Knee arthroscopy is an endoscopic operation used for the purpose of comprehensive diagnosis and surgical treatment of various joint injuries. A highly informative visual technique allows for high-quality examination and treatment of the joint in a closed manner, using puncture portals, which significantly reduces the degree of surgical trauma, minimizes pain and significantly shortens the recovery period.
A visual diagram of the operation.
It began to be used as an operation at the dawn of the 20th century. But until now, the procedure has gone through many stages of improvement. And now it has become a truly indispensable area in orthopedics, thanks to minimal trauma, one hundred percent diagnostic accuracy and high efficiency.
Concept and advantages of the procedure
The surgery is performed using specialized, state-of-the-art fiber optics integrated into an innovative device called an arthroscope. Thanks to the unique device, the procedure got its name. The process involves an internal study of bone and cartilage tissue, menisci, tendons, muscles, ligaments, connective tissue elements, and synovial fluid.
Image of the joint cavity.
For the purpose of highly informative diagnostics, a specialist, through a microportal, inserts the working tube of the device into the joint, into which a system of ultra-strong lenses, a powerful light source and digital video recording equipment are mounted. All structures that the arthroscope “sees” are visualized on the screen in a “live” form, and the image is received in a many times enlarged format. The doctor can find the exact location of the injury or degenerative changes, determine the nature of the pathology, the severity and take action.
Arthroscopy has been proven to be superior to any existing diagnostic methods. It clearly shows from the inside all the structural units of the bone connection in the smallest detail, allowing you to identify even small hidden damage that cannot be detected using standard fluoroscopy or arthrography, ultrasound, MRI, CT and other popular imaging methods.
The method is used not only as a diagnostic tool, but also as a therapeutic and restorative tactic. Having discovered certain violations of the cartilage surface, the doctor can immediately eliminate them. He will perform surgical manipulations through an additional incision (about 6 mm in size) using microsurgical instruments, and he will perform the entire process while looking at the monitor.
Rh, ultrasound, arthroscopy...
In case of knee injuries, first of all, it is necessary to take an x-ray of the joint. Although x-rays will not show damage to the meniscus and articular cartilage, they must be taken to rule out a fracture of the bones that form the joint in the first place. If an x-ray shows an intra-articular fracture, it makes sense to do a computed tomography study, which significantly complements and details the clinical picture. It allows you to clarify the nature of the displacement of fragments, the location and depth of the bone defect. In some cases, cartilage detachment occurs along with the bone plate - this can be seen on x-rays. Ultrasound of the knee joint is not very informative; its reliability is about 20–25%. Another diagnostic method - magnetic resonance imaging - allows you to see the condition of the ligament apparatus, menisci, cartilage layer by layer, which helps to identify pathology in a particular area of the joint. This study is prescribed mainly when the clinical picture is not clear enough. But only arthroscopy can provide 100% accuracy. Any intervention using arthroscopy always begins with an examination of all joint structures and an accurate diagnosis to decide on the necessary treatment.
Indications and contraindications
Let us immediately note that treatment extremely rarely leads to negative consequences. However, this cannot be ruled out if it was done despite contraindications. But first we will cover the recommendations, and then the restrictions.
Partial tear of the lateral ligament of the knee joint.
The procedure may be prescribed for:
- an unclear cause of pathological symptoms, when other methods are powerless to establish it;
- ligament ruptures, damaged tendons;
- suspected dislocation of the calyx (patella);
- the presence of free bodies in the cavity;
- inflammation of the synovial membrane of unknown origin;
- aseptic necrosis of the head of the articular bone;
- injuries, degenerative-dystrophic diseases of the meniscus;
- arthritic disease and gonarthrosis;
- intra-articular fractures, etc.
It is contraindicated in the presence of such ailments as:
- hypertension;
- diabetes mellitus in the stage of decompensation;
- disturbed balance of blood clotting;
- severe dysfunction of the pulmonary or cardiac systems;
- local skin inflammation.
Therapeutic and diagnostic arthroscopy is performed with caution; the consequences can be unpredictable if you are allergic to local/general anesthetic. Therefore, be sure to tell your specialist if you are prone to allergic reactions to any medications.
“Walking.” Fell... Woke up - plaster"
None of us are immune from injury. And not only in the movies there are situations: “Walk. Fell. Lost consciousness. I woke up - there was a cast." Active and extreme sports that are popular today have added more work to orthopedic traumatologists. Falls on a snowboard, skiing, or rollerblading often lead to joint injuries. And what suffers the most is the knee joint, which already bears a huge load. Ligament and meniscus tears, problems with articular cartilage - all this requires surgical help.
Preparing the patient for surgery
Preparation consists of a thorough examination of the patient, collecting anamnesis, and conducting basic instrumental and laboratory tests. Until the doctor is convinced that this is a safe operation and weighs the pros and cons, the operation is impossible. Therefore, at first, a round of some specialists of a narrow profile is always prescribed, for example, in addition to an orthopedist or traumatologist, depending on the situation, also a cardiologist, endocrinologist, pulmonologist, allergist, etc.
It is extremely important to take into account absolutely all the results of the preliminary diagnosis. They will influence the choice of anesthesia; a special role is given to the selection of the optimal type of anesthetic that will not cause harm to the body.
In addition to medical rounds, the patient is given directions for an ECG and fluorography, and for laboratory tests of blood and urine. Having made sure that it is advisable to undertake this operation, they conduct a consultation on preparation. During the consultation, you are warned that you will need to stop eating 12 hours before the procedure, and stop taking anticoagulants (aspirin, heparin and medications based on them) a couple of weeks before the procedure.
Patients who left reviews report cautionary recommendations from doctors regarding smoking and drinking alcohol. You will have to give up bad habits 10-14 days before the intervention and, of course, try not to return to them afterward or at least minimize the dose. If you intend to resort only to diagnosis, preoperative preparation is carried out according to similar rules.
Is there a risk?
As with any surgical intervention, when performing arthroscopy there is a certain risk of complications, the main of which are inflammatory postoperative processes. To avoid possible complications, it is best to trust those doctors who have experience in performing arthroscopic operations. In our clinic, such interventions have been “on stream” since 1996, so we can safely say that our specialists have the necessary qualifications and experience.
Description of the microsurgical process
In reviews, patients tell how quickly and painlessly they underwent the procedure, without general anesthesia. This is quite likely, but do not forget that clinical cases are not the same for everyone, and the physiological status of each patient is different. Therefore, it would be more correct to say that pain, thanks to strong local anesthesia, is almost impossible. However, post-operative discomfort in the area of the operated area will most likely bother you a little for some time.
Disintegration of ligaments when they rupture.
The video allows you to understand all the intricacies of the process. There are plenty of them on the Internet. But due to the fact that not everyone will be able to watch specific stories to the end, we suggest that you simply and calmly read about the important points.
Positioning of the patient on the operating table.
Based on the etiology and degree of pathological changes, the patient’s condition and concomitant diseases, the anesthetic agent is selected individually. Most often, local anesthesia is used, that is, regional anesthesia (epidural or conduction). The regional anesthetic contains lidocaine, ropivacaine or bupivacaine. To enhance the anesthetic effect, a medicine from the opiate category can be added to the main solution in a mini-dose. In some situations, however, general intravenous anesthesia is appropriate.
First, regardless of the surgeon's plans, a diagnostic arthroscopy will be performed. It involves inserting an endoscopic probe in the form of a rod into the cavity of the bone joint. When anesthesia takes effect, then diagnostic surgery begins. To do this, the limb, half bent at the knee, closer to the thigh, is twisted to reduce blood flow, after which a puncture (6 mm) is made, through which a contrast agent is injected to enhance the visibility of the articular and periarticular structures. Next, a tube is inserted through this operating port. The specialist thoroughly examines every millimeter of the problem organ.
The surgical field, you can see a glow inside.
The video is broadcast in real time on the screen and reveals any existing defects in the diseased joint. If the doctor considers it necessary to perform regeneration of pathological elements, he will create an additional incision (6-8 mm), through which he will eliminate the detected defect using the necessary instrument from the microsurgical set. He can perform partial resection of osteochondral tissues, plastic surgery of ligaments and tendons, suturing or removal (partial, complete) of the meniscus, expropriate chondromic bodies, extract effusion and pus, administer anti-inflammatory drugs, take a fragment of tissue or synovium to study their composition, etc.
At the end of the surgery, the surgical field is washed and all instruments are removed. The doctor treats the wound with disinfectant compounds, installs drainage and makes a small suture, which he closes with a sterile adhesive plaster. On the operated knee, in order to give it maximum immobility, a tight fixing bandage is applied from the foot to the middle of the thigh.
The entire session takes an average of 1 hour, in some cases up to 3 hours. Restorative measures are simple, but they must be strictly followed so as not to provoke dangerous complications. Negative phenomena that can develop will be discussed further.
Complications after knee arthroscopy
Like any surgical method, this method, even with all its minimal invasiveness, can have an unfavorable outcome. Complications result from non-compliance with rehabilitation standards, violation of the principles of asepsis and antisepsis, and medical errors. An unfavorable picture occurs infrequently, so there is no need to panic. You must initially take full responsibility when choosing a clinic.
ACL reconstruction.
Feedback from patients after knee arthroscopy, together with official statistics, allowed us to create a list of the most common excesses. It includes the following negative phenomena that occur in the early or late postoperative period:
- increase in general body temperature;
- pronounced permanent or periodic pain in the joint area, often radiating to the lower leg or hip segment;
- local hyperemia, swelling, hyperthermia;
- local infections, abscesses;
- vascular thromboembolism;
- intra-articular hemorrhage;
- arthritis due to inflammation, bursitis;
- bleeding from the wound;
- pain and numbness due to damage to nerve formations;
- violation of the integrity of the ligaments as a result of incorrect manipulations by the surgeon.
Don't bend your knees!
The main symptoms of knee injuries are pain and limited mobility in the knee joint. If a person bends and straightens his leg and feels that he has pain on the outside or inside of the knee, then first of all one can think about damage to the meniscus. If some kind of mechanical obstruction appears when flexing or extending the leg, this indicates a “blockage” of the joint as a result of a meniscal tear or detachment of the articular cartilage. Unsteadiness when walking indicates a ligament rupture. It is more difficult for one person to climb up the stairs, for another it is more difficult to go down, pain may occur when moving, when getting up from a squat - all these are specific symptoms of various damage to the structures of the knee joint, so consultation with a doctor is necessary.
Recovery Features
To prevent swelling of the soft tissues covering the knee, apply cold to the wound. Dry ice packs are applied every 60-90 minutes during the initial stages of rehabilitation. The person must remain in the hospital under the supervision of specialists for at least two days. He is prescribed good painkillers, as well as a series of antibiotics to prevent infectious pathogenesis. It is allowed to get up already on the 3rd day, but walking is allowed only with a walker or crutches. It is necessary to protect the leg from full load for at least one week.
The success of arthroscopic knee surgery depends entirely on the quality of postoperative care. Full recovery occurs in approximately 1-1.5 months; all this time, all points of the rehabilitation program, individually drawn up by a highly competent rehabilitologist, must be followed in strict order.
Massage, a complex of exercise therapy, physiotherapy, hard work and patience help to recover at an intensive rate. After approximately 7-10 days, it is possible to cancel the supporting means for movement, the person is allowed to move as nature requires, namely, without support on two legs with an equal load, the movements are smooth and slow, the step is small. Therapeutic exercises and walking for a certain period of time are carried out in a special functional orthosis, worn on the problematic leg.
Scars.
Exercise therapy in the early stages is gentle. In the first week, they usually practice in a lying position. The basis of the complex is tension/contraction of the hip muscles, raising the straight limb by 45 degrees with a 5-second hold, and warming up the ankle. Lymphatic drainage massage is used to relieve postoperative swelling. It is performed manually or using a microcurrent machine by a professionally trained massage therapist. In the later period, cycling, swimming, walking and running in water are prescribed.
A fairy tale in reality
The main advantage of arthroscopic operations is minimal tissue damage; therefore, the recovery period takes much less time than after traditional open surgery. The results of endoscopic operations are like a fairy tale. For example, after arthroscopic resection of part of the meniscus, the patient is allowed to walk in the evening on the day of surgery, and after two weeks he can return to his usual activities. Of course, if the patient is indicated for complex reconstructive arthroscopic surgery, then the rehabilitation period will be longer, and he may have to move around with crutches for some time. But compared to the fact that after a regular, open operation he will be forced to walk on crutches for a month, this already seems like a “trifle.” Of course, there are some contraindications for arthroscopy: - impossibility of performing anesthesia; - acute and chronic infectious diseases, as well as previously suffered infectious diseases of the joint; - exacerbation of rheumatoid arthritis.
