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Knee Surgery-Knee Arthroscopy
Knee arthroscopy is a surgical procedure in which a small camera is used to examine tissues inside the knee joint. Additional instruments may also be inserted to repair the knee.
Alternative Names
Arthroscopic lateral retinacular release; Synovectomy; Patellar debridement
Description
Arthroscopic surgery on the knee involves inserting a small camera, less than 1/4 inches in diameter, into the knee joint through a small incision. The camera is attached to a video monitor, which the surgeon uses to see inside the knee. In some facilities, the patient can choose to watch the surgery on the monitor as well. For a simple surgical procedure, a local or regional anesthetic is administered, which numbs the affected area. The patient remains awake and able to respond. For more extensive surgery, general anesthesia may be used. In this case, the patient is unconscious and pain-free. After the camera is inserted, saline is pumped in under pressure to expand the joint and to help control bleeding. Some surgeons also use a tourniquet to prevent bleeding. After looking around the entire knee for problem areas, the surgeon will usually make one-to-four additional small incisions to insert other instruments. Commonly used instruments include a blunt hook to pull on various tissues, a shaver to remove damaged or unwanted soft tissues and a burr to remove bone. A heat probe may also be used to remove inflammation (synovitis) in the joint. At the completion of the surgery, the saline is drained from the knee, the incisions are closed and a dressing is applied. Many surgeons take pictures of the procedure from the video monitor to allow the patient to see what was done.
Indications
Arthroscopy may be recommended for knee problems, such as:
- A torn meniscus (either repair or remove)
- Mild arthritis
- Loose bodies (small pieces of broken cartilage) in the knee joint
- A torn or damaged anterior cruciate or posterior cruciate ligament
- Inflamed or damaged lining of the joint (synovium)
- Misalignment of the knee cap (patella)
Risks
The risks for any anesthesia are:
- Allergic reactions to medications
- Problems breathing
The risks for any surgery are:
- Bleeding
- Infection
Additional risks include:
- Bleeding into the joint (hemarthrosis)
- Damage to the cartilage, meniscus or ligaments in the knee
- Failure of the surgery to relieve symptoms
- Knee stiffness
Expectations after surgery Above all other accolades, arthroscopy has reduced the need to surgically open the knee joint. This has resulted in less pain and stiffness, fewer complications, decreased length (if any) of hospitalization and faster recovery time. A surgery done for a meniscal tear or loose bodies when the patient has no other problems (like arthritis) is usually uncomplicated, and most patients can expect a full recovery. The presence of arthritis dramatically reduces the effectiveness of arthroscopy and up to 50 percent of patients may not improve post-operatively. Arthroscopic removal of the synovium (arthroscopic synovectomy) can be of great benefit to patients with rheumatoid arthritis. Arthroscopic or arthroscopic-assisted surgery done to repair the meniscus or reconstruct ligaments in the knee is much more complicated with prolonged recovery and more variable results.
Convalescence
For a simple meniscal cleaning (debridement) procedure, recovery is usually quite rapid. The patient may need to use crutches, however, for a while to reduce weight placed on the knee joint to control pain. Pain, meanwhile, can be managed with medications. For more complicated procedures where anything is fixed or reconstructed, patients may not be able to walk on the knee for several weeks, and the overall recovery may be anywhere from several months to a year.
Shoulder Surgery-Shoulder Arthroscopy
Shoulder arthroscopy is a type of surgery that uses a mini-camera (arthroscope ) inserted through a small incision to examine or repair the tissues inside or around your shoulder joint.
Description
The surgeon makes a small incision, about one-quarter inch long, near the shoulder joint. A small camera (arthroscope) is then inserted into the joint. The camera is attached to a video monitor to allow the surgeon to see the inner workings of joint itself. Unlike knee arthroscopy, most people are asleep during the surgery. Therefore, you will be unable to watch the video monitor. Before the procedure begins, a nerve block may be used to numb your shoulder and arm to help reduce pain after surgery. Once inside the shoulder, a salt solution (saline) is pumped into the area to expand the joint. This helps the surgeon see the joint and helps control any bleeding. The surgeon will also look around the entire joint to check the cartilage, tendons and ligaments of the shoulder. If damaged tissues need to be repaired, the surgeon will make one-to-three additional small incisions to insert other instruments. These may include a blunt hook to pull on tissues, a shaver to remove damaged or unwanted tissues and a burr to remove bone. In addition to working on the shoulder joint, the surgeon often places the camera in the space above the rotator cuff tendons (the subacromial space). The surgeon can evaluate the area above the rotator cuff, clean out inflamed or damaged tissue, remove a bone spur and even fix a rotator cuff tear while in the general area. At the end of the surgery, the fluid is drained from the shoulder, the small incisions are closed and a dressing is applied. Your surgeon will probably take pictures of the procedure from the video monitor to show you what was found and what was done.
Indications
Arthroscopy may be recommended for shoulder problems, such as:
- A torn or damaged cartilage ring (labrum) or ligaments (in cases of shoulder instability)
- A torn or damaged biceps tendon
- A torn rotator cuff
- A bone spur or inflammation around the rotator cuff
- Stiffness of the shoulder
- Inflammation or damaged lining of the joint
- Arthritis of the end of the clavicle (acromioclavicular joint)
Risks
The risks for any anesthesia are:
- Allergic reactions to medications
- Problems breathing
The risks for any surgery are:
- Bleeding
- Infection
- Nerve damage
Additional risks include:
- Stiffness of the shoulder
- Failure of the surgery to relieve symptoms
- Failure of the repair to heal
- Weakness of the shoulder
Expectations after surgery Arthroscopy is an alternative to "open" surgery that completely exposes the shoulder joint. Arthroscopy results in less pain and stiffness, fewer complications, shorter (if any) hospital stays and possibly faster recovery time. The expectations vary depending on the purpose of the surgery. In cases where repair is needed, the body still has to heal after arthroscopic surgery, just as if the surgery were open. Therefore, the overall recovery time may still be long. Surgery to fix a cartilage tear is usually performed because the shoulder is not stable. Many people recover fully, and the symptoms of instability go away. However, some people can still have instability of the shoulder after arthroscopic repair. Using arthroscopy for rotator cuff repairs or tendonitis usually relieves the pain, but you may or may not regain all of your strength.
Convalescence
Recovery can take anywhere from one-to-six months, depending on the surgery that was performed. You will probably have to wear a sling for the first week. If you had a more extensive repair, you may have to wear the sling for a longer period. You may also need to take medications to control your pain. When you can return to work or play sports will depend on the surgery that was performed, but it can range from one week to several months. For many procedures, especially if a repair is performed, physical therapy may help you regain the motion and strength of your shoulder. The length of therapy will depend on the repair that was done.
