The most common procedures performed under the guidance of Arthroscopic Knee Surgeon are Partial Menisectomy (removal of Torn Meniscus), Meniscal Repair, removal of loose fragments, smoothing of joint surfaces (chondroplasty), removal of inflamed joint lining (synovectomy), lateral release for an unbalanced kneecap (patella), and Cruciate Ligament Reconstruction.
Whether a Meniscus can be repaired or not depends upon the location of the Meniscus Knee Tear and how long back the knee pain injury was. The outer third (periphery) of the meniscus has good blood supply and thus tears in this region can be repaired. The inner 2/3rd of the meniscus is devoid of blood supply and thus tears in this region require a Meniscectomy Surgery. If the tear is removed, the patient can walk on the Knee immediately. If the tear is repaired, the Meniscus requires six weeks to heal. During the initial six weeks, the patient should not bear weight on the Knee, and must wear a brace. Also if the injury is more than 6 weeks old than it is better to perform a Meniscectomy rather than a Meniscus Repair.
If the Meniscus is damaged it can cause further joint destruction, so it is better to remove the torn portion. The arthroscopic procedure removes only part of the Meniscus; normal Knee functioning is expected unless pre-existing arthritis or Chondromalacia (bad cartilage) is detected.
Usually, a tear of the ACL results in sudden pain, giving way of the Knee, or a combination of both. There may be a lot of swelling due to haematoma collection in the joint.
Other ligaments in the Knee can be injured at the same time as the ACL. These may need to be treated simultaneously. The most common injury that occurs with the ACL is a Meniscus Tear.
The ACL cannot heal by itself, but not all tears of the ACL need to be fixed whether one requires surgery or not depends upon the age and one's activity level. People under 40 years of age should have their ACL reconstructed to prevent arthritis. ACL Reconstruction is never done to just relieve pain in the Knee. The goal of Arthroscopic Knee Surgery is to prevent instability of the Knee Joint. Thus patients who have a give away sensation in the Knee, when they walk, run or climb stairs are the ideal candidate for ACL Reconstruction Surgery.
Even if the Knee Joint does not become unstable (give way) it will still be loose after an ACL injury. This leads to damage in other supporting structures, such as the medial and lateral collateral ligaments and the Menisci. In someone with a recent ACL injury, the risk of associated Meniscus Damage may be 30 to 40 percent. In someone who has had an ACL injury that has been present for years and who may have buckling episodes, the risk of associated Meniscus Damage is 90 percent. ACL and Meniscus Injury may contribute to the early onset of arthritis in the Knee.
Local, spinal, epidural, or general anesthesia can be used for Arthroscopic Surgery. Except for when general anesthesia is used, the patient can stay awake and watch the procedure on the television monitor. An anesthetist is always present if there is a need for further sedation or pain control. Prior to surgery, an anesthetist will discuss with you the various options and answer your questions.
As there are various procedure conducted through Arthroscopy, there are specific instructions given to the patients after each procedure. General instructions to all patients are as follows:
|Diet||:||Resume your regular diet as soon as possible.|
|Medication||:||You will be given a prescription for pain medication and oral antibiotics.|
|Bandage||:||You will have an elastic bandage from your foot to your thigh. There will be bulky dressings under the elastic wrap. This will be removed after two to three days.|
|Bathing||:||You will be able to shower within two to three days following surgery. Do not soak your operated leg in a tub or whirlpool for at least three weeks after surgery. The incisions are not fully closed and soaking the leg would increase the risk of infection.|
|Ice||:||Use ice over the Knee. It is best to apply ice for 20 minutes at a time, usually three to four times per day. During the first two days after Arthroscopic Knee Surgery.|
|Elevation||:||Keeping your leg elevated above the level of your heart will help the swelling and discomfort to reduce. A pillow should not be placed directly under your Knee as this encourages the Knee to stay in a bent position. Instead, place the pillow under the calf and foot.|
|Crutches||:||Crutches are required for walking at first. Most patients use crutches for the first 2-3 days.|
|Follow-Up Office Visit||:||You will be instructed to follow-up at our clinic two weeks after your surgery. At this time, your stitches are removed, and your surgery is reviewed.|
|Exercise||:||You may be taught some exercises to do initially after surgery. After 2 weeks you will be given a prescription for formal Knee Rehabilitation by a physiotherapist.|
|Return to work||:||Most people are able to return to their jobs or school within 10-15 days. The exception to this is for people who have strenuous jobs that require them to be on their feet a lot, lifting objects, climbing or driving. It is very important to minimize activity (stay home and elevate your leg) for four days after surgery. This will speed the ultimate recovery by preventing excessive post-operative inflammation.|