Arthroscopy involves the surgical placement of miniature tubes with video cameras into the joint to visualize and treat various orthopaedic problems. Along with the shoulder (see arthroscopic subacromial decompression), arthroscopic surgery of the knee has become the most commonly performed orthopaedic surgical procedure. Arthroscopic techniques have revolutionized operative management of knee pathology. "Open surgery" of the knee has been replaced by minimally invasive, out-patient based surgery, resulting in less post-operative pain and a rapid return of function. In the past, knee surgery was an in-patient procedure characterized by a surgical scar, hospitalization, and a lengthy recovery.
Arthroscopic procedures have been successfully employed to treat a wide spectrum of knee pathology such as:
In this discussion we will be addressing Arthroscopic Knee Surgery for the treatment of meniscal pathology, more commonly referred to as torn cartilage.
You may hear your physician refer to various conditions of the knee as an Internal Derangement. This is a general term for a mechanical problem affecting the knee. The diagnosis may be refined by employing specific physical examination tests and certain studies such as an MRI Scan. After the diagnosis of torn meniscus is made, and depending on the severity of the symptoms, arthroscopic surgery may be recommended.
The procedure is performed in an ambulatory setting utilizing local anesthesia and sedation. The entire procedure generally takes less than one or two hours, and within an additional hour after completion, you are ready to return home. Prior to your procedure you will require pre-admission blood work and a discussion with the anesthesiologist. Depending on your age and general medical condition, you may also require a medical clearance from your internist or family physician. Approximately one week prior to your surgery, all anti-inflammatory medication, such as aspirin, motrin or other similar medications should be discontinued so as to reduce bleeding during the procedure.
The surgeon will make a series of small incisions around the knee to gain access to the interior of the joint. The structures are displayed on a video screen, by moving the arthroscope through different compartments of the knee. He will perform a diagnostic evaluation of the knee, confirming the diagnosis of a torn meniscus. By visualizing the entire inside of the knee joint with the arthroscope, unexpected pathology can be dealt with at the same time.
A number of specialized micro-motorized instruments are used to trim away only the portion of the meniscus which is torn. This innovation allows healthy, untorn meniscus to be retained, thus providing its normal function as a stabilizer and a "shock absorber". In some cases, the meniscus can even be repaired, restoring the structure to pre-injury status.
At the conclusion of the procedure the incisions will be closed with a single suture and a dressing and knee splint will be applied. You will proceed to the recovery room and within an hour you should be on your way home. Pain medication will be prescribed. Most patients find that ice packs applied for 20 minutes as needed also aid in pain relief. You may walk on the knee as tolerated, but rest and elevation are best. Some drainage on the dressing is normal. However, if you have pain not controlled by the medication, experience a temperature above 100, or tingling and numbness in the leg, be sure to call your doctor.
You will be seen in the office a day or two after surgery. At that time the dressing will be removed and the incisions covered with just a band-aid. You will be allowed to walk, shower, and will be given a prescription to start physical therapy. Prior to beginning therapy, there are exercises which can be performed at home.
Some swelling of the knee post-operatively is normal. This can last up to four weeks. Don't be alarmed. The therapy, which usually lasts six to eight weeks, will address this problem.
Due to the minimally invasive nature of arthroscopic knee surgery, post-operative recovery generally progresses rapidly. This revolutionary out-patient procedure provides the patient with treatment resulting in little if any scaring, less post-operative pain, and rapid return of knee function.
Reprinted with permission of Evergreen Publications.
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