Its execution involves the practice of very small skin incisions at the knee level and the use of the arthroscope, an instrument in the shape of a straw and equipped with a camera and a light source.
Knee arthroscopy procedures require some preparation, which however is very simple to implement.
In knee arthroscopy, the post-operative phase, healing times and return to daily activities vary according to the reasons for implementing the surgical technique in question.
Brief anatomical recall of the knee
The knee is the important synovial joint of the human body, located between the femur (superiorly), tibia (inferiorly) and patella (anteriorly).
Several anatomical elements take part in its constitution, including:
- The articular cartilage, located on the lower surface of the femur;
- The synovial membrane, which covers the joint from the inside and produces synovial fluid, a lubricating fluid;
- Tendons and ligaments, which guarantee joint stability and correct alignment between the femur and tibia;
- Synovial bags, which are small sacs of synovial membrane, filled with synovial fluid;
- The internal meniscus (or medial meniscus) and the external meniscus (or lateral meniscus), which are pads of cartilage located on the surface of the tibia.
Like any type of arthroscopy, knee arthroscopy also involves the use of a special instrument, called an arthroscope.
What is the arthroscope and what is it used for in knee arthroscopy?
The arthroscope is the main and most representative instrument of arthroscopy.
Comparable in length and width to a drinking straw, the arthroscope has, at one end, a network of optical fibers with the dual function of camera and light source, and, almost at the other end, an ignition cable. fiber optic network and for connecting the aforementioned camera to a monitor.
During arthroscopic interventions (therefore also during knee arthroscopy), the arthroscope is the instrument that the operating doctor introduces, from the camera and light source side, into the knee joint and subsequently uses , as an exploratory camera capable of transmitting what is filmed on the connected monitor.
Thanks to its straw shape, the arthroscope is an extremely handy device capable of wedging into every corner of the joint of interest; furthermore, thanks to its thinned shape, its introduction into the human body does not require the "making a large incision, but only a small skin opening no larger than a centimeter.
Who does knee arthroscopy?
As a rule, knee arthroscopy procedures are the responsibility of an orthopedic physician who specializes in diagnosing and treating knee joint problems.
(X-rays and nuclear magnetic resonance) did not provide enough data to make a definitive diagnosis of a knee problem.Arthroscopy of the knee with diagnostic purposes, therefore, is a clarifying examination of uncertain situations. The advantages deriving from the use of a video camera as an exploratory probe source of the joint of interest give it this role of clarifying examination.
It may happen that a "knee arthroscopy performed initially for diagnostic purposes becomes therapeutic, when the executing physician has clarified the present joint problem and has decided to resolve it during the same intervention.
When is it therapeutic?
Knee arthroscopy is used for therapeutic purposes, in the presence of knee problems resistant to non-surgical treatments (which always represent the first line solutions) or in the presence of knee problems that can only be cured by surgery.
What makes it possible to diagnose and treat?
Knee arthroscopy makes it possible to diagnose and treat:
- The rupture of a meniscus (or tear of a meniscus);
- Laceration of the anterior cruciate ligament or posterior cruciate ligament;
- Total or semi-total tearing of the medial collateral ligament or the lateral collateral ligament;
- Injuries of the patellar tendon;
- Defects of the articular cartilage;
- A bursitis (inflammation of a synovial bursa) in the knee
- Baker's cyst. Baker's cyst is an abnormal lump that forms behind the knee as a result of synovial fluid leaking from the popliteal bursa (a synovial bursa of the knee).
- Fractures of the tibial plateau;
- A synovitis (inflammation of the synovial membrane) of the knee
- Diseases of the patella (patellar dislocation, patellar chondropathy and fractures).
Who are the most common patients?
In general, the individuals who, despite themselves, must benefit from the diagnostic and therapeutic potential of knee arthroscopy are:
- Sportsmen, in particular those practicing sports activities that involve running with sudden changes of direction and physical contact;
- The elderly, with problems of osteoarthritis or rheumatoid arthritis.
The use of these investigations serves to establish whether or not there are the health conditions essential for the success of the knee arthroscopy operation.
Information on the modalities of the operation
Normally provided at the end of the cognitive clinical examinations, the information relating to the operative modalities of knee arthroscopy concern topics such as:
- The main steps of knee arthroscopy procedures;
- The approximate duration of the intervention;
- The type of anesthesia used;
- The rehabilitation exercises to be carried out at home in the first days following the procedure;
- The duration of post-operative physiotherapy required;
- The waiting for complete healing to be achieved.
Pre-operative measures
The pre-operative measures are precautions that the patient must follow to the letter, so that the knee arthroscopy is successful.
Also illustrated at the end of the cognitive clinical examinations, they consist of:
- Discontinue any anticoagulant drug therapy, as these drugs tend to promote bleeding when making cuts such as surgical incisions.
- On the day of the procedure, have a complete fast for at least 8-10 hours. The only food allowed is water, but only up to a couple of hours after the operation;
- Always on the day of the intervention, be accompanied home by a family member or friend, because at the end of the knee arthroscopy procedures, thanks to the anesthesia, attention and vigilance skills are compromised (activities such as driving, therefore, could be very dangerous).
- Local anesthesia. It involves limited pain insensitivity to the knee. Thus, during the procedure, the patient is conscious.
- Spinal anesthesia. Practiced on the back, near the spinal cord, it involves an "insensitivity to pain from the waist down. Therefore, even in such circumstances, during the procedure, the patient is conscious.
- General anesthesia. General anesthesia causes the patient to fall asleep, who, therefore, during the operation, is completely unconscious and insensitive to any type of stimulus (painful or not).
The orthopedist who will perform the knee arthroscopy and an anesthetist (N.B: in every surgery with anesthesia, there is a doctor who specializes in anesthetic and resuscitation practices) decide which type of anesthesia to practice.
The choice between local, spinal and general anesthesia is affected by the purpose of knee arthroscopy, the age of the patient and the experience of the orthopedist to operate in the various circumstances.
Did you know that ...
On the occasion of knee arthroscopy procedures, the use of general anesthesia is reserved for patients who have an allergy to the anesthetics used in local or spinal anesthesia.
Operational moment
The operative moment of the knee arthroscopy begins after the confirmation by the anesthetist that the anesthesia has taken place.
This crucial phase of the procedure is entirely up to the orthopedist, who provides, in order, to:
- Disinfect the entire knee to minimize the risk of infection;
- Make an "incision of about one centimeter, at the height of the knee, which allows you to" enter "the joint;
- Through the incision, inject a saline solution to "clean" the inside of the joint;
- Insert the arthroscope into the usual incision and begin to search the knee internally, looking for the problem to be diagnosed or treated;
- Make another couple of small incisions, in order to insert the surgical instruments necessary to treat the problem detected in the previous phase or of which he was aware from the beginning;
- At the end of the procedure, remove the arthroscope and, if used, the surgical instruments;
- Apply some resorbable sutures on the incisions and a compression bandage around the knee, to protect the latter and avoid the classic post-operative swelling.
When the orthopedist knows early on that he must perform a therapeutic knee arthroscopy, he could make all the incisions at the same time.
What sensations does the patient experience during the procedure?
The patient experiences minimal discomfort or pain when inserting the needle for the injection of the anesthetic; after that, he no longer perceives anything that could somehow be unpleasant or problematic.
How long does it last?
Knee arthroscopy procedures can last from 15 to 30 minutes, when they are only diagnostic, and from 40 to 120 minutes, when they are therapeutic (in these circumstances, the complexity of the pathology to be treated has a decisive influence).
, dizziness and lightheadedness.
What are the after-effects of the actual procedure?
In the first few days following a knee arthroscopy procedure, the operated knee will be painful and swollen.
Pain and swelling should not be alarming (unless they are persistent), as they are two normal consequences of incisions and the introduction of surgical instruments into the joint.
As for the surgical incisions, they heal within 1-2 weeks.
What can help relieve pain and swelling?
- To rest
- Take a pain reliever (e.g. acetaminophen, aspirin, and ibuprofen)
- Make ice packs (4-5 packs a day lasting 15-20 minutes)
- Keep the operated limb raised
- The purpose. Purely diagnostic procedures have significantly shorter recovery times than therapeutic procedures.
- The problem to be treated. For example, anterior cruciate ligament reconstruction has a much longer prognosis than removing a small piece of torn meniscus (meniscectomy).
- The age and state of health of the patient.
- The work activity carried out by the patient. Those who practice sedentary work heal earlier than those who practice heavy work, because they stress the operated joint less.
- The attention that the patient has towards himself. He heals sooner and better who does not burn the steps, follows the instructions of the doctor and the physiotherapist, and does not miss periodic checks.
Periodic checks
After each knee arthroscopy procedure, especially if therapeutic, the orthopedist sets some periodic checks to monitor the long-term outcome of the procedure.
The number of periodic post-operative checks varies in relation to the severity of the joint problem being treated (eg meniscectomy involves two checks, one after one week and one after one month).
Physiotherapy
After knee arthroscopy procedures, physiotherapy is critical for restoring normal joint mobility. To get the maximum benefit from it, it should start a few days after the operation.
Return to daily and sporting activities
After the knee arthroscopy procedures, the return to daily activities (eg driving) and to sports depends on what the intervention specifically envisaged.
;Specific complications, on the other hand, include:
- Bleeding inside the operated joint;
- Infection inside the operated joint;
- Excessive post-operative joint stiffness;
- Involuntary damage to a neighboring nerve
- Involuntary damage to a healthy element of the operated joint.
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