ARTHROSCOPY – AN INTRODUCTION

Do you have knee problems!

The most common symptoms are:

• Pain
• Stiffness and swelling
• Catching or locking of your knee
• The sensation of your knee “giving way”

You may not be able to move your knee through its full range of motion You might feel a “pop” when you damage your knee. your knee may slip, pop or lock.

Key hole surgery in knee

Arthroscope is a fibre-optic telescope that can be inserted into a joint (commonly the knee, shoulder and ankle) to evaluate and treat a number of conditions .A camera is attached to the arthroscope and the picture is visualized on a TV monitor. The doctor can visualize each and every detail of the interior of the knee and treat accordingly.Knee arthroscopy is a common procedure

The advantage of arthroscopy or key hole joint surgery over traditional open surgery are

1. The joint does not have to be opened up fully. Instead, for knee arthroscopy only two very small incisions are made ,each the size of a pen
2. This reduces recovery time and increase rate of surgical success due to less trauma to the connective tissue. It is especially useful for professional athletes, who frequently injure knee joints and require fast healing time.
3. There is also less scarring, because of the smaller incisions.
4. Shorter hospital stay and less pain due to surgery

Three different types of anesthesia may be used for knee arthroscopy surgery:

• Your knee may be numbed with painkilling medicine.
• Spinal anesthesia. The pain killing medicine is injected into a space in your spine.
• General anesthesia. You will be unconscious and unable to feel pain.

The patient can remain awake and watch the surgery on the monitor, in the first two.

Basic Knee Anatomy

The knee joint is made up of the femur, tibia and patella (knee cap) which are lined with articular (surface cartilage). The knee joint has a small amount of synovial (lubrication) fluid to help with smooth motion .Between the tibia and femur lie two floating cartilages called menisci and ligaments called the medial and lateral collateral ligaments and the anterior and posterior cruciate ligaments which support the knee from buckling and giving way.

Patient Information.

• Stop taking Aspirin and Anti-inflammatories 5 days prior to your surgery. you are advised to stop smoking a few days prior to your surgery. You will need to remain fasted for 6 hours prior to the procedure.
• You will wake up in the recovery room after surgery and then be transferred back to the ward .A bandage will be around the operated knee. Once you are recovered you will be shown a number of exercises to do. Pain medication will be provided.
• It is NORMAL for the knee to swell after the surgery. Elevating the leg when you are seated and placing Ice-Packs on the knee will help to reduce swelling. (Ice packs on for 20 min 3-4 times a day until swelling has reduced) You shouldn’t apply ice directly to your skin as it can damage your skin
• You are able to drive and return to work when comfortable unless otherwise instructed . Recovery from simple procedures is usually very fast. Recovering from more complicated procedures will take longer and You may need to use crutches for a while.

The Arthroscopy is useful in evaluating and treating the following conditions :

• Meniscal Cartilage Tears : Sudden meniscal tears often happen during sports. Older people are more likely to have degenerative meniscal tears. Just an awkward twist when getting up from a chair may be enough to cause a tear. Torn cartilages continue to cause symptoms of discomfort, pain and swelling. In the open surgical technique the entire meniscus including the healthy portion is removed which can lead to early wear and tear With arthroscopy Only the torn section is removed and the knee become symptom free.In certain cases the torn portion can even be repaired with arthroscopy .
• Torn surface (articular) cartilage. This is most significant as a major shock-absorbing function is compromised. Large pieces of articular cartilage can float in the knee causing locking of the joint and further rapid wear and tear. The surgery smoothes the edges of the surface cartilage, replaces lost cartilage and removes loose bodies.
• Removal of loose bodies (cartilage or bone that has broken off) and cysts.
• Anterior Cruciate Ligament Injuries The anterior cruciate ligament (ACL) is the major stabilizing ligament of the knee. Once ruptured the ACL does not heal and usually causes knee instability and inability to return to normal sporting activities. An ACL reconstruction is required here.
• Patello-femoral (knee-cap) disorders. The arthroscope can be used to treat problems like mal-tracking and significant surface cartilage tears
• Inflammatory Arthritis: e.g. Rheumatoid arthritis. Arthroscopy reduce the amount of inflamed synovium (joint lining) that is producing excess joint fluid. This procedure is called a synovectomy.
• Bakers cysts: This is a fluid filled cavity behind the knee and in adults arises from a torn meniscus or worn articular cartilage in the knee. This can treated arthroscopically
• Washout of infected knees
• General diagnostic purposes – Investigations: A routine X-Ray of the knee is usually required. An MRI scan which looks at the cartilages and soft tissues may be needed .

Risks of Arthroscopy:

The risks and complications of arthroscopy are extremely small. occasionally there is more damage in the knee than was initially assumed and that this may prolong the recovery time. In general arthroscopic surgery does not improve knees that have well established Osteoarthritis After a major cartilage or ligament injury has been treated the knee can return to normal function. There is still a persistent small increase in the risk of developing long-term wear and tear in some cases and depending on the degree of injury, activity modification may be required. Activities that help prevent knees deteriorating quickly include:

• Low impact sports like swimming, cycling and walking
• Reducing weight and maintaining a healthy diet

In fact , many of the players and atheletes of the modern era would not be playing and leading normal life were it not for the beneficial effects of knee arthroscopy and it has the potential to resurrect many a lives in pain and agony to a fruitful and happy outcome.

Shoulder Arthroscopy : Exploring the Pandora’s Box

Shoulder is like a Pandora box with lot of possible pathologies like ligament tears,labrum tears,capsule tears,cartilage injury,loose body and what not !!! Shoulder is a highly flexible and mobile joint with less stability compared with other joints. Tthe bones forming shoulder joint are scapula and humerus proximal end. The lateral end of scpula called glenoid articulates with head of humerus. The glenoid is coverd by soft articular cartilage as is the proximal humerus . There is huge size discrepancy between glenoid and proximal humeral head. The humeral head is retained against the glenoid through the arc of motion with the the help of live soft tissue bands including the glenoid labrum and the capsule. Injury to these structure cause shoulder dislocation which can recur unless the injury is rectified by arthroscopic surgery. Similarly there are muscles around the shoulder which act in a concerted manner to bring about the movements of the shoulder.broadly termed the rotator cuff ,the same can rupture following major/repeated minor trauma causing pain and limitation of active movements of the shoulder.the same should be repaired arthroscopically to get functional recovery. Mmultiple lesions can be addressed at same time during arthroscopy . The postop period is less painful and recover faster with arthroscopy.

For further information : British Association for Surgery of the Knee