Arthroscopic surgery

What is an arthroscopy?

An arthroscopy is the examination of a joint using a special instrument called an arthroscope. This is like a thin telescope which uses particular lenses and sometimes fibre-optic techniques to allow the specialist to see inside a joint. It enables examination of the surfaces of a joint and also treatment of certain problems without the need to cut the joint open. Although arthroscopy can be used on almost any joint including the shoulder, elbow, wrist and hip it is most commonly used for diagnosis and treatment of knee conditions.

What does arthroscopy involve?

Most arthroscopies are performed as a day case procedure i.e. the patient goes into hospital in the morning and goes home the same day. However, this may not be the case if the surgeon is planning to do more extensive surgery on the joint. The patient is starved before surgery, in case a general anaesthetic is needed, and is then taken to theatre. In most instances a general anaesthetic is given although it is possible to perform some arthroscopies under local anaesthetic.

Once the individual is anaesthetised, the surgeon makes a small cut into the skin over the joint and then inserts the arthroscope into the joint. The arthroscope is usually about 8 inches long, rigid and about the width of a pen and it has its own light source enabling the surgeon to essentially 'see' into the joint. Often an extra small hole is made to allow the insertion of a probe, further instruments or a tube to allow the joint to be flushed with sterile water. All these things assist the surgeon to see and operate on the structures within the joint.

What happens after an arthroscopy?

At the end of the procedure the arthroscope and all other instruments are removed from the joint and the holes are either stitched (usually with dissolvable sutures) or sometimes they are closed with special sticky strips. Occasionally no closure material is used and the cuts are allowed to heal naturally. A firm bandage is generally applied. If the patient is a day case a check will be made to ensure that they are well before they are allowed home. They will have been informed beforehand that they are not fit to drive and will therefore need a friend or relative to take them home. If treatment has been performed during the arthroscopy, the individual may be referred to a physiotherapist for special exercises to help the joint recover.

What are the possible complications of arthroscopy?

Arthroscopies are now a very common procedure and have very few complications. However, there is always a small risk of complications from the anaesthetic. In addition there is a chance of infection of the cut into the joint or of the joint itself although this is rare. Occasionally a thrombosis (blood clot) may result in the leg following arthroscopy of the knee which may require drug treatment to thin the blood. Again this is an unusual complication.

What is an arthroscopic meniscectomy?

An arthroscopic meniscectomy is one of the more common types of operation performed on the knee using an arthroscope. Inside the knee there are two discs of cartilage called the menisci by doctors but are commonly referred to as the 'cartilages'. These structures act to pad the shock waves through the knee during activity and help to assist the smooth gliding of the lower leg bone (the tibia) against the upper leg bone (the femur). A common knee injury is where one of these menisci becomes torn. This tends to cause knee pain and sometimes locking or giving-way of the knee.

Before arthroscopes were invented if surgery was needed the whole knee joint had to be surgically opened, with all the possible complications and extended recovery time associated with a major operation. An arthroscopic meniscectomy means that part or all of the affected cartilage can be removed using instruments inserted through the arthroscope itself or through the second incision mentioned above.

After this operation it is important for the patient to follow the instructions of the surgeon. In general the individual will be able to weight bear after only a few days and return to work within a week or so depending on whether the job involves heavy lifting or not.

What is an arthroscopic cruciate ligament repair?

Another fairly common knee injury is something called a ruptured cruciate ligament. A number of famous footballers have had this injury which involves the rupture (break) of one or both cruciate ligaments which are ligaments inside the knee joint which cross over each other - hence the name 'cruciate'. These ligaments provide stability to the joint. Therefore it is particularly important to repair them in sportsmen/women or those who are very active since otherwise the knee remains unstable and prone to wear and tear.

Again this operation used to require opening the knee joint. However, nowadays it is frequently done using arthroscopic techniques. The operation is quite complicated and therefore the surgeon sometimes uses additional techniques to help him see exactly what is going on inside the joint during surgery including computer graphics and the use of special dyes inside the joint. The ligament is repaired using sutures or grafts introduced into the joint such as a piece of tendon from the kneecap being used to bridge the gap in the ruptured ligament.

A period of rest and physiotherapy is again needed after this operation although a return to most normal activities is possible within about two weeks although the surgeon may restrict more vigorous activities until he is happy with the progress of the patient.

Arthroscopies are used for diagnosis and treatment of other joint conditions and have now become a very common, safe and effective form of management for a number of joint problems.

Last updated 12 June 2015


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