Arthroscopy is a minimally-invasive procedure used for the diagnosis and treatment of conditions affecting joints. The doctor can directly view the internal structures of a joint using an instrument called an arthroscope.
Orthopaedic surgeons use arthroscopy to diagnose and treat joint problems. An arthroscope is a small, tube shaped instrument that is used to look inside a joint.
It consists of a system of lenses, a small video camera, and a light for viewing. The camera is connected to a monitoring system that allows the doctor to view a joint through a very small incision. The arthroscope is often used in conjunction with other tools that are inserted through another incision.
The joint most frequently examined using arthroscopy is the knee. However, arthroscopy can be used to examine other joints, including the following:
Joints are formed where bones meet. Most joints are mobile, allowing the bones to move. Basically, the knee is two long leg bones held together by muscles, ligaments, and tendons. Each bone end is covered with a layer of cartilage that absorbs shock and protects the knee.
There are two groups of muscles involved in the knee, including the quadriceps muscles (located on the front of the thighs), which straighten the legs, and the hamstring muscles (located on the back of the thighs), which bend the leg at the knee.
Tendons are tough cords of tissue that connect muscles to bones. Ligaments are elastic bands of tissue that connect bone to bone. Some ligaments of the knee provide stability and protection of the joints, while other ligaments limit forward and backward movement of the tibia (shin bone).
The knee consists of the following:
An arthroscopic procedure may be used to diagnose and assist in the treatment of the following conditions:
Corrective surgery or a biopsy may be performed using arthroscopy. For example, torn ligaments can be repaired or reconstructed. Arthroscopic surgery may eliminate the need for an open surgical procedure.
Before the surgery
During the procedure
Arthroscopy may be performed on an outpatient basis or as part of the stay in a hospital. Arthroscopy may be performed under general anaesthesia, or while under localized anaesthesia. The type of anaesthesia will depend upon the specific procedure being performed. The anaesthesiologist will discuss this with the patient in advance.
Generally, an arthroscopic procedure follows this process:
After the procedure
After surgery, the patient will be taken to the recovery room for observation. The recovery process will vary depending on the type of anaesthesia that is given. The circulation and sensation of the affected extremity will be monitored. Once blood pressure, pulse, and breathing are stable and the patient is alert, he/she will be taken to the hospital room or discharged home. Arthroscopic surgery is usually done on an outpatient basis.
Once the patient is at home, it is important to keep the incision site clean and dry. Specific bathing instructions will be given. If stitches are used, they will be removed during a follow-up visit. If adhesive strips are used, they should be kept dry and generally will fall off within a few days.
The patient can take a pain reliever for soreness as recommended by the doctor. Aspirin or certain other pain medications may increase the chance of bleeding. Hence only recommended medications should be taken.
Activity and the use of the joint may be limited for 24 to 48 hours after a diagnostic arthroscopy. If other procedures are performed, such as a ligament repair, activity and use of the joint may be limited for a longer period of time. For knee surgery, the patient may be given an immobilizer to wear. The doctor may also instruct the patient to apply ice to the surgical site and to elevate the knee when sitting. Specific instructions will depend on the exact procedure performed.
The doctor should be notified to report any of the following:
Normal diet can be resumed unless the doctor advises differently.
Risks / Complications
As with any surgical procedure, complications can occur. Some possible complications may include, but are not limited to, the following:
There may be other risks depending on the patient’s specific medical condition.
Arthroscopy is a surgical procedure that orthopaedic surgeons use to visualize, diagnose, and treat problems inside of a joint. The word arthroscopy comes from the Greek words, “arthro” (joint) and “skopein” (to look). The term literally means to look within the joint. During the knee arthroscopy, the surgeon will make 2-3 tiny incisions to insert the pencil-sized instruments. These instruments contain a small lens and lighting system to magnify and illuminate the structures inside the joint. By attaching the arthroscope to a miniature camera, the surgeon can visualize and examine the inside the joint. They can examine the bones, cartilage, and ligaments of the knee and repair or correct various problems or injuries.
Diagnosing a joint injury will always begin with a thorough medical history, physical examination, and radiographic studies (x-rays, MRI, CT scan, etc.). Through the arthrosocope, a final diagnosis is made which is often more accurate than through traditional “open” surgery, x-ray studies, or MRI alone.
Some of the more common reasons that knee arthroscopy is done in orthopaedics include:
Arthroscopic surgery is done in the operating room or surgical suite under a general anaesthetic or under a local block (regional anaesthesia). A small incision (about the size of a buttonhole) will be made to insert the arthroscope into the knee joint. 2-3 additional buttonhole incisions are often needed to examine other parts of the joint or to insert other instruments. When indicated, corrective surgery is performed with specially designed instruments that are inserted into the joint through the accessory incisions. Many common knee injuries can now be treated arthroscopically.
After arthroscopic surgery, the small incisions will be covered with a bulky dressing and knee immobilizer. The patient will be moved from the operating room into the recovery room. Some patients will need little or no pain medication, although it is not uncommon to have pain if an injury was treated. Pain medication should be used as needed for the first few days after surgery.
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