Arthroscopy is sometimes recommended to treat knee osteoarthritis. The knee joint is rinsed, sometimes the cartilage surfaces are smoothed.
Arthroscopy is a surgical procedure that requires topical or general anesthesia. An arthroscope is first inserted into the knee joint through a small incision in the skin and joint capsule. The arthroscope is a probe with a small camera that allows you to look inside the joint. Joint mirroring is therefore also suitable for examining the knee joint.
Therapeutic knee arthroscopy with partial meniscus removal is one of the most common surgical procedures in the United States and Europe. In Germany, around 100,000 such operations are performed on patients with degenerative joint diseases every year.
Arthroscopy is carried out by the specialist in orthopedics and trauma surgery. You can find surgeons collaborating with GMG here
Mostly, arthroscopy is not only used for diagnosis, but also therapeutically. For this purpose, fine instruments such as scissors or milling are inserted into the joint via a second cut.
There are two options for therapeutic arthroscopy:
Before this surgery a patient signs an informed consent statement for operative treatment and anesthesia. These documents define what kind of anesthesia will be applied during the arthroscopic knee surgery. Small incisions are made on skin, in the area of the knee joint. Microsurgical instruments and microscopic digital camera are inserted via these incisions inside. The surgeon tracks all actions during the surgery or diagnostic procedure on the screen. The image can be magnified up to 60x that gives a surgeon maximally precise picture. Due to the arthroscopic knee surgery it is possible to avoid knee joint replacement. One more advantage is the ability to leave bed in a few hours instead of a few days as it was before.
At the beginning, arthroscopy was only a convenient diagnostic method. However, the rapid progress of medical technologies made it possible to switch from diagnostic arthroscopy to therapeutic.
If at the very beginning arthroscopic surgery was limited to the simplest purposes – for example, removing of a damaged part of the ligament and fragments of the meniscus, later on, in the 70s and 80s of the last century, arthroscopy had reached such a level, that the majority of surgical interventions became possible without opening a joint.
Using special micro-tools increases the accuracy of surgery and makes it minimally traumatic, enabling, at the same time,preservationof healthy tissues. To accurately remove damaged areas and, at the same time, to keep healthy parts of the joint as much as possible, a surgeon needs high skilland a lot of experience.
Absolute contraindications (conditions in which a surgeon rejects surgery without doubts):
This method is used both as a surgical intervention and as a diagnostic procedure. If it is used for both purposes at the same time, we speak about therapeutic and diagnostic arthroscopy.
The knee joint mobility is provided by the ligamentous apparatus - the anterior and posterior cruciate, medial, and lateral ligaments (these ligaments are located on the outside).
Ligament damages often occur in case of injuries (falling, bruises). As a result of trauma the patient experiences strong pain sensations and cannot make full movements, bending a leg in a knee. Therefore, in such cases, the plastic of cruciate ligament is prescribed.
The anterior ligament of the knee joint length is approximately 40 mm, the posterior ligament is 30 mm. Each of them is actively involved in the stabilization of the joint, so if damaged, the patient cannot bend the leg at the knee fully. Arthroscopy procedure allows a physician to diagnose a specific injury area, remove inflammatory processes products and restore ligament tissue.
Knee ligaments arthroscopy is carried out to restore their anatomical mobility, and is performed using live biological tissues (popliteal muscles tendons or patellar tendons) or neutral artificial materials, called transplants.
A bioresorbable element, which is a self-absorbable implant that restores the natural stabilization of the joint, is installed as a fixative.
The anterior cruciate ligament is the most vulnerable to traumatic effects, therefore, injuries of this department are recorded in surgery most often. When talking about the knee stabilization surgery, first of all, the plastic of the anterior ligament is meant.
During arthroscopy procedure damaged tissues are removed through a perforated hole (all doctor's actions are visible on the monitor with 40-60-fold zoom) and replaced with a transplant.
The surgeon must create the anatomical structure as close as possible to the natural one, providing a normal ligaments tension and the natural amplitude of movements. The fact that athletes after surgical arthroscopy show high results in international competitions, without experiencing any pain, excessive fatigue or discomfort during movement is the best evidence of this technique's high efficiency.
The posterior cruciate ligament damage is a severe trauma and, fortunately, not a common one. Causes - a fall from a height, an accident, gunshot and knife wounds. Arthroscopy of the posterior cruciate ligament plastic is classified as a complex operation, and is performed under general anesthesia.
Meniscus rupture occurs as a result of a strong mechanical effect (blows, falls). Professional athletes, circus performers, dancers are at the greatest risk. Trauma is accompanied by severe pain and limb mobility loss.
Arthroscopic meniscus resection is a minimally invasive surgery, with the purpose of the removal of the damaged fragments of the articular part. Meniscus rupture can be:
In this case, the operation is prescribed to restore after a meniscus rupture. The main surgery purpose is to remove ruptured parts, as well as products of inflammatory processes, and suppurations.
The damaged part of the meniscus is subjected to resection (cut off), after making a small incision (0.5 cm in diameter). One day after, the patient can already stand on the injured leg, and after 2 weeks he can withstand simple loads. Due to the complete removal of the damaged parts, it is possible to do sports and make heavy loads after 1-2 months using special sports knee pads.
Since the trauma is accompanied by the strongest pain syndrome, the patients do not hesitate visiting the specialist, and this fact increases the chances of a complete cure. After surgical arthroscopy for partial or complete resection of the meniscus, the patient can stand up several hours after operation has been performed, and D/C occurs after 1-2 days if there are no signs of complications.
The efficiency of the knee joint's sanational arthroscopy, prescribed to patients with rheumatoid arthritis, is proven over time. The use of an irrigation device with an outflow system, through which medicinal solutions are injected, allows the removal of pathological formations fragments (urate crystals, cartilage detritus, fibrin flakes, cytokines) from the articular cavity. Anti-inflammatory drugs injection is the final stage of the arthroscopic procedure.
Within a few hours after arthroscopy, a positive therapeutic effect is observed, which is expressed in the cessation of pain, reduction of swelling and hyperemia in the knee area, and expansion of the movements amplitude. This surgical procedure is also valuable thanks to the fact that after it is carried out, the need for taking painkillers and anti-inflammatory drugs that increase the load on the liver is reduced.
As a diagnostic method, this procedure is used to analyze such diseases and disorders:
Diagnostic knee joint arthroscopy is performed to confirm the diagnosis, especially in cases where the clinical picture remains unclear.
This is a modern method of examination, which allows to determine the cause of the violation with maximum precision and choose the appropriate treatment methods correctly. The diagnostician in the clinic inserts an arthroscope to study the patient's condition and analyze the complications based on the pictures received - this is the essence of the technique. The procedure is not expensive,most patients can afford it.
Skin and soft tissues perforation is performed at the knee joint, in the area of the joint space, (incision length does not exceed 6 mm). An arthroscope with a light source turned on is inserted into the holes, illuminating the area of the intra-articular space.
Joint examination during arthroscopy is carried out in the following sequence:
During the examination, the doctor is using the probe, which allows to assess the tissues density.
For better visibility and accuracyduring arthroscopy, the operating field is exsanguinated. For this purpose, a pneumatic tourniquet is applied to the thigh to prevent bleeding, which is attained by inflating the cuff of the tourniquet.
Since using tourniquetsincreases probability of side effects (severe pain, circulatory disorders in the operated limb, thromboembolism, etc.), before it is applied, the limb is tightly wrapped with an elastic bandage to ensure safer exsanguination.
Important! Simultaneous application of the tourniquets on the both legs causes an increase in intracranial and arterial pressure, which can lead to serious complications if a patient has cardiovascular diseases (coronary heart disease or left ventricular hypertrophy). The duration of the surgery should not exceed two hours, as adult patients may develop irreversible damage to the peripheral nerve, whilst in children, a critical increase in body temperature may occur.
Pain derived from squeezing thelimbwith the tourniquet is called a “tourniquet pain”. It is characterized by a gradual increase and resistance to pain management with local anesthetics. This fact is takeninto accountwhen surgery is planned to set a proper duration and type of anesthesia.
Since arthroscopy involves minimally invasive incision of the knee, the anesthesiologist conducts a number of diagnostic activities and pre-selects an effective anesthetic. Besides, when choosing anesthesia, it is important to consider the surgery duration. Here's what you need to learn about anesthesia before the procedure:
The surgery is performed under general anesthesia. Epidural (spinal) anesthesia is possible only in case of serious comorbidity or minor defects requiring minimal correction.
A tourniquet is applied to the middle part of the thigh to stop the blood supply and minimize the intensity of bleeding. For arthroscopy above and below the knee, three small incisions are made: a central one and two lateral ones. Incisions length does not exceed 3-5 cm. Then three specially designed devices, arthroscopes, are inserted into the articular cavity. One of them is a light source that has a camera element attached to the end. The surgeon receives an enlarged, high-resolution image on the screen. All the necessary manipulations inside the knee joint are carried out through the third device. The cavity is filled with a transparent aseptic solution, increasing the pressure in it. For greater convenience and to increase the review,
The main arthroscopy therapy measures include the meniscus removal, ligament stitching, transplant implantation, blood clots aspirations, fibrin, fragments and damaged structures, patella stabilization, etc. At the final stage of arthroscopic surgery, the joint cavity is examined one more time, washed with a sterile liquid, antibiotics, then solutions are completely pumped out. Bleeding vessels are coagulated. The total surgery duration ranges from 40 minutes to 1.5 hours.
The incisions are stitched in layers with several sutures and covered with sterile gauze or plaster. On top of the knee joint a pressure bandage is applied, which is changed as and when necessary. The stitches are removed on the 7th to 10th day after arthroscopic surgery. At the doctor's discretion, drains can be left in the postoperative wound, which are removed the next day.
The main advantage of arthroscopy is no need for almost complete knee joint cavity opening, as well as less affection of the surrounding structures and tissues, significantly reduced healing time, rapid recovery of the patient's function and working ability.
Hospital stay: Knee arthroscopy is usually performed on an outpatient basis or in case of previous illnesses and/or lack of home care. The patient has to be under the doctor's supervision, he receives painkillers (nonsteroidal anti-inflammatory drugs, analgesics). In some cases, there's a possibility of short-term gypsum splints application to immobilize the knee joint. In case of persistent intense pain, the patient stays in the unit for a little while.
To prevent vascular disorders and edema, 7–9 days of hypodermic anticoagulants injections (heparins) are prescribed. To prevent the joint infection development during and after surgery, treatment with a broad-spectrum antibacterial drug is necessary.
During the rest, the leg is fixed in an elevated position, it is allowed to attach a heating pad with ice to the joint for a short time (up to 7-10 minutes several times a day).
A good thromboembolic complications prevention measure after arthroscopy is wearing an elastic tissue bandage made of class 2 compression for the first 10-14 days, which is applied on the operated lower limb from the toes to the middle of the thigh.
The patient is allowed to get up and gradually expand his motions range right from the first day. The use of crutches is not required, except severe cases, elderly patients, and complications. The resumption of the usual knee joint load and flexion movements are allowed a week after the operation. As an additional measure, gymnastics is prescribed 2-3 times a week to prevent the development of muscle weakness, and atrophy. One week after arthroscopy, it is recommended to conduct a stationary bike low resistance training.
Each case requires an individual exercise intensity and time calculation with a gradual increase in loads on the knee joint.
In the early postoperative period, it is advisable to avoid thermal, warming, and water procedures. Visiting the pool, bath, sauna, or solarium is prohibited.
During the year after arthroscopy, it is not recommended to engage in sports such as jogging on a hard surface, jumping, exercises associated with the shuttle movements and maximum knee joint extension with additional load.
Anterior cruciate ligament is the main stabilizer of the knee. Injuries give the feel of instability and uncertainty of moves. Instability and problems in joint mechanics lead to further damage of medial and lateral meniscus and cartilage.
Arthroscopic cruciate ligament surgery provides much less load on the joint compared to the open surgery. The key of success is precise location of bone canals in the initial cruciate ligament structure.
Comparing with other surgery techniques, arthroscopy has a number of advantages:
Arthroscopic knee surgery costs approximately 5.600 €. You should plan at least two days of inpatient stay. Complex arthroscopic surgery aimed at fixing meniscal tears costs slightly more: 7.000-8.000 €. Arthroscopic therapy in cartilaginous tissue or cruciate ligament injuries costs 3.500-6.000 €, depending on the amount of damage. Additional diagnostic services such as MRI or CT will cost up to 800 €.
Orthopedic centers provide ability for an accompanying person to stay in one room with a patient, it would cost 55-100 € a night. Our specialists will answer all your questions regarding arthroscopic knee surgery.