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Arthroscopy

Arthroscopy

Arthroscopy (also called arthroscopic surgery) is a minimally invasive surgical procedure on a joint in which an examination and sometimes treatment of damage is performed using an arthroscope, an endoscope that is inserted into the joint through a small incision.

Arthroscopic procedures can be performed to evaluate or treat many orthopaedic conditions including torn cartilage (known by doctors as “meniscus”), torn surface (articular) cartilage, ACL reconstruction, and trimming damaged cartilage.

The advantage over traditional open surgery is that the joint does not have to be opened up fully. For knee arthroscopy only two small incisions are made, one for the arthroscope and one for the surgical instruments to be used in the knee cavity. This reduces recovery time and may increase the rate of success due to lesser trauma to the connective tissue. It is especially useful for professional athletes, who frequently injure knee joints and require fast healing time. There is also less scarring, because of the smaller incisions. Irrigation fluid is used to distend the joint and make a surgical space. Sometimes this fluid leaks (extravasates) into the surrounding soft tissue, causing edema.

The surgical instruments are smaller than traditional instruments. Surgeons view the joint area on a video monitor, and can diagnose and repair torn joint tissue, such as ligaments and menisci or cartilage.

The surgical instruments are smaller than traditional instruments. Surgeons view the joint area on a video monitor, and can diagnose and repair torn joint tissue, such as ligaments and menisci or cartilage.

It is technically possible to do an arthroscopic examination of almost every joint, most commonly the knee, shoulder, elbow, wrist, ankle, foot, and hip.

Risks

Complications, though uncommon, may include:

  • Tissue damage. The placement and movement of the instruments within the joint can damage the joint’s structures, blood vessels or nerves.
  • Infection. Any type of invasive surgery carries a risk of infection.
  • Blood clots. Rarely, procedures that last longer than an hour can increase the risk of blood clots developing in your legs or lungs.

Procedure:

Exact preparations depend on which of your joints the surgeon is examining or repairing. In general, you should:

    • Avoid certain medications. Your doctor may want you to avoid taking medications or dietary supplements that can increase your risk of bleeding.
    • Fast beforehand. Depending on the type of anesthesia you’ll have, your doctor may want you to avoid eating solid foods eight hours before your procedure.
    • Arrange for a ride. You won’t be allowed to drive yourself home after the procedure, so make sure someone will be available to transport you.
    • Choose loose clothing. Wear loose, comfortable clothing — baggy gym shorts, for example, if you’re having knee arthroscopy — so you can dress easily after the procedure.
    • Arrange for a ride. You won’t be allowed to drive yourself home after the procedure, so make sure someone will be available to transport you.

Although the experience varies depending on why you’re having the procedure and on which joint is involved, some aspects of arthroscopy are fairly standard.

  • You’ll remove your street clothes and jewelry and put on a hospital gown or shorts.
  • A nurse will place an intravenous catheter in your hand or forearm and inject a mild sedative.

During the procedure

The type of anesthesia used varies by procedure.

  • Local anesthesia. Numbing agents are injected below the skin to block sensation in a limited area, such as your knee. With local anesthesia, you’ll be awake during your arthroscopy, but the most you’ll feel is pressure or a sensation of movement within the joint.
  • Regional anesthesia. The most common form of regional anesthesia is delivered through a small tube placed between two of your spine’s lumbar vertebrae. This numbs the bottom half of your body, but you are still awake.
  • General anesthesia. Depending on the length of the operation, it may be better for you to be unconscious during the procedure. General anesthesia is delivered intravenously.

You’ll be placed in the best position for the procedure you’re having. This may be on your back, on your stomach or on your side. The limb being worked on will be placed in a positioning device, and a tourniquet may be used to decrease blood loss and make it easier to see inside the joint.

Another technique to improve the view inside your joint is to fill it with a sterile fluid, which helps distend the area and provide more maneuvering room.

One small incision will admit the viewing device. Additional small incisions at different points around the joint allow the surgeon to insert surgical tools to grasp, cut, grind and provide suction as needed for joint repair.

Each incision will be less than 1/4 inch (7 millimeters) long and can be closed with one or two stitches, or with narrow strips of sterile adhesive tape.

After the procedure

Arthroscopic surgery usually takes between 30 minutes and two hours, depending on the procedure performed. After that, you’ll be taken to a separate room to recover for a few hours before going home.

Your aftercare may include:

  • Medications. Your doctor may prescribe antibiotics to prevent infection, as well as medication to relieve pain and inflammation.
  • R.I.C.E. At home, you’ll need to rest, ice, compress and elevate the joint for several days to reduce swelling and pain.
  • Protection. You may need to temporarily use splints, slings or crutches for comfort and protection.
  • Exercises. Your doctor may prescribe physical therapy and rehabilitation to help strengthen your muscles and improve the function of your joint.

Call your surgeon if you develop:

  • A temperature of 100.4 degrees Fahrenheit (38 degrees Celsius) or higher
  • Pain not helped by medication
  • Drainage from your incision
  • Redness or swelling
  • New numbness or tingling

In general, you should be able to resume desk work and light activity in a week, and more strenuous activity in about four weeks. Remember, however, that your situation may dictate a longer recovery period, along with rehabilitation.

Prognosis:

Your surgeon will review the findings of the arthroscopy with you as soon as possible. You may also receive a written report, as may your primary physician.

After arthroscopic surgery to treat a joint injury or disease, healing may take several weeks. Your surgeon will monitor your progress in follow-up visits and address any problems that arise.

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