KNEE ARTHROSCOPY

Key hole surgery (Arthroscopy)

The knee is one of the most injured joints in the body. The knee joint bears three to six times the body weight during various activities and susceptible to injury due to sudden twisting and turning like in racquet sports like badminton, tennis or twisting injury.

Knee arthroscopy is a type of keyhole surgery used both to diagnose and treat problems with joints. An arthroscopy involves the use of a device called an arthroscope to examine the joints. This is a thin tube that contains a light source and a camera. Images are sent from the arthroscope to a video screen or an eyepiece, so the surgeon is able to see inside the joint. It’s also possible for tiny surgical instruments to be used along side an arthroscope to treat certain joint conditions.

Advantages of Arthroscopy – As the equipment used during an arthroscopy is so small, only minor cuts need to be made in the skin causing less tissue damage. This means the procedure has some potential advantages over traditional, “open” surgery, including:

1. Less pain and disability after the operation.
2. Faster healing time. You can often go home the same day for some procedures. If hospitalisation is required most procedures need 1-2 days of stay compared to several days of stay with open procedures.
3. Lower risk of infection
4. You may be able to return to normal activities more quickly – can return to sedentary work almost immediately and to more vigorous work with in 1 to 2 weeks.
5. Some procedures can be done better with arthroscopic surgery and perhaps for some that is the only way they can be done.

Common knee conditions treated by Arthroscopy

Meniscus tear
The meniscus is a C-shaped fibrocartilage shock absorber which is located at the peripheral aspect of the joint . The majority of the meniscus has no blood supply and is unable to undergo the normal healing pro-cess. When the meniscus is damaged from injury or degeneration from age the torn piece begins to move in an abnormal fashion inside the joint and may get caught between the bones of the joint (femur and tibia). When this happens, the knee becomes painful, swollen, and difficult to move (locking) and damages the articular cartilage.

Depending on the type of tear, the piece of meniscus that is torn may be removed arthroscopically from the knee (partial meniscectomy) or repaired with special meniscal sutures.

Anterior, Posterior cruciate or multi ligament injuries
The anterior cruciate ligament (ACL) is the major stabilising ligament of the knee which prevent leg bone slipping anteriorly. It is very important for daily activities like stepping, jumping and sports. Usually the tearing of the ACL occurs with a sudden direction change or when a deceleration force crosses the knee. The patient often feels or hears a popping sensation, has the rapid onset of swelling, and develops a buckling sensation in the knee when attempting to change direction.

The posterior cruciate ligament PCL is the primary stabilizer of the knee preventing backward shift of the tibia over the femur. If the tibia moves too far back, the PCL can rupture.

After a complete ACL tear, some people are unable to participate in cutting or pivoting-type sports, while others have instability during even normal activities, such as walking. The torn ligament do not heal on its own and reconstruction of ACL is usually done arthroscopically.

Posterior Cruciate ligament.
If you have injured just your posterior cruciate ligament, your injury may heal quite well without surgery. Your doctor may recommend simple, nonsurgical options. Sometimes isolated PCL injuries cause instability and anterior knee pain and may require reconstruction by arthroscopic techniques.

Multi ligamentous knee injury
When there is major trauma to the knee, multiple knee ligaments can be torn at the same time. Injuries to multiple ligaments result in a knee dislocation. Surgery is almost always necessary to repair or reconstruct the ligaments which can be done arthroscopically.

Knee Infection (Septic Arthritis)
Infection in the knee causes pain, swelling, warmth and restricted knee movements. Most common causes of septic arthritis is bacteria.
Causes for septic arthritis are post-surgery (iatrogenic), joint injury and any septic focus in the body. Along with antibiotics, Arthroscopy is used for irrigation and drainage of the infected joint and removal of necrotic tissue and infected joint lining tissue (synovectomy).

Synovial biopsy or synovectomy
In chronic inflammatory conditions the lining of the joint or synovium gets inflamed and thickened producing pain and swelling. Biopsy of the synovium from an arthroscopy would confirm the pathology. Synovectomy or removal of the whole synovium would help in reducing the pain and swelling.

Removal of loose bodies
Loose bodies inside the knee joint are formed due to either cartilage defects, Osteoarthritis, direct impact or a proliferative condition called synovial chondromatosis. They usually pro-duce pain and locking of the joint and can be treated by arthroscopic removal.

Diagnostic surgery / To assess knee joint
Arthroscopy can aid in diagnosing causes of knee pain when other scans fail to pick up any abnormal find-ings – eg: To check suitability for uni-compartment or half knee replacement.

Articular cartilage injuries
Articular cartilage is the is the smooth, white tissue that covers the ends of bones where they come together to form joints. This may be injured or weakened due to certain conditions like osteochondritis dissecans.
Some patients with an articular cartilage injury improve with conservative treatment. If patients do not get better with conservative therapy, or have a large articular cartilage lesion, surgery may be necessary. Surgical options include – Smoothing of the lesion and removing loose edges only (debridement); Techniques to stimulate scar cartilage to grow into the lesion (micro fracture). Techniques to replace the lesion with new cartilage (osteochondral autografts, osteochondral allografts, or autologous chondrocyte implantation)

Osteoarthritis knee
Osteoarthritis is age related degeneration / wear and tear in the joint caused by the breakdown and eventual loss of the cartilage. It causes pain, swelling and reduced motion in the knee joint. Arthroscopic lavage and debridement is sometimes indicated for mechanical symptoms of knee pain where the knee is washed with saline and loose pieces and fragments are removed and smoothened. The lavage removes toxics enzymes that may reduce the pain and inflammation of the joint.

Knee Infection (Septic Arthritis)
Infection in the knee causes pain, swelling, warmth and restricted knee movements. Most common causes of septic arthritis is bacteria.
Causes for septic arthritis are post-surgery (iatrogenic), joint injury and any septic focus in the body. Along with antibiotics, Arthroscopy is used for irrigation and drainage of the infected joint and removal of necrotic tissue and infected joint lining tissue (synovectomy)

Stiff Knee
Restricted knee movements may be after injury, surgery, inflammatory conditions or infection. It can be treated with arthroscopic removal of scar tissue and release of tight bands.

Plica
It is a hypertrophied synovial fold present inside the knee which can cause pain and snapping sensa-tion. Removal produces pain relief.

Knee cap (Patella) Instability
The knee cap is designed to fit in the centre of this groove, and slide evenly within the groove during the knee movements. But due to biomechanical alterations, in some patient’s knee cap tends to slip outwards during the knee movements. It is called patellar instability which can cause pain and insecure feeling. Knee Arthroscopy can be used to visualise the joint surface, ligaments along with stabilising procedures of the patella.