Arthroscopy literally means ‘looking inside a joint’. Modern day techniques allow us to do this by means of an arthroscope (small telescope), which we insert into the knee joint through a one centimetre incision, hence the term ‘keyhole surgery’. A second small incision (cut into the skin) allows the passage of instruments into the knee joint to deal with any abnormalities.
5 uses of arthroscopy
Removal of cartilage tears: Meniscal tears – splits in the cartilage on each side of the knee used to absorb impact – are a very common problem. Any tears of the menisci can lead to loose flaps which can get caught between the bone surfaces, and can cause:
- Sudden and sharp pain
- Locking – you cannot bend or straighten your knee properly
- Instability – the knee gives way from under you
- Often these symptoms are associated with marked swelling of the knee (effusion)
To remove the torn portion arthroscopically, is a relatively simple and successful treatment.
Biopsy is often carried out for recurrent knee pain and swelling, when there is no obvious cause such as a fall or injury. Inflammation of the joint lining (synovitis) could be a cause, with inflammatory joint disease (rheumatoid disease or gout) or reactive inflammation (reactive synovitis) often seen following a recent cold or flu, being major culprits.
Osteoarthritis is a form of wear and tear of the joint caused by advancing age. This is the commonest form of arthritis and is due to a gradual deterioration of the joint lining where the bearing surface breaks up and becomes uneven, and no longer allows smooth joint movement without pain. Other signs of this wear and tear are gradual stiffening of the knee joint and moderate swelling of the joint and changes seen on X-rays.
Arthroscopy helps here, by:
- Helping gauge the extent of any joint surface damage, in order to plan further treatment
- Tidying up the knee joint by washing out ebris built up over the years
- Smoothing off some of the worst affected areas
- Excising degenerative tears of menisci
- Removal of loose fragments of bone or cartilage.
- Reconstruction of torn ligaments.
Know about your surgery
- Almost all arthroscopic knee surgery is done on an outpatient basis. Usually, you will be asked to arrive at the hospital an hour or two prior to your operation. Do ensure that you don’t eat or drink anything after midnight the night before your surgery.
- After arrival, you will be evaluated by a member of the anaesthesia team. Local anaesthesia numbs your knee, regional anaesthesia numbs you below your waist, and general anaesthesia puts you to sleep. The anaesthesiologist will help you determine which would be the best for you.
- If you have local or regional anaesthesia, you may be able to watch the procedure on a TV screen, if you wish.
- The orthopaedic surgeon will make a few small incisions in your knee. A sterile solution will be used to fill the knee joint and rinse away any cloudy fluid, providing a clear view of your knee.
- The surgeon will then insert the arthroscope to properly diagnose your problem, using the TV image to guide the arthroscope. If surgical treatment is needed, the surgeon can use a variety of small surgical instruments through another small incision. This part of the procedure usually lasts 30 minutes to an hour.
- At the conclusion of your surgery, the surgeon may close your incisions with suture or paper tape and cover them with bandage.
- You will be moved to the recovery room. Usually, you will be ready to go home in one or two hours. You should have someone with you to drive you home.
3 reasons why doctors opt for arthroscopy
- It allows doctors to diagnose conditions (confirm the cause of knee symptoms and problems) and plan further treatment.
- The detected problems can be treated – like a surgery to remove damaged tissue from inside the knee.
- An ‘examination under anaesthetic’ of the knee joint comparing it with the other knee, is a helpful procedure.
This gives valuable information with regard to any joint laxity or ligament damage, which may or may not need surgery. Should any ligament disruption be seen at the time of arthroscopy, some surgeons choose not undertake ligament reconstruction surgery unless discussed prior to the arthroscopy operation, since the patient’s involvement in every step of the healing process is very important.