Arthroscopy

Arthroscopy may be used to confirm diagnosis of or treat a large number of conditions, including acute trauma to soft tissues. These may be removed, repaired or reconstructed. Examples of such injuries, which often occur during sports, include:

Other conditions in which arthroscopy may used include:

The patient’s baseline data is gathered prior to the procedure. A physician evaluates the patient’s medical history, including symptoms and allergies, and conducts a physical examination to assess motion, stability, strength and alignment of the joint.

Arthrography or other x-rays are taken of the joint, and the physician may order other tests, such as MRI (magnetic resonance imaging), bone scan or blood tests. The benefits and risks involved with arthroscopy are discussed with the patient.

The patient is typically instructed not to eat anything for at least six hours before the procedure. Small amounts of clear liquids (e.g., water, apple juice) may be allowed up to a few hours before the surgery.

Local, regional or general anesthesia may be used during arthroscopy depending upon the wishes and needs of the individual patient and surgeon. A tourniquet is usually applied above the operative joint to decrease blood loss and increase visibility. The procedure itself generally lasts about an hour, occasionally as long as an hour and a half.

The surgeon makes a small incision in the skin around the joint and inserts an arthroscope. The joint is then filled with a sterile saline solution to provide a better view.

Surgical instruments (e.g., scissors, clamps, shavers, lasers) can be inserted either through the arthroscope or through additional small incisions. Damaged tissues are then removed or repaired.

After surgical repair, the arthroscope and other instruments are removed. The joint is flushed with a sterile saline solution. The incision may be closed by suture, paper tape or stitches, and the joint is covered with a bandage.

After the procedure is complete, the patient is taken to a recovery room for a few hours. Vital signs are monitored until the patient is stable and surgical dressing is inspected for drainage and reinforced. The patient is taught to recognize and report symptoms that may indicate complications, such as severe or persistent pain, excessive drainage, redness, swelling or fever.

The physician may prescribe analgesics for pain and nonsteroidal anti-inflammatory drugs (NSAIDs) for pain and inflammation. Antibiotics may be given to help prevent infection. Devices such as splints, slings, crutches, canes and walkers may also be prescribed.

The patient is typically allowed to go home in one or two hours. It will be necessary for someone to drive the patient home. The joint will need to be wrapped, rested, iced and elevated for several days following the procedure to reduce swelling and pain.

The surgical dressing may typically be removed the day after surgery. The patient may be allowed to shower but will be instructed to avoid directing water at the incisions and will be prohibited from soaking in a tub. The incisions need to be kept clean and dry. Physical therapy or occupational therapy, including gradually progressive exercises of the joint, may be recommended.

Several follow-up appointments may be necessary. Typically, during the first of these, the physician removes the sutures, tape or stitches. The patient can usually resume daily activities within a few days, but the joint may require several weeks to fully recover.

Arthroscopies are now a very common procedure and have very few complications. However, there is always a small risk of complications from the anaesthetic. In addition there is a chance of infection of the cut into the joint or of the joint itself although this is rare. Occasionally a thrombosis (blood clot) may result in the leg following arthroscopy of the knee which may require drug treatment to thin the blood. Again this is an unusual complication.

An arthroscopic meniscectomy is one of the more common types of operation performed on the knee using an arthroscope. Inside the knee there are two discs of cartilage called the menisci by doctors but are commonly referred to as the 'cartilages'. These structures act to pad the shock waves through the knee during activity and help to assist the smooth gliding of the lower leg bone (the tibia) against the upper leg bone (the femur). A common knee injury is where one of these menisci becomes torn. This tends to cause knee pain and sometimes locking or giving-way of the knee.

Before arthroscopes were invented if surgery was needed the whole knee joint had to be surgically opened, with all the possible complications and extended recovery time associated with a major operation. An arthroscopic meniscectomy means that part or all of the affected cartilage can be removed using instruments inserted through the arthroscope itself or through the second incision mentioned above.

After this operation it is important for the patient to follow the instructions of the surgeon. In general the individual will be able to weight bear after only a few days and return to work within a week or so depending on whether the job involves heavy lifting or not.

Another fairly common knee injury is something called a ruptured cruciate ligament. A number of famous footballers have had this injury which involves the rupture (break) of one or both cruciate ligaments which are ligaments inside the knee joint which cross over each other - hence the name 'cruciate'. These ligaments provide stability to the joint. Therefore it is particularly important to repair them in sportsmen/women or those who are very active since otherwise the knee remains unstable and prone to wear and tear.

Again this operation used to require opening the knee joint. However, nowadays it is frequently done using arthroscopic techniques. The operation is quite complicated and therefore the surgeon sometimes uses additional techniques to help him see exactly what is going on inside the joint during surgery including computer graphics and the use of special dyes inside the joint. The ligament is repaired using sutures or grafts introduced into the joint such as a piece of tendon from the kneecap being used to bridge the gap in the ruptured ligament.

A period of rest and physiotherapy is again needed after this operation although a return to most normal activities is possible within about two weeks although the surgeon may restrict more vigorous activities until he is happy with the progress of the patient.

Arthroscopies are used for diagnosis and treatment of other joint conditions and have now become a very common, safe and effective form of management for a number of joint problems.

Arthroscopy offers many diagnostic and therapeutic benefits. It is the most accurate method of diagnosing the cause of internal damage in the joints. It may be used to visualize issues that may not be noticed on x-rays or during an MRI (magnetic resonance imaging). False-positive and false-negative results are typically rare.

Therapeutically, arthroscopy can provide results comparable to open surgeries for certain conditions with fewer complications. The incidence of disease and rate of infection are both reduced. Range of motion is not as likely to be reduced, and less recovery time is needed. Arthroscopy is often, but not always, less costly than open surgeries. But in some cases open surgery is needed.

Risks of arthroscopy are relatively low. Complications are very rare and, when they do occur, are generally minor and treatable.