German clinics offer innovational, minimally invasive diagnostics and treatment of joint disorders. Arthroscopic surgery (key-hole surgery of the knee) is a minimally invasive method usually done in patients with mild destructive process in the affected joint. It involves removing of fragments and pieces of bone and cartilage in the knee, which are simply washed washed out. Rough surfaces causing Osteoarthritis and inflammation can be made smoother. As the incision in the knee is so small, scarring is minimal and trauma is reduced, giving a consequent reduction in pain and postoperative complication.
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.
- Anterior cruciate ligament rupture or injury
- Meniscus injury
- Debride in the knee joint cavity
- Rheumatoid arthritis
- The existence of unidentified loose bodies in the cavity (cartilage flaps, loose meniscus fragments).
- Knee arthrosis deformans
- Liquid accumulation
- Failed surgeries performed before
- Joint fractures
- Chronic fat pad hyperplasia
- Arthropathy deformans
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.
Comparing with other surgery techniques, arthroscopy has a number of advantages:
- Low traumatism. It does not involvecutting a 10-20 cm long incisionto open the joint cavity, sothe tissues surrounding the joint get minimal damage. To introduce an arthroscope and surgical instruments, a cut of 0.3-0.5 cm is sufficient. In most cases, the incision is not even sutured: itsuccessfully heals without suturing.
- Withjoint arthroscopy, the patient,as a rule, can be discharged on the same day as surgery, but after open interventions– only after 10-14 days.
- Aarthroscopy is well tolerated by patients as it produces fewer pain, swelling, and joint exudate.
- Postoperative complications, such as cicatricial contracture of the joint, infections of the joint cavity, and excessive bleeding, develop very rarely.
- Prolonged immobilization of the joint with a plaster cast is not required as after open arthrotomy.
- Minimal rehabilitation period:the patient recovers quickly and can return to normal activities soon. After open surgery, workability is restored on average in 4-6 weeks, whilst after arthroscopy in 2-3 weeks.
- The scar left after surgery is small and unobtrusive.
- Some procedures became possible only with the implementation of arthroscopy. For example, removing chondromas that block the joint and cause pain, as well as treating chondromalacia of the joints.
Absolute contraindications (conditions in which a surgeon rejects surgery without doubts):
- Poor general health of the patient whenany surgical interventions are contraindicated.
- Purulent inflammation in the tissues around the joint, as infection can get into the joint.
- Infected wounds.
- Bony or fibrous ankylosis, a condition in which the articular cleftis filled with bone or dense connective tissue causing immobilization of the joint. You can see this on anX-ray picture.
Diagnostics and meniscus surgery implies a small skin incision. The damaged meniscus tissue is resected using highly precise miniature instruments. A surgeon does everything possible to avoid the radical meniscus resection. Sometimes the tears are stitched up or fixated by staples. Material they are made of is dissolvable. The stitched meniscus should not be loaded during a few weeks after surgery.
After arthroscopy of the knee joint, the most patientsare allowed to immediately stand up and step on the lower limb, as well gently flex and extend the knee. However, it depends on the type and extent of surgery. There are some operations that require a longer recovery. In this case, the patient, first, have to walk on crutches with a partial load on the operated limb and wear a special device–an orthosis (a tutor).
Rehabilitation after kneearthroscopy begins from the first day after surgery and is performed strictly under the supervision of a doctor.
Rehabilitation starts right after the arthroscopic knee surgery. A partial load is allowed almost at once. The preventive therapy for thrombosis lasts a few days (heparin injections). The most of patients gain full shape in a few days, and return to sports training in 2 weeks. It is forbidden to load the knee joint in full after meniscus stitch up or additional surgical treatment of the cartilage. Remedial gymnastics is recommended. The prognosis after arthroscopic knee surgery is very good: in most of cases patients turn back to sports without any problems.
Arthroscopic surgery in crucial ligament injury
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.
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.