LIGAMENT INJURIES OF KNEE – KNEE ARTHROSCOPY PROCEDURES

Overview
 
Knee Arthroscopy is a procedure for diagnosing and treating knee 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.
 

Diagnostic procedures
 
Doctors often turn to arthroscopy if X-rays and other imaging studies have left some diagnostic questions unanswered.
 

Intra articular and Extra-Articular Injections- 
•    Visco-Supplementation, 
•    PRP

Surgical procedures

•    Arthroscopic ACL Reconstruction
•    Arthroscopic PCL Reconstructions and repair
•    Treatment of Multiligament injuries
•    Meniscal Repair and Balancing
•    Cartilage procedures- Microfracture, OATS- Osteochondral Autograft Transfer System, Autologous Chondrocyte Implantation (ACI)
•    Loose body removal and Synovectomy
•    MPFL reconstruction
•    Alignment Correction Surgeries- High Tibial Osteotomy, Distal Femur Osteotomy
•    Arthroscopic Release of Stiff Joints

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Risks

 

Arthroscopy is a very safe procedure and complications are uncommon. The possible complications include:

• Infection- The risk of infection in arthroscopy is about 0.1% compared to open procedures in which it is about 1%. The Risk of deep surgical site infection is about ten times lower in Arthroscopic procedures compared to open surgeries.

• Knee stiffness- Though a rare complication , certain types of surgeries like synovectomy carries the risk of the knee becoming stiff and might need prolonged physiotherapy or repeat procedures.

• Chondrolysis/ Damage to cartilage- Although a very rare complication its known to occur and cause significant pain in the joint.

• Neurovascular injury- Risk of neurovascular injury is present, especially when repairing or reconstructing posterior structures like PCL as they are very close to the neurovascular structures.

• Compartment syndrome- this complication can occur as a result of fluid extravasation, muscle swelling or prolonged tourniquet time. This can sometimes be due to unknown (Idiopathic) causes as well.

• Reaction to implants- This Complication is greatly reduced with the use of modern implant materials and manufacturing processes. However individual allergic reactions to materials cannot be predicted.

• Deep Vein Thrombosis- Rarely in patients prone to DVT can develop clots in the veins of the leg and develop secondary complication due to clot migration.
   

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

• Intravenous catheter will be inserted in your hand or forearm and pre-anesthetic medication administered.
   

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.

• You'll be placed in the best position for the procedure you're having. This is usually on your back for Knee Arthroscopy procedures.

• 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. 

• The joint will be irrigated and distended with a sterile Fluid for better visualization.

• Small incisions or holes are made around the joint called ‘Arthroscopy portals’ to introduce the viewing devices and working devices.

• Incisions will be small enough to be closed with one or two stitches, or with narrow strips of sterile adhesive tape.

• During some surgeries like ACL reconstruction additional small incisions will be made to harvest the donor tendon grafts and making bone tunnels for ligament reconstruction.

• Some reconstructions like MCL /PLC / LET reconstructions involve larger incisions and will be discussed with you during evaluation and counselling.

 

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 and then shifted to the ward.
 

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.