Arthroscopy is a medical procedure for diagnosing, managing and treating conditions that affect the joints. During this procedure, the doctor inserts a camera called an arthroscope, attached to a narrow tube inside the target joint through a small incision. The images or videos collected by the camera are displayed on a monitor, allowing the doctor to see inside the joint without making a large incision. The images help healthcare providers, such as Mattalino Orthopaedic in Phoenix, AZ, guide miniature surgical instruments during knee arthroscopy.
Arthroscopy comes in handy when X-rays and other imaging techniques cannot offer a satisfactory diagnostic report. Besides helping to treat the conditions that affect the knees, arthroscopy also helps treat joint conditions that affect the wrist, shoulder, ankle, elbow, and hip. The knee is the biggest and perhaps the most complex joint in the body. It is also more prone to injury compared to other joints in the body.
Structure of the Knee
To determine whether you need a knee arthroscopy, it is vital to understand the structure of the knee. The knee is made up of 3 significant bones; one end of the femur (thighbone), the patella (kneecap), and one end of the tibia (shinbone). Additionally, the knee has other essential structures, including:
The articular cartilage is a slippery substance that covers the back of the kneecap and the ends of the thighbone and shinbone. It helps these knee bones glide smoothly across each other when you straighten or bend the leg.
The synovium is a thin lining that surrounds the knee joint. It produces a fluid that lubricates the cartilage, reducing friction during movement.
The meniscal cartilage is divided into 2 wedge-shaped pieces that act as shock absorbers. Positioned between the thighbone and the shinbone, they are tough and rubbery, helping stabilize and cushion the knee joint.
Ligaments connect a bone to other bones. The knee has 4 major ligaments. They act as strong cables by holding the bones together and keeping the knee stable. There are 2 cruciate ligaments inside the knee joint. They cross each other, forming an X with the posterior cruciate ligament in the back and the anterior cruciate ligament in front. The other 2 major ligaments are collateral ligaments. They are located on both sides of the knee.
Do I Need a Knee Arthroscopy?
The doctor may advise you to consider knee arthroscopy if the condition affecting your knee is painful and does not respond to nonsurgical treatment. Nonsurgical options include physiotherapy, rest, and injections or medications that reduce pain and inflammation. The procedure can offer relief from pain caused by injury or disease that damage the cartilage surfaces and other soft tissues surrounding the knee. It can help:
- Remove inflamed synovial tissue
- Reconstruct a torn anterior cruciate ligament
- Treat kneecap problems
- Repair or remove a torn meniscus
- Trim a damaged articular cartilage
- Treat a knee infection
- Remove loose fragments of bone or cartilage
- Remove a Baker’s cyst
Cause of knee pain include:
- Osteoarthritis: Inflammation, pain and joint damage caused by deterioration and degeneration of the knee joint
- Bursitis: Inflammation resulting from overuse or injury of the knee
- Tendinitis: Pain that becomes worse when walking up an incline (climbing stairs)
- Torn ligament
- Meniscus tear
Arthroscopy vs Other Procedures
Most patients prefer arthroscopy over other procedures because:
- Less pain after the procedure
- Less tissue damage
- Fewer stitches are needed
- Faster healing time
- Lower risk of infection
How to Prepare
Evaluations and Tests
The orthopedic surgeon may ask his team of experts to assess your overall health before the procedure. This will help him identify and issues that may influence the outcome of the procedure. Patients with certain health problems may require further evaluation to determine the most suitable approach. Preoperative tests also help the surgeon make a tailored preparation plan that suits your needs and medical condition. Standard preoperative tests include blood tests or an electrocardiogram (EKG).
If you do not have any major health condition, the procedure will be performed on an outpatient basis. Before the procedure, the orthopedic surgeon will advise you on taking steps to help you prepare. It is important that you inform him of any over-the-counter medications, prescriptions, or supplements you are taking. Certain medications can increase the risk of bleeding. You may also need to stop taking other drugs such as ibuprofen and aspirin days or weeks before the procedure.
You may also need to stop eating and drinking 8 to 12 hours before the procedure, depending on the type of anesthesia the doctor will administer. Wear loose, comfortable clothing. For example, you can choose some baggy shorts. Additionally, since you will not be allowed to drive immediately after the procedure, you should arrange for a ride back home.
Anesthesia is administered in the operating room. The type of anesthesia used depends on the extent of the arthroscopy.
To block sensation, numbing agents are injected below the skin in the knee. You will be awake during the procedure, but you will only feel a sensation of pressure or movement within the joint.
Regional anesthesia is usually delivered through a small needle near the spinal canal to block sensation in the bottom half of the body. Although you will not feel any pain below your waist, you will remain awake. This anesthesia is more likely to be used when both knees require an arthroscopy.
General anesthesia is delivered intravenously. It puts you to sleep during the procedure.
The skin around your knee si cleaned to prevent surgical site infection. Surgical draping is used to cover your leg, leaving the prepared incision site exposed. The surgical team may use a positioning device on the leg to stabilize the knee during the procedure.
The surgeon begins the procedure by making a few small incisions in the knee. He then uses a small pump to fill the knee joint with a sterile solution. The solution expands the joints and rinses away any cloudy fluid, giving the orthopedic surgeon a clear and detailed view of the structures inside the knee. This helps him with the initial diagnosis of the joint. Once the doctor is satisfied with the findings, he inserts the arthroscope. The attached camera sends the images to the screen, allowing the surgeon to explore the area and identify any problems.
Once the surgeon determines you need surgery to correct the issues causing you problems, he inserts tiny specialized instruments through other small incisions. These instruments can perform several tasks, including grasping, shaving, cutting, and meniscal repair. Other special devices help to anchor stitches into the bone.
After the problem is fixed, the surgeon will remove the tools, use a pump to drain the sterile solution, and stitch up the incision. Since the incisions are small, the doctor may close each with one stitch. He may also use narrow strips of sterile adhesive tape. After closing the incisions, he will cover the knee with a soft bandage. Typically, the procedure lasts less than an hour.
Once the procedure is complete, you will be taken to another room to recover for a few hours before leaving.
Once the procedure is complete, you will be taken to another room to recover for a few hours before leaving. A friend or a family member can drive you back home and look after you, at least for the first day. Although recovering after knee arthroscopy will not take as long as recovering after open knee surgery, you should strictly follow your doctor’s instructions when you return home.
The doctor will recommend medications to help with pain relief and to reduce the risk of blood clots.
To help with the recovery process, rest, ice, compress, and elevate the affected joint for several days.
As we have mentioned above, your knee will be covered with a dressing after the procedure. Before leaving the healthcare facility, the doctor will tell you when you can bathe or shower. He will also tell you when to change the dressing. This helps to keep the incisions clean and dry. The doctor may also require you to make another visit to his office to assess your progress and initiate a postoperative treatment program.
You might need temporary crutches or other assistance devices after the procedure. It would help if you talked with the doctor to determine when it is safe to put weight on your foot and leg.
Exercises play a crucial role before and after knee arthroscopy. They help the knee to regain full strength and range of motion. A physical therapist can guide you through exercises that can strengthen the muscles around the knee. These exercises can help the knee to recover fully. The doctor may also provide you with information about some simple exercises and stretches you can do at home. The type of exercises suitable for you will depend on the extent of the problem and your general health. While exercises are essential, ensure you consult the doctor before working out at home.
Work and Driving
Many people resume full, unrestricted activities after arthroscopy. Patients who work at a desk can resume work a few days after the procedure. Most can get behind the wheel after 1 to 3 weeks. Recovery is determined by the severity of the condition affecting the knee and your overall health. Except for patients who undergo a ligament reconstruction, others should return to resume most physical activities within 8 weeks, or sometimes much sooner. However, it would be best if you gradually eased into higher impact activities to avoid aggravating the knee joint.
You should also consult your doctor before returning to work, especially if your job involves heavy lifting. The doctor might also require some patients to make lifestyle changes to protect the joint. For example, the doctor might ask you to replace high impact activities, such as running with lower impact activities, such as cycling or swimming. To protect the knee joint’s integrity, the doctor may also advise you to work towards healthy weight loss. The strain that extra weight places on the joints can eventually lead to wear and tear.
Besides lowering the quality of your life affecting your overall wellbeing, knee problems can have an adverse effect on your career, especially if you are an athlete. However, you should not give up on your career even though nonsurgical treatment options do not seem to offer long-term solutions. You also need not undergo an open knee surgery just because these strategies are not working for you. Contact Mattalino Orthopaedic in Phoenix, AZ, to explore the benefits of knee arthroscopy.