Dr. Rahul Damle – Knee Arthroscopy Specialist
What is arthroscopy ?
Arthroscopy is a surgical procedure orthopaedic surgeons use to visualize, diagnose and treat problems inside a joint.
The word arthroscopy comes from two Greek words, “arthro” (joint) and “skopein” (to look). The term literally means “to look within the joint.” In an arthroscopic examination, an orthopedic surgeon makes a small incision (about the size of a button-hole) in the patient’s skin and then inserts pencil-sized instruments that contain a small lens and lighting system to magnify and illuminate the structures inside the joint.
Light is transmitted through fiber optics to the end of the arthroscope that is inserted into the joint. By attaching the arthroscope to a miniature television camera, the surgeon is able to see the interior of the joint through this very small incision rather than a large incision needed for surgery.
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.
In some facilities, the patient can choose to watch the surgery on the monitor as well.
After the camera is inserted, saline is pumped in under pressure to expand the joint and to help control bleeding.
After looking around the entire knee for problem areas, the surgeon will usually make one to four additional small incisions to insert other instruments. Commonly used instruments include a blunt hook to pull on various tissues, a shaver to remove damaged or unwanted soft tissues, and a burr to remove the bone.
At the completion of the surgery, the saline is drained from the knee, the incisions are closed, and a dressing applied. The procedure is generally recorded and the recording handed over to the patient.
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, may be needed. Through the arthroscope, a final diagnosis is made which may be more accurate than even MRI Scan studies. Also at the same time, the injury or the damaged tissues can be repaired !
Knee Arthroscopy : Indications
Arthroscopy may be recommended for knee problems, such as:
1. A torn meniscus (either repair or remove)
2. Loose bodies (small pieces of broken cartillage) in the knee joint
3. A torn Anterior Cruciate or Posterior Cruciate Ligament (ACL / PCL Reconstruction)
4. Inflamed or damaged lining of the joint (synovium) for Synovectomy / Biopsy
5. Malalignment of the knee cap (Patella) / MPFL Reconstruction
6. Mild arthritis / Chondroplasty
7. Cartilage biopsy for ACI etc
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.
Preparing for Surgery
During your pre-op visit, lab tests will be advised to insure that you are in good general -health. Chest x-rays and an ECG are obtained if you have not had one taken for six months or if otherwise indicated. A physician will also review your medical history and the medications that you take. He will do a general physical exam.
Convalescence & Recovery
The patient is usually discharged from the hospital within 1 day depending upon the condition the patient was operated for. For a simple meniscal surgery, recovery is usually quite rapid. The patient may need to use crutches for a while to reduce weight placed on the knee joint to control pain. Pain can be managed with medications.
For more complicated procedures where anything is fixed or reconstructed, the recovery takes a little more time.
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 will 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.
What are the possible complications?
Although uncommon, complications do occur occasionally during or following arthroscopy.
Infection, phlebitis (blood clots of a vein), excessive swelling or bleeding, damage to blood vessels
or nerves, and instrument breakage are the few complications that can occur, but do so in less than 1
percent of all arthroscopic procedures.