it occurs
Diagnosis of knee injuries
Your GP or physiotherapist will ask about your symptoms and examine you. This may include feeling for fluid in the joint by pressing gently over your kneecap, especially if your knee doesn't look severely swollen. Your GP or physiotherapist will ask you to describe how the injury happened, where your pain is and what type of pain it is.
Your GP or physiotherapist may test for injury to your knee ligaments or soft tissues by bending and flexing your knee, and moving your leg into different positions, while you lie or sit down.
Your GP or physiotherapist may also ask you to perform movements such as stepping, squatting or hopping.
Your GP/physiotherapist may refer you for other tests in a hospital or clinic. These may include an MRI or ultrasound scan or occasionally X-ray. These tests can help to diagnose more complicated or severe injuries.
Treatment of knee injuries
The treatment you will receive will depend on what damage you have done and how bad the damage is.
You should follow the PRICE procedure to manage any type of soft tissue injury to your knee. PRICE stands for the following.
· Protection. Protect your injury from further harm.
· Rest. Rest the injury for the first two to three days, then reintroduce movement so you don't lose too much muscle strength.
· Ice. Apply a cold compress such as ice or a bag of frozen peas wrapped in a towel to help reduce swelling and bruising. Don't apply ice directly to your skin as it can damage your skin.
· Compression. Compress the joint by bandaging it to support the injury and help decrease swelling.
· Elevation. Elevate your knee by resting it above the level of your heart and keep it supported.
There are certain things you should not do in the first three days after your injury to avoid doing further damage to your knee. These can be remembered as HARM.
· Heat. This includes having a hot bath or using a heat pack.
· Alcohol. Drinking alcohol can increase bleeding and swelling in the affected area.
· Running or other forms of exercise.
· Massaging the injured knee. This can cause more swelling or bleeding.
You may need to use crutches or wear a brace to make sure that you keep weight off the affected knee.
You can buy painkillers such as paracetamol or ibuprofen to treat mild and moderate pain. Your GP may prescribe stronger painkillers if your pain is severe. As well as easing your pain, painkillers may help to any reduce inflammation and swelling. Always read the patient information that comes with your medicine and if you have questions, ask your pharmacist or doctor for advice.
Physiotherapy
If your injury is more severe or complex, your GP may refer you to a physiotherapist (a health professional who specialises in movement and mobility). You can also choose to see a physiotherapist privately. Your physiotherapist may also use various techniques to help speed up the healing of your knee.
Braces to support your knee are occasionally used during rehabilitation, usually when an injury has been severe.
In some situations, you may need to have surgery to repair the injury to your knee. This is likely to be the case if:
· you have ruptured your lateral collateral ligament
· you have damaged your anterior cruciate ligament and you do a lot of sport, or have also torn cartilage or your medial collateral ligament - you may need a reconstruction operation, which involves taking a graft of tendon (usually from your kneecap) to replace the damaged ligament
· more than one ligament or tissue in your knee has been damaged
· you have torn your patellar tendon
· your knee remains painful or locks after a meniscus injury
Prevention of knee injuries
There are some precautions you can take to try to reduce the risk of damaging your knee ligaments.
· Exercise regularly to maintain a good level of fitness. This will mean your muscles are stronger and better able to support your joints, including your knees. If you haven't been active for a while, start gently and gradually increase the intensity.
· Spend five to 10 minutes warming up before exercise to increase blood flow to your muscles and reduce the chance of an injury. Many sports professionals advise stretching your muscles after warming up and again after cooling down; however the benefit of stretching before or after exercise is unproven.
Knee scope - arthroscopic lateral retinacular release; Synovectomy - knee; Patellar (knee) debridement; Meniscus repair; Lateral release; Knee surgery
For more details please contact:
Dr. Prateek Gupta (Senior Surgeon)
Arthroscopy Surgery Clinic
C2/5 Safdarjung Development Area (SDA),
Aurobindo Marg, New Delhi - 110016
INDIA
Telephones: +91 9810852876, +91 11 26517776
24 x 7 Helpline & Appointment: +91 9810633876
Email: sportsmedicinedelhi@yahoo.com,
sportsmedicineclinics@gmail.com
Website: http://www.sportsmedicineclinicdelhi.com/arthroscopy.htm