Arthroscopic knee surgery

The knee is the largest and one of the most important joints in the body. It is a strong but flexible hinge joint, playing an essential role in movement related to carrying the body weight in horizontal (running and walking) and vertical (jumping) directions.

Between the femur (upper leg bone) and tibia (lower leg bone) is the meniscus, a layer of tough fibrocartilage that acts as a shock absorber. The knee joint is vulnerable to injuries, that most often occur during sports or recreational activities, work-related tasks, or home projects.

• Tear of meniscus – meniscus resection and in severe cases meniscus refixation
  The meniscus can be torn and damaged because of trauma caused by forceful twisting or hyper-flexing of the knee joint, or it can gradually wear out because of age and overuse.

• Knee ligament tear (ACL) – Arthroscopic ACL reconstruction. The ACL reconstruction helps stabilize and support the joint. ACL injuries are common, particularly in case of sports.
  The ACL can be injured if the joint of your knee is bent backward, rotated, quickly shifted laterally or if any of these movements occurrs simultaneously.

• Displaced patella (kneecap) – arthroscopic lateral release of patella, or in severe disfunction tuberositas tibiae medialisatio
  The patella (kneecap) is balanced in the front of the knee on the femur (thigh bone). In case of  painful knee, there is a tendency for the patella to tilt toward the outside of the knee. It occurs as a result of a chronic pull of the knee cap to the outside by the thigh muscles, creating a strain on the medical or inside tissues (the retinaculum).

• Pieces of bone, cartilage or tissue that are loose in the knee joint – Arthroscopic debridement knee surgery or arthroscopic loose-body removal. “Loose bodies” is another expression for small free floating pieces of debris in the joint.
  Loose bodies can cause pain, swelling,  locking, and catching of the joint,  including fractures, trauma, bone and cartilage inflammation, and benign tumors of the synovial membrane.

• Condropathy or osteochondral lesion is an injury of the smooth surface on the end of bones, e.g the wear of articular cartilage (chondro) and the bone (osteo) of tibia or femur in the knee joint – in this case, arthroscopic knee cartilage shaving surgery and in severe cases arthroscopic shaving with mosaicplasty can be the proper solution.
  Our surgeons perform the most advanced treatments for cartilage defect. Depending on the severity and overall size of the damage multiple plugs or dowels may be required to adequately repair the joint. Mosaicplasty, a form of chondral grafting, is a surgery designed to replace cartilage on the surface of the knee joint that has been damaged by trauma or arthritis by implanting osteochondral plugs.

An arthroscopic knee surgery is a useful way for surgeons to detect the source of knee pain and treat the problem.

Arthroscopy is recommended in case of the following knee problems:

• Torn meniscus
• Torn or damaged anterior cruciate ligament (ACL)
• Torn or damaged collateral ligament
• Swollen (inflamed) or damaged lining of the joint
• Kneecap (patella) that is out of position (misalignment)
• Small pieces of broken cartilage in the knee joint
• Repair of defect in cartilage
• Some fractures of the bones of the knee

Arthroscopic knee surgery is one of the most frequently used procedures in case of certain types of  knee injuries. During the procedure, your orthopaedic surgeon inserts the arthroscope (a thin flexible fiberoptic scope which is introduced into a joint space through a small incision )  into your knee joint and use it with the aim of repairing or removing damaged parts.

Arthroscopic knee surgery abroad has the same medical protocol like your home country. At our hospital, we provide the following treatments:

Meniscus repair

Arthroscopic meniscectomy is a minimally invasive surgery used to treat a torn meniscus cartilage in the knee, when the torn segment of the meniscus is removed.

ACL reconstruction

Arthroscopic ACL surgery takes place only after the post-injury swelling and inflammation has diminished. When the ACL sustains a complete tear, the surgeon must replace it with a graft, usually obtained from the patient’s own knee (termed an autograft).

Arthroscopic lateral release of patella (kneecap)

During the procedure, the surgeon incises the lateral stabilizing structures of the patella, in particular, the lateral retinaculum. The lateral retinaculum attaches the lateral patella to the lateral femoral epicondyle, the iliotibial band, and the anterolateral tibia. Arthroscopic lateral release is generally performed in combination with medially based stabilization procedures to subserve effectively the medial realignment.

Arthroscopic loose-body removal

Today the standard is to remove possibly all loose bodies by arthroscopy. This is a minimally invasive procedure.

Arthroscopic knee cartilage shaving surgery

This common treatment intended for patients where the cartilage defect has not worn all the way down to the bone. Inserting a pencil-thin arthroscope into the knee through a small incision, the surgeon shaves and smoothes shredded or frayed cartilage. Ideally, the smoothing and shaving away procedure of the damaged cartilage helps to ultimately decrease friction and irritation, thus reducing the symptoms of swelling, noise, and pain.

Arthroscopic mosaicplasty

Mosaicplasty is the technique of harvesting small circular (4-8 mm) autogenous grafts from the knee from non-weight bearing regions of the knee, and transplanting the grafts in a mosaic pattern until the osteochondral defect is filled.

Benefits

The advantage of arthroscopic knee surgery over traditional open surgery is that the joint does not have to be opened up fully. Only two, sometimes three small incisions are made — one for the arthroscope and one for the surgical instruments to be used in the knee cavity. Arthroscopic knee surgery shortens recovery time and  increases the rate of surgical success due to less trauma in the connective tissue. In most cases, the procedure takes only a few (1-2) hour.  In this particular case, smaller incisions lead to less wound

An arthroscopy can ultimately provide relief from knee pain and improve mobility. Maintaining a normal and active lifestyle with greater comfort is the key benefit of this procedure.

Risks

There are risks, that associated with any type of surgery, though they are treatable and occur infrequently.

Potential postoperative problems after knee arthroscopy include:

• Infection inside the joint
• Blood clots
• Accumulation of blood in the knee
• Deep vein thrombosis/embolism
• Bleeding inside the knee joint
• Stiffness in the knee
• Injury or damage of the cartilage, ligaments, meniscus, blood vessels, or nerves of the knee

The number of knee surgery has nearly doubled in less than 10 years. If you have pain in your knee, you should consult a surgeon in order to preserve your own knee joint and delay, or possibly even prevent serious knee problems. Your physician will recommend you the proper treatment, on the basis of your medical history and diagnosis.

If you decide to have knee arthroscopy, you may need a complete physical examination before surgery to assess your health condition.

Before arthroscopic knee surgery, enlighten your orthopaedic surgeon about the medications  you take regularly. He or she will tell you which medicines are not recommended you to take before surgery.

2 weeks before your knee arthroscopic surgery:

• You may be told to stop taking certain kind of medicines
• Ask which medicines you should still take on the day of your surgery.
• Tell your surgeon if you have been drinking alcohol
• If you smoke, don’t do it before surgery. Smoking can slow down wound -, and bone healing.
• Always let your physician know about any cold, flu, fever, or other illness you have before your surgery.

On the day of your surgery:

• You will be asked not to drink or eat anything for 6 to 12 hours before the procedure.
• Take the prescribed medicines  with water.
• Please arrive in time at Medicover Hospital.

Recovery after arthroscopic knee surgery is faster than recovery after traditional open knee surgery. Still, it is important to follow your orthopaedic surgeon’s instructions carefully after you return home. Feeling some pain is a natural part of the healing process. Your doctor and nurses will work on reducing  pain, that will shorten your recovery period. Medications are  prescribed for short-term pain relief after surgery. In order to relieve swelling and pain, the surgeon wil recommend to apply ice. It is important to keep your incisions clean and dry. Your surgeon will tell you  when and how to take a shower or bath. Most patients need crutches or other assistance after arthroscopic knee surgery. You will get advice about when it is safe to put weight on your leg.

Therapeutic exercise will play an important role in your recovery process. You should exercise your knee regularly for several weeks after surgery to restore motion and strengthen the important muscles. If you’ve had a ligament reconstruction, you should be able to return to most physical activities after 6 to 8 weeks.

During your healing period, you will need some check-ups before return to intense physical activities

ACL post-operative check-ups recommended:

6 weeks, 12 weeks and 6 months after the surgery

After you get home, applying ice on your knee for 15-20 minutes per  hour is essential. It’s important to keep the bandages dry. Ice helps to reduce pain and swelling. For the first few weeks after surgery, the most important goal is to regain the ability to fully straighten your knee. It is much more important initially than being able to walk long distances. Too much walking will cause swelling and pain.

Keep the bandages on your knee until you have your first post-operative check-up. The first arthroscopy post-operative check-up is recommended 6 weeks after surgery.

Most patients feel the benefit of arthroscopic knee surgery within 4 to 6 weeks. Reduction of pain and swelling, and improvement of knee strength is constantly being experienced during the recovery period.  Follow-up appointment should be made 6 weeks after the surgery.

At Medicover hospital, the arthroscopic knee surgery package cost includes the following service and care:

Arthroscopic knee surgery

1-2 day stay (depending on the type of surgery) at Medicover hospital

Full pension (breakfast, lunch, dinner) during your stay

Stitches removal

The first check up, 7 to 10 days after surgery

Physiotherapy the day after surgery