Knee arthroscopy is a minimally invasive method that helps diagnose and treat intra-articular knee problems. With this procedure it is possible to have a visual assessment and palpation of all knee elements, that is, the cruciate ligaments, the menisci, medial and lateral, as well as the articular cartilage covering the bones.
The knee joint is created by the connection of the femur to the tibia. The bone surfaces are covered by articular cartilage and the anterior cruciate ligament (ACL) connects them. Between the articular surfaces the two menisci interfere, the medial and the lateral.
The arthroscope, a cylindrical camera attached to a monitor and various tools to correct knee injuries are inserted into the joint through two small incisions with a diameter of 5 mm each. The joint is filled with saline solution in order to be extended and to wash the surgical area.
The arthroscope is positioned inside the knee joint, which is illuminated by a source of cold lighting.
The main indications for arthroscopy are:
- Diagnosis of intra-articular knee disorders
- Knee meniscus rupture
- Anterior cruciate ligament rupture
- Posterior cruciate ligament rupture
- Removal of loose bodies
- Osteochondral lesions
- Synovial bursa disorders
- Selected tibial condyle fractures
- Septic arthritis
The duration of the procedure depends on the experience of the surgeon and the type of damage in the joint. Arthroscopic meniscectomy lasts about 15 minutes, and anterior cruciate ligamentoplasty takes about 1 hour.
How is knee arthroscopy performed?
Arthroscopy is usually performed without hospitalization. The type of anesthesia varies depending on the severity of the injury, the general condition and the age of the patient. The anesthesiologist has the choice among general, epidural, regional or even local anesthesia. Usually, we have at least 2 entrance gates with incisions of 4-5mm, through which arthroscopy is performed. One of them is used for the camera and the other for the tools, with the help of which corrective and therapeutic actions are performed. In some cases we can place a cylindrical tube in the 2nd gate (cannula) through which multiple tools can be used without injuring the tissues. At the end of the procedure, sterile strips are placed on the entrance gates and they are bandaged.
What are the benefits of arthroscopy?
Arthroscopy is easier to anesthetize (since even local anesthesia can be used), there is no serious or no post-operative pain, it is not a bloody surgery, it allows the patient to be mobilized immediately and return home on the same day. Finally, it enables the surgeon to review the entire joint and not focus on a single injury, as he would in the “open” surgery.
What are the disadvantages of arthroscopy?
Arthroscopy has few disadvantages, but many advantages. The main advantages are minor joint injury, low morbidity, low risk of complications, minor trauma, short hospital stay, minimal or no postoperative pain and better diagnosis and treatment of disorders.
However, the experience and special training of the surgeon, the precise preoperative diagnosis, the good surgical technique and the appropriate equipment are a prerequisite for success.
What kind of anesthesia is used?
A combination of regional anesthesia with general anesthesia with a laryngeal mask is usually applied. During this procedure, the patient inhales an anesthetic gas and sleeps during the operation without sedation of the central nervous system and the respiratory center. Few drugs are administered in connection with general anesthesia and the patient is breathing alone without being dependent on the respirator. An advantage of this method is safe anesthesia, postoperative analgesia, immediate mobilization and rapid discharge from the hospital.
In what conditions can knee arthroscopy be useful?
Arthroscopy is indicated in a wide range of pathological conditions, such as infectious, inflammatory (rheumatoid) and non-inflammatory (seronegative) arthritis, where it serves both in the identification and classification of the disease, as well as in the treatment (bursectomy, washouts, arthroscopic lavage and chondroplasty). More specifically, it is involved in a wide range of traumatic diseases (meniscus rupture, anterior and posterior cruciate ligament rupture, patellar instability, chondrocyte transplantation, ligament reconstruction surgery, etc.).
What is the patient’s preparation for arthroscopy?
The patient undergoes a routine preoperative examination, which includes chest X-ray, electrocardiogram, general blood count and biochemical tests. These can be done upon admission to the Hospital, or earlier as an outpatient. Diabetes and hypertension are particularly taken into account. Any clinical sign of local joint inflammation may postpone arthroscopy for later, unless it is performed for this purpose (biopsy, flushing, etc.).
How long do you stay in hospital after arthroscopy?
The hospital stay after meniscectomy is about 3 hours and after ligamentoplasty 1 day.
How is the recovery period after arthroscopy?
Usually, after surgery, the patient feels a little drowsiness, especially if he or she was under general anesthesia. The picture of the patient 1-2 hours after surgery is spectacular, in the case of a regional block, where the patient due to analgesia, doubts whether he has actually been operated on. Hyposensitivity and numbness subsides after a few hours. The mobilization is immediate and the patient walks within the first hours after surgery. However, depending on the repaired injury, the recovery program is tailored to the needs of the individual patient.
How Much Will I Pain The Day After Surgery?
Knee arthroscopy to treat meniscus ruptures is almost painless. The patient can walk with a walking cane and bend the knee to a great extent immediately.
Are there any complications in arthroscopy?
Complications potentially occur even in the simplest procedure, even by the most experienced surgeon. Practically, however, in arthroscopic surgery, such complications can occur, either intraoperatively with a specific use of tools, or postoperatively, which is most commonly associated with inflammation, thrombophlebitis or postoperative edema. In general, their percentage is now below 1% and is easily manageable.
When does physiotherapy begin?
Physiotherapy begins as soon as the surgery ends, in the recovery room, where the patient is asked to begin moving his or her limbs and will be encouraged to get fully mobilized when he or she returns to his or her room. The full physiotherapy program begins on the next day.