Arthroscopy means “looking into the joints”. Arthroscopy is a surgical procedure we use to visualize, diagnose, and treat problems inside a joint. This is done with a telescope after making only a small cut (Keyhole) over the joint. A camera is attached to the telescope which transmits the image from the joint on to a large monitor. This picture helps us to diagnose the problems of the joint by directly looking at it. This can be further aided by the feel of the structures of the joint by passing instruments into the joint by making one or two additional small cuts. These specially designed thin and long instruments passing through the small holes help us to operate and correct the problems of the joints without actually opening the joint or making a big cut. The advantage here is less pain and quick recovery.
Generally, patients can go home on the same day after the operation. The main joints upon which I routinely perform keyhole surgeries are the knee and shoulder joints. The problems of these joints can be due to aging, simple injuries in addition to the more common Sports injuries. The knee joint may have Meniscus (cartilage) tears, Ligament ruptures, bone and synovium (joint lining) problems. The shoulder may have muscle tears, tight space due to overgrowth of certain tissues, stiffness, and instability (dislocation) problems. Arthroscopy helps us in treating several joint problems that occur commonly. But it has revolutionized the treatment of sports injuries. For further information on arthroscopy
Some of the routinely performed arthroscopic surgeries
|Diagnostic arthroscopy||Subacromial decompression|
|Joint lavage for osteoarthritis of knee||Bankarts repair|
|Loose body removal||Rotator cuff repair|
|ACL reconstruction||Frozen Shoulder release|
|Meniscectomy & Meniscal repairs|
What is Arthroscopy?
The Greek word for joints is “Atheros”, and Greek word for looking is “Scope”, so arthroscopy means looking into the joints. Since this is done through a small cut it is commonly known as a minimally invasive surgery or a keyhole surgery. It can be performed on many joints like shoulder, elbow, wrist, hip, knee and ankle joints, though shoulder and knee are the commonest.
When investigating the conditions of the joints it is very helpful to be able to look inside the joint in order to see exactly what is going on in addition to examining the joint from outside. It is done with special equipment. Operative procedures for any abnormalities can be done through a second small cut. It is routinely done as a planned procedure as a day case, but sometimes it is done as a matter of urgency, for example following an injury to a joint like a twisted swollen knee joint.
What are the advantages?
a) Small incisions and small scares.
b) Less tissue damage and less chance of infection.
c) Less pain and disability after surgery and patient can return to sedentary work almost immediately and to more vigorous work within 1 to 2 weeks.
d) Better diagnosis of many joint problems.
e) Most procedures can be performed on outpatient basis. If hospitalization is required most procedures need 1-2 days of stay compared to several days of stay with open procedures.
f) Some procedures can be done better with arthroscopic surgery and perhaps for some that are the only way they can be done.
Preparation for surgery
After deciding to proceed with arthroscopy some basic blood tests are done and patient’s fitness is assessed. Like any other surgery patients would be asked not to eat or drink any for at least 6 hours prior to surgery. Patients can watch the surgery if it is done under regional anesthesia.
The prescription would be given for painkiller tablets and other medicines as necessary. The joint needs to be rested a little for a couple of days but like in case of arthroscopy of the knee joint you can walk to and from the toilet with crutches but to avoid excessive use of the joint. One important aspect is physiotherapy to get full movement in the joint and to strengthen the muscles around the joints. Within the limits of pain, these exercises can be started as soon as possible after surgery. You would be asked to visit the hospital after 2 days for a change of dressing.
Exercises for the knee
The exercises can be carried out many times in a day. Start with 4 repetitions of each exercise, increasing to as many as you feel able to do without getting any pain.
Sit reclining with your legs supported.
a). Keeping your legs straight, pull your toes up towards you and brace the muscles at the front of the thigh, pushing the back of your knee as flat as possible.
b). Place a rolled towel under your knee. Pull your toes up towards you and tighten the thigh muscles, lifting your heel to straighten your knee fully. Hold for 5, and then relax slowly.
c). Repeat exercise a, but this time lift your leg approximately 6 inches off the bed, keeping the knee braced and completely straight. Hold for 5, and then lower slowly.
d). You must regain the flexibility in your knee once the pain starts settling. Bend your knee, pulling your heel towards your bottom as far as possible, and then straighten.
When you had any other reconstructive surgery like ligament and meniscal surgery post-operative care and advice will be different. Similarly, arthroscopy of the shoulder would be followed up by specific exercises depending upon the type surgery.
Common conditions needing Arthroscopy
A torn meniscus ( to repair or remove), a torn anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL), For removal or biopsy of inflamed or damaged lining of the joint(synovium), Misalignment of the kneecap (patella), Small pieces of broken cartilage and loose bodies in the knee joint, Removal of Baker’s cyst(a swelling behind the knee that is filled with fluid), Some fractures of the bones of the knee. Washing the knee which is constantly sore due to arthritis can also be beneficial.
Labral Tears, Loose Bodies, Snapping Hip Syndrome (something is catching within the hip joint), and Cartilage Damage with small flap tears can benefit.
Arthroscopy of the shoulder may be recommended for infective arthritis(septic lesions), biceps tear, SLAP lesions, Rotator cuff lesions, impingement syndrome, recurrent dislocation of the shoulder and other instability problems with or without hyperlaxity, Frozen shoulder, loose bodies etc. Problems associated with the other joints in shoulder joint complex i.e. subacromial joint, acromioclavicular joint are also easily examined giving access to rotator cuff lesions, acromion pathology, and clavicular problems.