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knee arthroscopy

KNEE ARTHROSCOPY

knee arthroscopy OVERVIEW

Knee arthroscopy is a surgical procedure that allows doctors to view the knee joint without making a large incision through the skin and other soft tissues around the joint. During an arthroscopic procedure, your surgeon passes a narrow tube attached to a fiber-optic video camera through a small "button-size" incision. This provides a view from inside your knee joint which is transmitted to a high-definition video monitor. Therefore, without making a large incision, your surgeon can easily visualize the knee joint. Surgeons can even repair some types of damage within the joint during arthroscopy with thin surgical instruments that can be inserted through additional small incisions near the knee.

basic knee anatomy

As the largest joint in your body, healthy knees are required to perform most basic daily activities. Basically, the knee is made up of the lower end of the large thighbone (femur), the upper end of the shinbone (tibia), and the kneecap (patella). The surfaces of theses three bones that touch are covered with articular cartilage, a smooth layer that protects the bones at points of contact and enables the joint to move easily. Your knee can be divided into three major compartments: the Medial compartment (the inside part of the knee), Lateral compartment (the outside part), and Patellofemoral compartment (the front of the knee between the kneecap and thighbone).

The menisci are C-shaped wedges located between the femur (thighbone) and tibia (shinbone). The menisci act as shock-absorbers to cushion the joint. Large ligaments hold the femur and tibia together and provide knee joint stability. The long thigh muscles give the knee strength and additional stability. All remaining surfaces of the knee joint are covered by a thin lining called the synovial membrane which releases a fluid that lubricates the cartilage and reduces friction within the knee. In a healthy knee joint, all of these components work together to provide smooth, pain-free knee range of motion. Disease (most often Arthritis) or injury within the joint can disrupt this harmony, resulting in pain, lack of joint mobility, muscle weakness, and reduced function.
knee anatomy diagram
The most common cause of chronic knee pain and disability is arthritis. Although there are many types of arthritis, most knee pain is caused by just three types: Osteoarthritis, Rheumatoid Arthritis, and Post-Traumatic Arthritis.
Osteoarthritis is an age-related "wear and tear" type of arthritis. Osteoarthritis typically occurs in people over the age of 50 but may at times occur in younger people. In Osteoarthritis, the cartilage that cushions the bones of the knee thins and wears away. Damaged cartilage causes the bones that then rub against one another, leading to knee pain and joint stiffness.
Rheumatoid Arthritis is a disease in which the synovial membrane that surrounds the joint becomes inflamed and can thicken. Chronic inflammation within the knee joint can damage the cartilage and eventually cause cartilage loss, pain, and knee joint stiffness. Although there many types of "inflammatory arthritis" Rheumatoid arthritis is the most common form in this group.
Post-traumatic Arthritis can follow a serious knee injury. Fractures of the bones near the knee joint or tears of the supporting ligaments can damage the articular cartilage over time, resulting in joint instability, pain and limited knee function.
osteoarthritis and rheumatoid arthritis diagram

when is knee arthroscopy useful

Knee Arthroscopy may be recommend if you have a painful condition that does not improve with nonsurgical treatment. Nonsurgical treatment includes rest, physical therapy, and medications or injections designed to reduce joint inflammation. Knee arthroscopy may sometimes relieve the painful symptoms of certain problems that damage the cartilage surfaces and soft tissues surrounding the knee joint. Possible therapeutic arthroscopic procedures for the knee include: removal or repair of a torn meniscus, reconstruction of a torn anterior cruciate ligament, removal of inflamed synovial tissue, trimming of damaged articular cartilage, removal of loose fragments of bone or cartilage, treatment of patella (kneecap) problems, and diagnosis/treatment of knee sepsis (infection). Knee arthroscopy typically has a much more limited role in treatment of the arthritic knee.

basic knee arthroscopy procedure

Anesthesia
Once you are moved into the operating room, you will be given anesthesia. To help prevent surgical site infection, the skin on your knee will be cleaned. Your leg will be covered with surgical draping that exposes the prepared incision site. At this point, a positioning device is sometimes placed on the leg to help stabilize the knee while the arthroscopic procedure takes place.

Procedure
To begin the procedure, the surgeon will make a few small incisions, called "portals," in your knee. A sterile solution will be used to fill the knee joint and rinse away any cloudy fluid. This helps your orthopedic surgeon see the structures inside your knee clearly and in great detail. Your surgeon's first task is to properly diagnose your problem. He or she will insert the arthroscope and use the image projected on the screen to guide it. If surgical treatment is needed, your surgeon will insert tiny instruments through other small incisions. Specialized instruments are used for tasks like shaving, cutting, grasping, and meniscal repair. In many cases, special devices are used to anchor stitches into bone.

Closure
A soft bandage will protect your incisions while they heal.Most knee arthroscopy procedures last less than an hour. The length of the surgery will depend upon the findings and the treatment necessary. Your surgeon may close each incision with a stitch or steri-strips (small bandaids), and then cover your knee with a soft bandage.

partial knee replacement surgical procedure

Video Source: Knee Arthroscopy - Surgical Teaching Video. First-person operative technique, edited and animated to guide you through the procedure. Created by: Mr Malek RacyAdvisor and Surgeon: Mr Fazal Ali

Complications

The complication rate after arthroscopic surgery is very low. If complications occur, they are usually minor and are easily treated. Possible postoperative problems with knee arthroscopy include: Infection, Blood clots, Knee stiffness, and the Accumulation of blood within the knee joint. Your surgeon will go through steps to help lower your risk of post-surgical complications.

physical therapy and recovery following knee arthroscopy

While recovery from knee arthroscopy is faster than recovery from traditional open knee surgery, it is important to follow your doctor's instructions carefully after you return home.

Pain Management
After surgery, you will likely feel some pain. This is a natural part of the procedure and healing process. Your doctor and nurses will work to reduce your pain immediately after surgery to help you recover from faster. Medications are often prescribed for short-term pain relief after surgery. Many types of medicines are available to help manage pain, including opioids, non-steroidal anti-inflammatory drugs (NSAIDs), and local anesthetics. Your doctor may use a combination of these medications to improve pain relief, as well as minimize the need for opioids. Be aware that although opioids help relieve pain after surgery, they are a narcotic and can be addictive. Opioid dependency and overdose has become a critical public health issue in the U.S. It is important to use opioids only as directed by your doctor. As soon as your pain begins to improve, stop taking opioids. Talk to your doctor if your pain has not begun to improve within a few days of your surgery.

Medications
In addition to medicines for pain relief, your doctor may also recommend medication such as aspirin to lower the risk of blood clots.

Swelling
You will be instructed to keep your leg elevated as much as possible for the first few days after surgery. Apply ice as recommended by your doctor to relieve swelling and pain.

Dressing Care
You will leave the hospital with a dressing covering your knee. It is important to keep your incisions clean and dry. Your surgeon will tell you when you can shower and when you should change the dressing. Your surgeon will see you in the office within a few days of your surgery to check your progress, review the surgical findings, and begin your postoperative rehabilitation program.

Bearing Weight
Most patients need crutches or other assistance immediately following arthroscopic surgery. Your surgeon will tell you when it is safe to put weight on your foot and leg. If you have any questions about bearing weight, call your surgeon.

Rehabilitation Exercise
You should exercise your knee regularly for several weeks after surgery. This will restore motion and strengthen the muscles of your leg and knee. Working with a physical therapist can help you achieve your best recovery. Physical Therapy exercises will play an important role in how well you recover and your ultimate joint function. A formal physical therapy program may be prescribed to improve your final result.

Driving
Your doctor will discuss with you when you may drive. Typically, patients are able to drive from 1 to 3 weeks after the procedure.

follow-up and precautions following knee arthroscopy

Many people are able to return to full, unrestricted activities after arthroscopy. Your recovery will depend on the type of damage that was present in your knee and your conditioning prior to surgery. Unless you have had a ligament reconstruction, you should be able to return to most physical activities after 6 to 8 weeks and sometimes much sooner. Higher impact activities may need to be avoided for a longer time. If your job involves heavy work, it may obviously be longer before you can return to your job. Discuss when you can safely return to work with your doctor. For some people, lifestyle changes are necessary to protect the joint. An example might be changing from high impact exercise (such as running) to lower impact activities (such as swimming or cycling). Your surgeon will help guide you through recommendations during the recovery process.
Source: American Academy of Orthopaedic Surgeons, https://orthoinfo.aaos.org/; American Association of Hip and Knee Surgeons, https://hipknee.aahks.org/total-hip-replacement/
Cory Calendine, MD is an Orthopedic Surgeon and founding partner of the Bone and Joint Institute of Tennessee at Williamson County Hospital in Franklin, TN. Dr. Calendine is an expert in Joint Replacement, specializing in Hip and Knee Surgery. From diagnosis through treatment, the Orthopedic Surgical experts at the Bone and Joint Institute use the latest techniques and technology to improve care for people with musculoskeletal problems. For more information, please contact our office or schedule your appointment today.
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