Arthroscopy (ahr-THROS-kuh-pee) is a procedure for diagnosing and treating joint problems. A surgeon inserts a narrow tube attached to a fiber-optic video camera through a small incision — about the size of a buttonhole. The view inside your joint is transmitted to a high-definition video monitor.
Arthroscopy allows the surgeon to see inside your joint without making a large incision. Surgeons can even repair some types of joint damage during arthroscopy, with pencil-thin surgical instruments inserted through additional small incisions.
Why it's done
Doctors use arthroscopy to help diagnose and treat a variety of joint conditions, most commonly those affecting the:
Knee, Shoulder, Elbow, Ankle, Hip, Wrist
Diagnostic procedures
Doctors often turn to arthroscopy if X-rays and other imaging studies have left some diagnostic questions unanswered.
Surgical procedures
Conditions treated with arthroscopy include:
Loose bone fragments, Damaged or torn cartilage, Inflamed joint linings, Torn ligaments, Scarring within joints, Arthritis, Posterior cruciate ligament injury, Swollen knee
Risks
Arthroscopy is a very safe procedure and complications are uncommon.
Problems may include:
Tissue or nerve damage. The placement and movement of the instruments within the joint can damage the joint's structures.
Infection. Any type of invasive surgery carries a risk of infection.
Blood clots. Rarely, procedures that last longer than an hour can increase the risk of blood clots developing in your legs or lungs.
How you prepare
Exact preparations depend on which of your joints the surgeon is examining or repairing. In general, you should:
Avoid certain medications. Your doctor may want you to avoid taking medications or dietary supplements that can increase your risk of bleeding.
Fast beforehand. Depending on the type of anesthesia you'll have, your doctor may want you to avoid eating solid foods eight hours before your procedure.
Arrange for a ride. You won't be allowed to drive yourself home after the procedure, so make sure someone will be available to pick you up. If you live alone, ask someone to check on you that evening or, ideally, stay with you the rest of the day.
Choose loose clothing. Wear loose, comfortable clothing — baggy gym shorts, for example, if you're having knee arthroscopy — so you can dress easily after the procedure.
What you can expect
Although the experience varies depending on why you're having the procedure and which joint is involved, some aspects of arthroscopy are fairly standard.
You'll remove your street clothes and jewelry and put on a hospital gown or shorts.
A nurse will place an intravenous catheter in your hand or forearm and inject a mild sedative.
During the procedure
The type of anesthesia used varies by procedure.
Local anesthesia. Numbing agents are injected below the skin to block sensation in a limited area, such as your knee. You'll be awake during your arthroscopy, but the most you'll feel is pressure or a sensation of movement within the joint.
Regional anesthesia. The most common form of regional anesthesia is delivered through a small needle placed between two of your spine's lumbar vertebrae. This numbs the bottom half of your body, but you remain awake.
General anesthesia. Depending on the length of the operation, it may be better for you to be unconscious during the procedure.
General anesthesia is delivered through a vein (intravenously).
You'll be placed in the best position for the procedure you're having. This may be on your back or on your side. The limb being worked on will be placed in a positioning device, and a tourniquet might be used to decrease blood loss and enhance visibility inside the joint.
Another technique to improve the view inside your joint involves filling the joint with a sterile fluid. This expands the area around the joint.
One small incision is made for the viewing device. Additional small incisions at different points around the joint allow the surgeon to insert surgical tools to grasp, cut, grind and provide suction as needed for joint repair.
Incisions will be small enough to be closed with one or two stitches, or with narrow strips of sterile adhesive tape.
After the procedure
Arthroscopic surgery usually doesn't take long. For example, arthroscopy of the knee takes about an hour. After that, you'll be taken to a separate room to recover for a few hours before going home.
Your aftercare may include:
Medications. Your doctor may prescribe medication to relieve pain and inflammation.
R.I.C.E. At home, may find it helpful to rest, ice, compress and elevate the joint for several days to reduce swelling and pain.
Protection. You might need to use temporary splints — slings or crutches for comfort and protection.
Exercises. Your doctor might prescribe physical therapy and rehabilitation to help strengthen your muscles and improve the function of your joint.
Call your surgeon if you develop:
A fever, Pain not helped by medication, Drainage from your incision, Redness or swelling, New numbness or tingling
Results
In general, you should be able to resume desk work and light activity in a few days. You'll likely be able to drive again in one to three weeks, and engage in more strenuous activity a few weeks after that.
However, not everyone's recovery is the same. Your situation might dictate a longer recovery period and rehabilitation.
Your surgeon will review the findings of the arthroscopy with you as soon as possible and may send a written report. Your surgeon will continue to monitor your progress in follow-up visits and address problems.
And Also:
Reasons for Arthroscopic Knee Surgery
Arthroscopic knee surgery may be a treatment option for certain types of knee pain. Arthroscopic surgery is a procedure that involves inserting a small camera inside the joint. Through other small incisions, instruments can be inserted to repair or remove damaged structures. Arthroscopic knee surgery is often called "scoping the knee" or knee arthroscopy.
Many different surgical procedures that are commonly performed arthroscopically were once performed through the larger incisions. The advantage of arthroscopy he is being able to perform those surgical procedures without damaging normal structures around the joint. By being less invasive, the hope is there will be less pain and a faster recovery.
However, arthroscopic surgery is still a major surgical procedure, involves risks, and requires appropriate postoperative rehabilitation. It is important that you understand the nature of any surgical procedure being considered, the risks involved, and the postoperative recovery that will be necessary to achieve a successful result.
Reasons to Perform Arthroscopic Knee Surgery
Not all causes of knee pain can be effectively treated with an arthroscopic procedure. Some of the reasons to perform an arthroscopic knee surgery include:
1: Torn Cartilage/Meniscus Surgery: Meniscectomy is the official name of the surgery that involves the removal of a portion of the meniscus cartilage from the knee joint. The meniscus is a shock-absorbing wedge of cartilage that sits between the bone ends to provide cushioning and support. Smaller meniscus tears can usually be trimmed to relieve the symptoms of a torn meniscus.
Meniscus Repair: A meniscus repair is a surgical procedure done to repair the damaged meniscus. The meniscus repair can restore the normal anatomy of the knee and has a better long-term prognosis when successful. However, the meniscus repair is a more significant surgery. The recovery is longer, and, because of limited blood supply to the meniscus, repair of the meniscus is not always possible.
ACL Reconstruction: The anterior cruciate ligament, or ACL, is one of four major knee ligaments. The ACL is critical to knee stability, and people who injure their ACL often complain of their knee giving out from under them. Therefore, many patients who sustain an ACL tear opt to have surgical treatment of this injury. A majority of the ACL surgery is performed arthroscopically.
Plica Excision: A plica is a remnant of tissue left over from fetal development. In early development, your knee was divided into separate compartments. The dividers of the compartments are gradually lost over time, but some remnant remains. When this remnant tissue is more prominent, it is called a plica. When the plica is irritated, it is called plica syndrome. A plica resection is performed to remove this irritated tissue.
2: Lateral Release: The kneecap moves up and down the end of the thigh bone in a groove of cartilage. The kneecap can be pulled to the outside of this groove, or may even dislocate from the groove, causing pain with bending of the knee joint. A lateral release is performed to loosen the ligaments that pull the kneecap toward the outside of the groove.
3: Microfracture: Microfracture is a treatment used to stimulate the body to grow new cartilage in an area of damaged cartilage.
4: In a microfracture procedure, the firm outer layer of bone is penetrated, to expose the inner layers of bone where marrow cells exist. These cells can then access the damaged area and fill in the gap of cartilage.
Autologous Chondrocyte Implantation: In this procedure, arthroscopic surgery is used to identify areas of cartilage damage and harvest cartilage cells.
5: The person's own cells are then grown in the lab and reimplanted in the joint in a separate procedure, which is an open surgery rather than arthroscopic surgery.
Cartilage Transfer/OATS: Cartilage transfer involves moving cartilage from healthy parts of the joint to damaged areas. Small plugs of cartilage are removed, with a portion of underlying bone, and transferred to the area of damage. The plugs are taken from areas of the joint where the cartilage surface is not needed.
Performing Arthroscopic Knee Surgery
Knee arthroscopy can be done under general, regional, or local anesthesia. After adequate anesthesia, your surgeon will create 'portals' to gain access to the knee joint. The portals are placed in specific locations to minimize the potential for injury to surrounding nerves, blood vessels, and tendons. Through one portal, a camera is placed into the joint, and through others, small instruments can be used to address the problem. Patients who have arthroscopic knee surgery under a regional or local anesthesia can often watch their surgery on a monitor to see what is causing their problem.
The length of the knee arthroscopy procedure varies depending on what your doctor needs to accomplish. After surgery, your knee will be wrapped in a soft bandage. Depending on the type of surgery performed, your doctor may or may not allow you to place weight on the affected leg.
Most patients will work with a physical therapist to regain motion and strength of the joint. The length of rehabilitation will also vary depending on what procedure is performed at the time of surgery.
Complications
Complications of arthroscopic knee surgery include infection, swelling, and blood clots in the leg.
Complications are unusual after knee arthroscopy, and while they are cause for concern, knee arthroscopy is considered a low-risk surgical procedure.
A Final Word
Arthroscopic knee surgery is among the most common surgical procedures performed by an orthopedist. A variety of surgical procedures can be performed arthroscopically, utilizing small incisions and minimizing soft tissue damage. Not every surgical procedure can be performed through the small incisions, and there are some procedures that may be better performed through direct visualization rather than through a scope. That said, arthroscopy has tremendous benefits for many types of knee surgery, and can help people return to athletic and daily activities much sooner than they used to be able to.