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What is knee arthroscopy’?

Knee arthroscopy is a type of surgical procedure in which the surgeon inserts a small camera and other small surgical instruments into the knee joint through small incisions (cuts), and uses them to view and treat various knee problems. Pinnacle Orthocentre is leading one of the best for Sports medicine & Best Arthroscopic Surgery Hospitals in Thane, India.

What are the advantages of arthroscopic surgery?

In arthroscopic surgery, the surgeon inserts a small camera, called an arthroscope, into the joint, through a small (approximately 1cm) cut in the skin. The images picked up by the camera are viewed on a monitor. Other miniature surgical incisions are then inserted into the knee joint through other small incisions (called ‘portals’), and used to treat the problems within the joint.

The alternative to this is ‘open’ surgery, in which a single large incision is made and the structures of the knee joint are directly exposed and repaired.

The advantages of arthroscopic surgery are that, because it is done through such small incisions, it results in less post-operative pain, less joint stiffness and faster recovery.

Anatomy

The knee joint is the largest joint in the body. It is made up of three bones – lower end of the thigh bone (femur), upper end of the leg bone (tibia) and the knee cap (patella). The other important structures are the soft tissues (ligaments, cartilages, etc.) that lie inside the joint between the bones forming it, as well as around it.

Articular cartilage: This is the slippery substance that covers the ends of the bones, allowing them to glide smoothly over each other as you move your knee.

Synovium: This is the substance that lines the inner surface of the joint and produces the fluid that fills the joint. This fluid acts as a lubricant and reduces friction during joint movement.

Menisci: These are the two wedge-shaped pieces of cartilage that lie in the space between the femur and the tibia. Each meniscus is a tough and rubbery structure. They act as shock absorbers, and help to cushion the joint.

Ligaments: Ligaments are strong structures that connect bones to each other. There are four main ligaments in each knee, which connect the femur and tibia and keep the knee stable.

Collateral ligaments: These lie on either side of the knee and provide side-to-side stability.

Cruciate ligaments: These are two ligaments lying inside the knee, that cross each other in an ‘X-shaped’ manner. The one lying in front is called the anterior cruciate ligament (ACL), and the one lying behind is called the posterior cruciate ligament (PCL). They together provide front-to-back stability to the knee.

When is knee arthroscopy necessary?

Knee arthroscopy is useful to treat a number of conditions affecting the structures of the knee joint. Common arthroscopic procedures include:

  1. Reconstruction of a torn ACL
  2. Removal or repair of a torn meniscus
  3. Removal of inflamed/infected synovial tissue
  4. Removal of loose fragments of bone/cartilage from the joint
  5. Trimming/repair of damaged articular cartilage

Diagnosis and Work-up

Derangements of the knee joint are diagnosed on the basis of your symptoms and by examination of the knee joint. Most patients will also require an MRI of the knee joint, which clearly visualizes all the soft-tissue structures of the knee joint, and helps identify damaged structures.

Pre-operative work-up will routinely consist of blood tests, chest x-ray and ECG. Additional tests may be required if you have any additional ailments such as high blood pressure, diabetes etc.

Anaesthesia

Arthroscopic procedures are usually performed under spinal anaesthesia. In this, the anaesthetist injects medicines into the spine, which causes you to become numb below the waist. The numbness wears off after a few hours.

Procedure

  • As mentioned before, the surgeon will make small cuts over the knee and insert miniature surgical instruments and a camera into the knee joint.
  • In order to aid visualization, the joint is filled with a sterile fluid (normal saline).
  • The first step is to inspect all the structures in the joint and to confirm where the problem lies.
  • Next, special instruments like shavers, cutters, graspers etc. are used to repair/remove the damaged structures.
    • For meniscal repairs, special instruments may be used to insert stitches into the meniscus.
    • For ACL reconstructions, the surgeon must harvest a piece of ligament to replace the torn one. This is usually done by harvesting one of the tendons of the hamstrings (the strong muscles at the back of the thigh), through a separate incision on the same knee. The harvested tendon (called the graft) is then anchored into the femur and tibia using special implants like screws and buttons.
  • At the end of the surgery, the surgeon will close the small cuts in the skin with sutures/staples.

Recovery

  • For a few days after the surgery you will have some pain and swelling in the joint. Your surgeon will prescribe medications to relieve the pain. Keeping the limb elevated and ice application will also help. You may also be given a brace to minimize movement at the knee and to give it support when walking.
  • Once the pain subsides, you will be started on exercises to strengthen the muscles around the knee and recover full range of movement at the knee. Your surgeon may refer you to a physiotherapist to guide you with the post-operative exercise regimens.
  • In most instances, you should be able to start bearing weight on the operated limb soon after surgery. Your surgeon will advise you on this, depending upon the type of procedure you have undergone.
  • You should be able to return to routine activities (walking, stair climbing) within a few weeks after surgery, however you may need to avoid high-impact activities (running, jogging) for several months.

At Pinnacle Orthocentre Hospital one of the few Arthroscopic Surgery Hospital in Thane we have a dedicated Sports Medicine Department headed by Dr Kshitij Thoke, one of the few Arthroscopic Surgeons in Mumbai who specializes in shoulder and knee arthroscopic surgeries.Dr Kshitij Thoke is a Fellowship trained Sports Medicine and Arthroscopy Surgeon.

For more information about Arthroscopic Surgery at Pinnacle Hospital please visit the website pinnacleorthocentre.com