Arthroscopic procedure & joint diseases

Arthroscopic Surgery / Wellton Hospital Korea

Arthroscopy is

(1)Achieves a high level of accuracy in diagnosis through high definition digital endoscope.

(2)A perfect alternative to conventional open surgical techniques, and causes considerably less tissue damage.

Arthroscopy

The arthroscope is a fiber-optic telescope, which is inserted into the joints (knee, shoulder or ankle) to evaluate and treat the conditions.  Most arthroscopic surgery is performed as day surgery with epidural  anesthesia.  The Arthroscopy is commonly performed for many sports injuries. 

Arthroscopy is useful for

 (1) torn floating cartilage (meniscus)

 (2) Torn surface (articular) cartilage

 (3) Removal of loose bodies and cysts.

 (4) Reconstruction of the Anterior Cruciate Ligament (ACL)

 (5) Patello-femoral (knee cap) disorders

 (6) Washout of infected knees

 (7) General diagnostic purposes

Diagnosis

Standing weight-bearing view X-ray of the knee is usually required.

MRI scan is needed if the diagnosis is unclear.

Meniscal Cartilage Tears:

Following a twisting type of injury the medial (or lateral) meniscus can tear. This results either from a sporting injury or may occur from a simple twisting injury when getting out of a chair or standing from a squatting position. Our cartilages become a little brittle as we get older and therefore can tear a little easier. The symptoms of a torn cartilage include

•Pain over the torn area i.e. inner or outer side of the knee

•Knee swelling

•Reduced motion

•Locking if the cartilage gets caught between the femur a tibia

CARTILAGE TEARS

Once a meniscal cartilage has torn it will not heal unless it is a very small tear that is near the capsule of the joint. Once the cartilage has torn it predisposes the knee to develop osteoarthritis (wear and tear) in 15 to 20 years. It is better to remove torn pieces from the knee if the knee is symptomatic.

Torn cartilages in general continue to cause symptoms of discomfort, pain and swelling until the loose, ragged pieces are removed. Only the torn section is removed and the knee should recover and become symptom free. If the entire meniscus is removed, the knee will develop osteoarthritis in 15 to 20 years. It is standard to remove only the torn section of cartilage in the hope that this will delay the onset of long-term wear and tear osteoarthritis.

Occasionally, provided the knee is stable and the tear is a certain type of tear in a young patient (peripheral bucket handle tear), the meniscus may be suitable for repair. If repaired, one has to avoid sports for a minimum of three months.

Articular Cartilage (Surface) Injury:

If the surface cartilage is torn, this is most significant as a major shock-absorbing function is compromised. Large pieces of articular cartilage can float in the knee (sometimes with bone attached) and this causes locking of the joint and can cause further deterioration due to the loose bodies floating around the knee causing further wear and tear. Most surface cartilage wear will ultimately lead to osteoarthritis. Mechanical symptoms of pain and swelling due to cartilage peeling off can be helped with arthroscopic surgery. The surgery smoothes the edges of the surface cartilage and removes loose bodies.

Anterior Cruciate Ligament Injuries:

Rupture of the Anterior (rarely the posterior) Cruciate Ligament (ACL) is a common sporting injury. Once ruptured the ACL does not heal and usually causes knee instability and the inability to return to normal sporting activities. An ACL reconstruction is required and a new ligament is fashioned to replace the ruptured ligament. This procedure is performed using the arthroscope.

Bakers Cysts:

Bakers cysts or popliteal cysts are often found on clinical examination and ultrasound / MRI scan. The cyst is a fluid filled cavity behind the knee and in adults arises from a torn meniscus or worn articular cartilage in the knee. These cysts usually do not require removal as treating the cause (torn knee cartilage) will in most cases reduce the size of the cyst. Occasionally the cysts rupture and can cause calf pain. The cysts are not dangerous and do not require treatment if the knee is asymptomatic.