Knee arthroscopy is an operation that uses a small camera (arthroscope) to visualize inside the knee. This is a minimally invasive surgery since the knee joint is not opened and the entire operation is carried out using small arthroscopy tools through half a 5mm skin incision.
Arthroscopy may also be used for other joints like shoulder, hip and wrist.
Arthroscopy may be recommended for the following knee problems
- Torn meniscus. Meniscus is cartilage that cushions the space between the bones in the knee. Surgery is done to repair or remove it.
- Torn or damaged anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL). Surgery is done to reconstruct or augment the torn ligament.
- Some fractures of the bones of the knee
- Swollen (inflamed) or damaged lining of the joint. This lining is called the synovium (joint fat).
- Knee-cap (patella) that is out of position (misalignment).
- Small pieces of broken cartilage in the knee joint
- Repair of defect in cartilage
ACL Reconstruction
- Why is it done?
- ACL reconstruction is surgery to reconstruct the ligament in the center of your knee. The anterior cruciate ligament (ACL) keeps your shin bone (tibia) in place. A tear of this ligament can cause your knee to give way during physical activity. Moreover, imbalances across the knee joint in an ACL deficient knee while walking may cause early destruction of the joint cartilage (osteoarthritis). Thus, the ACL reconstruction surgery is performed not only to get rid of instability and pain due the primary injury, but more importantly to prevent permanent damage to the joint cartilage.
- What is done?
- Using a microinstrument called the arthroscopic shaver, the torn remnant of ligament is removed. A tendon graft is harvested from the upper aspect of the shin bone, to prepare the new ligament. The new ligament is then secured in place of the native ACL in the thigh bone (femur) and the shin bone (tibia) using an endobutton or a screw. The entire procedure is performed using two key hole incisions to access the knee joint.
- Is there any advantage of early reconstruction?
- Early reconstruction is recommended in athletes and sportsmen for early return to sports. Also, this ensures that the normal kinematics (stability) of the knee joint is restored before any damage to joint cartilage has taken place.
- When should it not be done?
- We do not recommend this surgery in the elderly population (above 60 years of age) or if there is evidence that the joint cartilage is already damaged due to the ageing process (osteoarthritis); since the ligament reconstruction will not benefit the patient from the pain of osteoarthritis.
- What is the postoperative protocol?
- We do not recommend this surgery in the elderly population (above 60 years of age) or if there is evidence that the joint cartilage is already damaged due to the ageing process (osteoarthritis); since the ligament reconstruction will not benefit the patient from the pain of osteoarthritis.
- Hospitalization for 2 days, discharge on 3rd day. (We do not advocate day care surgery)
- Patient can walk from the next day of surgery. Use of Brace support while walking for 20 days is recommended.
- Walking with walker or tripod stick for 10 days, followed by walking without support.
- Return to work and physical activities (non-strenuous) from 5th day after surgery.
- Return to physical activities (strenuous- running, jogging etc.) 3 months after surgery.
- Return to high demand sports (cricket, football, tennis etc) 4 months after surgery.
Cartilage Pad or Meniscal injury
- Menisci or cartilage pads serve as “shock absorbers” within the knee joint. They prevent damage to the joint cartilage due joint reaction forces during standing, walking, running, jumping and contact sports.
- Types of meniscal tears :
- Traumatic tears- Occur due to twisting injury of the knee. The cartilage pad gets trapped between the two bone ends resulting in a tear. These tears are usually associated with a ligament injury such as the ACL tear.
- Degenerative tears- Occur due to age related weakening of the cartilage pads.
- Symptoms of meniscal tears :
- Pain and stiffness
- Catching and locking of the knee
- Feeling of the knee “giving way” while climbing down stairs
- Painful restriction of movements
- Treatment of meniscal tears :
- Non-surgical treatment: “RICE” therapy (Rest, Ice application, Compression and Elevation)
- Arthroscopic treatment: When non-surgical treatment does not provide relief from symptoms, the torn part of the meniscus is trimmed away using a camera device and a shaver through key hole incisions on the knee.
