After the development of Fibreoptic instruments 40 years ago, orthopaedic surgeons have the ability to do intricate accurate surgery through small incisions (keyhole surgery).
The advantages of arthroscopic techniques are that access to the knee can be achieved with the limited damage to the capsule of the knee.
With high definition camera technology the inside of the knee can be viewed on monitors. Constant research to improve management of cartilage and ligament injuries has provided surgeons with a myriad of options to ensure the best option for any particular knee problem. Arthroscopic knee procedures are usually done through two- three 5 mm incisions.
The most common knee arthroscopy procedures are:
Procedure is done as a day procedure under general anaesthetic. A tourniquet is applied to the thigh. A routine knee arthroscopy usually takes 30 minutes to 45 minutes. A soft bandage is applied post-operative.patient will receive post- operative physiotherapy with specific instructions determined by the particular procedure for each individual patient. Follow-up by a physiotherapist takes place 1 week post procedure and follow up with the surgeon at 2 weeks.
Although arthroscopic surgery as very low complication rate, below 5%, there does exist a medical procedure with zero complication risk.
In a percentage of cases where microfracturing or fixation of osteochondral lesion was indicated, the patient will be supplied with crutches for partial weight-bearing mobilisation.
In most cases the patients do not need crutches
Infections are rare, but if that happens then the patient will have to undergo another arthroscopic procedure. In this case the knee will be irrigated and intravenous antibiotics given. Most cases a drain will be placed which can be removed 2-3 days.
Prevention is better than cure. Early mobilisation, decreased waiting period before the surgery in the hospital, general anaesthetic and surgery time as short as possible, good hydration and foot exercises are all part of prevention. In high risk cases trombo-prophylaxis medication (blood thinning injections or tablets) will be used.
Warfarin needs to be stopped at least 5 days before the operation and the INR < 1.5 before the surgery can be done. After the procedure Clexane or oral trombo-prophylaxis will be given until the INR risk in the target zone again.
Plavix, Disprin or Ecotrin needs to be stopped at least 5 days before the procedure. It is safer that the cardiologist and Orthopaedic surgeon discuss each particular case with the patient’s own safety.
Bone marrow oedema is swelling/water that can be seen in a MRI in a patient’s bone. There are different causes, idiopathic (spontaneous with no known cause, sometimes referred to as Spontaneous osteonecrosis of the knee), trauma, osteoarthritis, infection and even arthroscopy. It is quite often very painful, especially night pain. The treatment is; analgesics, decreasing load on that particular bone ( cutches, adjustment of activities or unloader brace) and time to allow for healing.
The meniscus plays an important role in protecting the knee chondral cartilage from wear. Orthopaedic surgeons are well aware of this and will try to keep as much of the meniscus intact and try to repair a torn meniscus if it is in any way possible. If a repair is not possible, then the unstable unrepairable flap of the meniscus will be removed. It is obvious that the smaller the removed meniscus is, the lesser the effects on the chondral cartilage. In certain cases a very large part of the meniscus is removed. Although meniscus transplants is possible, the early results with her substitutes have not been favourable. There is also very long rehabilitation process with a meniscus transplant/substitute. Still the long term results with a partial meniscectomy with no other underlying pathology/instability are decent with only 25% reoperation rate at 25 years.