Arthroscopic knee surgery

What are the main parts of the knee?

The knee is one of the largest and most complex joints of the human body. The knee connects the thigh bone (femur) to the shin bone (tibia). There is a smaller bone that runs alongside the tibia called fibula, and the kneecap (or patella) is the fourth bone that makes the knee joint. Tendons attach the leg muscles that move the knee joint to the knee bones. Ligaments join the knee bones and provide stability to the knee:

The anterior cruciate ligament prevents the femur from sliding backward on the tibia (or the tibia sliding forward on the femur).
The posterior cruciate ligament prevents the femur from sliding forward on the tibia (or the tibia from sliding backward on the femur).
The medial and lateral collateral ligaments prevent the femur from sliding side to side.

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Two C-shaped pieces of cartilage called menisci (medial and lateral) act as shock absorbers between the thigh bone and the shin bone. Several so-called bursae (fluid-filled sacs) help the knee move smoothly.

The knee joint is vulnerable to injuries which are usually related to playing sports or doing some kind of physical work.

What are the most common types of knee complaints?

Meniscus tear

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 as a result of aging and overuse. The usual treatment is meniscus resection and in severe cases meniscus refixation.

Knee ligament tear (ACL)

The ACL reconstruction helps stabilize and support the joint. ACL injuries are common, particularly in those who practice sports. The ACL can be injured if the joint of your knee is bent backwards, rotated, suddenly shifted in lateral direction or if some of these movements occur simultaneously. The usual treatment is arthroscopic ACL reconstruction.

Displaced patella (kneecap)

In normal circumstances the patella (kneecap) is balanced on the femur (thigh bone), ont he front of the knee. In the case of pain in the knee, there is a tendency for the patella to shift towards the outside of the knee. It occurs as a result of a chronic lateral pull on the knee cap by the thigh muscles, creating a strain on the medial tissues (retinaculum). The usual treatment is arthroscopic lateral release of the patella, or in severe disfunction medialization of the tibial tuberosity.

Pieces of bone, cartilage loose bodies in the knee joint

“Loose bodies” is another expression for small pieces of debris floating freely within the joint.

Loose bodies can cause pain, swelling, locking, and other complaints. They can be the result of an injury or from generalized wear and tear over time. Depending on the severity of the condition, there can be one or many loose bodies inside the joint. They can be stable (they don’t move about inside the joint) or unstable (they float through the inside of the joint) which can cause pain or loss of motion.The usual treatment is arthroscopic debridement or arthroscopic loose-body removal.

Condropathy or osteochondral lesion

It 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 the tibia or femur within the knee joint – in this case, arthroscopic knee cartilage shaving and in severe cases arthroscopic shaving with mosaicplasty can provide a long-term solution.
Our surgeons used the most advanced techniques to repair cartilage defects. 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.

When is an arthroscopic knee surgery necessary?

Arthroscopic knee surgery is a great way for surgeons to detect the source of knee pain and treat the problem on the spot.

Arthroscopy is recommended in case of the following problems:

Torn meniscus
Torn or damaged anterior cruciate ligament (ACL)
Torn or damaged collateral ligament
Swollen (inflamed) or damaged lining of the joint
Misalignment of the kneecap (patella)
Presence of small pieces of broken cartilage floating within the knee joint
Cartilage defect
Certain fractures of the bones of the knee

How does the technique work?

Arthroscopy is a technique widely used to repair certain types of knee injuries. During the procedure, your surgeon will make a very small incision and insert a tiny camera — called an arthroscope — into the space within your knee joint. This allows them to view the inside of the joint on a screen. The surgeon can then investigate the problem and, if necessary, correct the issue using small instruments within the arthroscope to remove, replace or repair the damaged parts.

What are the arthroscopic procedures we provide?

At Medicover Hospital, we provide the following treatments using the arthroscopic technique:

Meniscus repair

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

ACL reconstruction

Arthroscopic ACL surgery can only take place once the post-traumatic swelling and inflammation have diminished. When the ACL sustains a complete tear, it is replaced by a graft – usually harvested from another part of the patient’s own knee (it is called an autograft).

Arthroscopic lateral release of the patella (kneecap)

During the procedure, the surgeon incises the lateral stabilizing structures of the patella, namely the lateral retinaculum the role off which is to attach the lateral patella to the lateral femoral epicondyle, the iliotibial band, and the anterolateral tibia. Arthroscopic lateral release is generally performed in combination with medial stabilization.

Arthroscopic loose-body removal

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

Arthroscopic knee cartilage shaving

This is a common technique intended for patients with cartilage defect where the damage is only partial and the bone is not exposed. Inserting a pencil-thin arthroscope into the knee through a small incision, the surgeon shaves and smoothes the surface or the shredded or frayed cartilage. This helps reduce friction and irritation, leading to a decrease is symptoms such as swelling and pain.

Arthroscopic mosaicplasty

Mosaicplasty is a technique where small circular (4-8 mm) autogenous grafts are harvested from non-weight bearing regions of the knee, and transplanted in a mosaic pattern to fill the osteochondral defect.

What are the risks and benefits of knee surgery?

Undergoing such a complex procedure does carry certain risks, however, in most cases these are far outweighed by the benefits which can truly be life-changing. Surgery can reduce or even entirely eliminate pain, and can bring on a significant increase in mobility.

With regular, specialized exercises and physiotherapy you can go back to living a normal, healthy life, and even do sports. Chances are that you will no longer need painkillers once your kne has healed completely.

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. The arthroscopic technique shortens recovery time and increases the rate of success due to less bleeding scarring and trauma to the connective tissue. In most cases, the procedure takes 1 to 2 hours.

Arthroscopy can provide long-term relief from pain and improve mobility. Thus, the main benefit is the ability to return to a normal and active lifestyle, with greater comfort.

Risks

As with any type of surgery, there are some risks and complications associated with knee arthroscopy, however, they are easily treatable and their occurrence is rather rare.

Potential postoperative problems after knee arthroscopy include:

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

Am I eligible for knee replacement?

Due to changing lifestyles the number of knee operations has nearly doubled in the past 10 years. If you suffer from pain or swelling in your knee, you should consult a surgeon in order to preserve your knee joint. Early intervention delay the onset of, and even prevent serious knee problems in the future. Your physician will examine you, run some tests and recommend a type of treatment based ont he diagnosis and your medical history

How to preapre for the surgery?

If you decide to undergo knee arthroscopy, you may need a complete physical examination before surgery to assess your general health and exclude potential risk factors.

Prepare a list of all of your symptoms and any known medical conditions, past illnesses and allergies, even if they seem unrelated to your knee problems. For this purpose, you will be given a detailed form to be filled out, followed by a physical examination. List all the drugs and medications you take, including vitamins and supplements. Ask a family member or friend to accompany you to your appointment and aks them to help you recall the information to be provided during your consultation.

Be aware of any restrictions to adhere to prior to procedure such as dietary restrictions for the day of the operation. You might be asked to stop taking certain medications. Your surgeon will provide you with all the necessary information regarding preparation for the diagnostic tests and the operation itself.

You will be given a patient information sheet and an informed consent form which you will be requested to read carefully and sign. These documents will contain everything you need to know regarding preparation, the surgery itself and recovery.

Arthroscopic knee surgery is performed under general anesthesia, so you won’t be awake during the procedure.

2 weeks before surgery:

You may be told to stop taking certain kinds of medicine
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, try and quit before surgery as smoking can slow down wound, and bone healing
Let your physician know if you have the flu, a cold, or another illness before your surgery

On the day of the surgery:

You will be asked not to eat or drink anything for 6 to 12 hours before the procedure
Take your medications with a little water
Please arrive on time for your surgery

What to expect after surgery?

Compared to traditional open knee surgery recovery after arthroscopic knee surgery is faster. That said, it is still very 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 relieving your pain with prescription drugs. Later on you can apply ice packs to ease your pain. It is important to keep the wounds clean and dry. Your surgeon will tell you when and how to take showers or baths. Most patients need crutches for a while after arthroscopic knee surgery. You will recieve instructions on how to increase weight bearing gradually.

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

Why is regular follow-up important after surgery?

During recovery, you will need to see your surgeon several times before you can return to intense physical activities.

Post-operative follow-up examinations after arthroscopic knee surgery:

6 weeks, 12 weeks and 6 months after surgery

After you are discharged from hospital, applying ice packs for 15-20 minutes every hour is essential, it helps reduce pain and swelling. It is important to keep the bandages dry. For the first few weeks after surgery you should aim to regain your ability to straighten your knee completely. In fact, in the initial phase this is much more important than being able to walk long distances. Too much walking can cause swelling and pain. Keep the bandages on your knee until your first post-operative follow-up examination.

Most patients start feeling the benefits of arthroscopic knee surgery within 4 to 6 weeks. A reduction in pain and swelling, and a gradual increase in strength can be felt throughout the recovery period. Ideally, the follow-up appointment should take place about 6 weeks after surgery.