When severe pain and difficulty moving the knee are a problem, arthroscopy may be the solution you're looking for. This is a less invasive procedure than open surgery and offers a faster and less painful recovery. In this blog, I'll answer the most common questions about arthroscopy.
What is knee arthroscopy?
Arthroscopy is a minimally invasive surgical procedure used to diagnose and treat problems in the knee. Instead of performing an open knee surgery, three small incisions the size of a buttonhole are made. These incisions allow access to the inside of the knee joint in a direct and controlled manner.
In the first incision, the arthroscope (a cannula containing a video camera with a light source) is inserted. This camera transmits clear, detailed images to a monitor in the operating room, allowing the surgeon to visualize the inside of the knee with great accuracy.
In addition, through the cannula, sterile fluid is irrigated and aspirated into the joint, maintaining a clean and clear environment for the procedure. The other two accesses allow the entry of special tools designed to act as the surgeon's hands inside the joint. These tools feature adaptations for cutting, cauterizing, and repairing damaged tissues, offering effective therapeutic options during arthroscopy.
Knee arthroscopy is a procedure that is performed for both diagnosis and treatment. During arthroscopy, several key actions can be carried out:
• Injury diagnosis: During arthroscopy, the soft tissues and bones of the knee are examined in detail to determine the extent of damage. This allows an accurate diagnosis to be confirmed and the next steps in the management of the injury to be established.
• Repair of soft tissues and bones: Incases of damage, during the arthroscopy injured tendons, ligaments or cartilage can be repaired. Injuries to the bone can also be treated to restore functionality and stability.
• Removal of damaged or inflamed tissue: when the damage or inflammation of the synovial membrane, bone or cartilage are severe we can remove these tissues and leave the knee free of elements that can compromise their long-term health.
In which cases is knee arthroscopy performed?
Knee arthroscopy is a procedure used in a variety of conditions and injuries that affect this joint. Here are some of the cases in which arthroscopy may be required:
• Meniscus tear
• Lesions of the anterior or posterior cruciate ligament
• Lesions of the synovial membrane of the knee
• Patela misalignment
• Cartilage injuries
• Baker's cyst
• Repair or reconstruction of cartilage defects
• Bone fractures in the knee
In addition, arthroscopy can also be useful in cases of arthritis or osteoarthritis to confirm the diagnosis and, in some cases, to remove damaged tissue.
Recommendations prior to arthroscopy
Before the procedure, it is important for the patient to follow some guidelines to ensure safe and effective arthroscopy:
• Fasting: usually between 8 to 12 hours before surgery.
• Medication Suspension: If the patient is taking chronic medications, it is crucial to determine if any of them can affect blood clotting. If yes, these drugs should be discontinued before arthroscopy.
• Supplements and habits: Also consider stopping supplements, herbs, alcoholic beverages, smoking, or other habits that may interfere with the procedure, promote bleeding, or delay recovery.
• Acute illnesses: If the patient has the flu, fever, or other acute illness before surgery, it is important to inform the doctor to assess whether it is safe to perform the procedure at that time.
What happens during arthroscopy?
Once in the hospital for arthroscopy:
• The patient will be provided with special attire to enter the operating room.
• Before entering the operating room, the medical team will go over the details of the procedure, the risks and benefits, and aftercare with the patient. This ensures that the patient is fully informed and prepared for arthroscopy.
What type of sedation is used during knee arthroscopy?
During arthroscopy, the priority is to ensure that the patient does not experience pain. To achieve this, combinations of different types of anesthesia are used:
• Local anesthesia: it is applied to the skin and tissue where the intervention will be performed. This allows the specific area to be numbed without affecting the patient's consciousness.
• Regional anesthesia: it is administered in a spinal cord by lumbar puncture (space between the lumbar vertebrae), blocking sensation and muscles from the waist down.
• Sedation: This is used to keep the patient calm and relaxed throughout the procedure. It’s usually intravenous.
• General anesthesia: In some cases, general anesthesia is used, which induces a state of deep sleep, amnesia, muscle relaxation and nerve block to avoid discomfort or pain.
Detailed procedure
Once under sedation and anesthesia, the leg is cleaned with surgical soap and the knee is placed in a stabilization system. Small incisions of 2 to 4 cm are made to insert the arthroscope, a metal tool with a camera that allows to see the inside of the knee in the operating room.
Base on the visual findings and we decide if we will have two additional access, to carry out specific repairs or treatments, such as sutures, scraping, or tissue removal. The incisions are closed with stitches and small bandages, and then the knee is wrapped with a larger dressing. After the intervention, the patient is supervised by the anesthesiologist in the recovery room to ensure adequate sedation and resumption of leg mobility. The orthopedic doctor will discharge you and, depending on the procedure, may recommend the use of crutches for a certain period.
Recovery and post-operative care
Recovery after knee arthroscopy varies depending on each case:
• Hospital discharge and immediate care: In most cases, patients can go home the same day as the procedure without needing to stay in the hospital. They are advised to wear clothes that are easy to put on and coordinate their transportation, as they will not be able to drive.
• Care of the incisions: the small wounds are closed with stitches and covered with surgical tape; these should be washed every day. The bandage can be removed the next day and the stitches will be removed at the follow-up appointment in the next 10 to 15 days after.
• Physical activity and therapy: After leaving the hospital, specific movements and exercises will be indicated. Depending on the severity of the injury, physical therapy and waiting a period of time may be necessary before returning to sports activities.
• Recovery by injury: The speed of recovery varies depending on the type of injury treated. Problems such as ruptured meniscus, cartilage, Baker's cyst, and synovial membrane tend to recover quickly, allowing people to return to their normal activities in less time. Recovery can usually take between 3-6 weeks (depending on the injury found and the surgical technique used).
• Use of crutches and supports: In more complex cases, such as tissue reconstruction or repair, crutches or other support devices may be needed for several months until full recovery.
• Pain Management and General Care: Pain medications are customized and recommendations are provided to improve recovery, such as elevating the knee, applying cold, and following physical therapy directions to improve flexibility, strength, and stability.
Some general recommendations to improve recovery
• Avoid placing all your weight on the affected knee for the first few days. Therefore, crutches or a support system are sent to you to use for a certain period of time.
• Elevate your knee when lying down, keeping it above the level of your heart. This helps reduce inflammation and pain.
• Take medication as directed to prevent pain and excessive swelling. In some cases, specific anti-inflammatories or blood thinners may be recommended.
• Wash the operated area with chlorhexidine soap over the surgical tape to maintain hygiene and prevent infection.
• If physical therapy is indicated, follow the recommended exercise and movement plan. This will help you avoid muscle loss and regain mobility and stability more quickly.
Watch for any changes in the skin around the sutures, such as redness, swelling, persistent pain that does not subside with prescribed medication, increased localized warm areas, or discharge of blood or pus. Although these events are rare, it is important for patients to be informed and report any unusual symptoms immediately.
"In my practice, I maintain close contact with my patients after each procedure to ensure they are informed of the warning signs and feel comfortable during recovery." Dr. Manzanal
Each case is unique, so recommendations on the initiation of physical activity, walking, the ability to return to driving and exercising should be discussed individually with each person. Intense physical activity will be avoided at the beginning and progress will be made according to the evolution of each patient.
Referencias:
1. Cleveland Clinic Knee Arthroscopy- USA. https://my.clevelandclinic.org/health/treatments/17153-knee-arthroscopy
2. Knee arthroscopy Information | Mount Sinai - New York. https://www.mountsinai.org/health-library/surgery/knee-arthroscopy
3. Arthroscopy – National Health Society (NHS) – United Kingdom.
4. Arthroscopy - Mayo Clinic. USA. https://www.mayoclinic.org/tests-procedures/arthroscopy/about/pac-20392974