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KNEE ARTHROSCOPY


Quite a number of knee problems could now be dealt through a key-hole surgery (knee arthroscopy). Most of the operations are done as a day-case procedures although the rehabilitation period will depend on the procedure done during the arthroscopy. Majority are relatively straightforward procedures, but rarely complications may occur including infection, thromboembolism, bleeding, wound healing problems, damage to the nerves or blood vessels, abnormal pain response and stiffness.

Meniscal tear:

One of the commonest reasons for doing a knee arthroscopy is to deal with a meniscal tear. This often follows a twisting type injury and presents with pain, swelling and mechanical symptoms including locking of the knee intermittently. The pain is usually in the inner or outer aspect of the knee. Depending on the nature and type of the meniscal tear, the surgeon removes the torn part of the meniscus or in special circumstances would attempt to repair it.

Undersurface of the knee cap

Medial meniscal tear

Normal lateral meniscus

Anterior Cruciate Ligament

Grade 1 cartilage damage

Grade 2 cartilage damage

Grade 3 cartilage damage

Anterior knee pain:

This is quite a common knee problems affecting all ages. The pain is usually in the front of the knee and is worse with activities including climbing stairs, walking uphill, getting up from a sitting position etc., The main line of treatment is physiotherapy to build up the quadriceps muscle. Arthroscopy is very rarely indicated. The problem may be due to mal-alignment of the knee cap and in selected patients further realignment surgery could be considered.

Loose bodies:

In some patients loose bodies in the knee (separate bone fragments) can be present and can cause mechanical symptoms including recurrent locking. This could be dealt through a keyhole surgery although very rarely the loose body may not be accessible during surgery.

Chondroplasty:

In patients with arthritis, the articular cartilage (surface lining) becomes worn out and becomes rough. In the past, arthroscopy was often done as a first stage procedure before considering a knee replacement. However, recent studies have shown that the pain relief is not uniform and often only temporary. Hence the indication for arthroscopy in the presence of arthritis is limited. It could be considered when there are mechanical symptoms of locking or catching sensation without significant arthritis (when the surgeon will be able to shave the roughened surface with a shaver (chondroplasty) and also in some cases when it is used to assess the extent of the surface damage.

Microfracture:

The knee joint is lined with articular cartilage which is a specialized lining allowing smooth movement and lubrication of the knee. If it gets damaged, the healing potential is very limited. In some patients with localized area of cartilage damage, the surgeon may decided to make fine holes in the damaged areas to allow blood flow which would help to heal partially with a fibrocartilage (micro fracture technique).

Anterior Cruciate ligament (ACL) reconstruction:

This ligament is important for the stability of the knee. This gets torn with usually a twisting type of injury and the knee typically swells immediately and takes a prolonged period to improve. The patient often feels a sense of giving away or insecurity of the knee particularly during pivoting. Usually the initial management is to strengthen the hamstring muscle. However if the symptoms do not settle or if there are other significant injuries like a meniscal tear the ligament could be reconstructed arthroscopically. Mr. Ganapathi does not perform ACL reconstruction. However, if you need such a surgery, he will refer you to one of his colleagues with special interest in ACL reconstruction.

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