What is knee arthroscopy and when is it useful?
Knee arthroscopy is an operative procedure which involves insertion of a camera and other instruments into the knee through small holes known as portals. This is minimally invasive surgery and has been available now in Australia for over thirty-five years. In the past, surgery on the knee involved large open incisions, and only more extensive procedures were undertaken such as removal of the whole meniscus. Nowadays more useful and diagnostic procedures can be undertaken in the knee through minimally invasive techniques.
How is a knee arthroscopy performed?
The operation is performed under an anaesthetic, usually a general anaesthetic or possibly a spinal (where the legs alone are numbed out) and this leads to a procedure taking thirty to sixty minutes. During the procedure, surgery is performed in the medial and lateral compartments of the knee (inside and outside of the knee) as well as the area behind the kneecap (patellofemoral region). Photographs are taken throughout the knee and are available for the patient at a later date to review. During the procedure the joint surfaces of the patella (knee cap) and the surface it glides on (trochlea), as well as the area above this region (suprapatellar pouch), can be inspected for loose bodies or flaps of tissue which could be catching in the joint. The medial and lateral compartments are inspected, assessing the cruciate ligaments and the joint surface for evidence of arthritis, torn menisci (cartilages, which can be either debrided or repaired) and other injuries. For cruciate injuries, a reconstructive procedure can be undertaken either at the same time or at a later date.
What procedures can be undertaken with arthroscopy?
The standard procedures are debridement of torn menisci (cartilage) where the edges that are irregular are tidied up (debrided) to lead to stability and prevent them from catching in the joint. Other procedures that can be undertaken are removal of loose bodies, debridement of loose chondral (joint surface) tissue and inspection of the joints. Cruciate Reconstructions (ACL) can also be performed arthroscopically. There are other procedures that people present for and are undertaken in certain situations like inflamed fat pads which can be debrided, but the results of surgery are not as good and therefore surgery in these latter scenarios are a last resort.
What are the success rates of knee arthroscopy?
Surgery results can be very good, with an 85-90% success rate, however they are not guaranteed and in some situations such as the debridement of chondral tissue or fat pads, the results may be only short lived. At Glenelg Orthopaedics, we like to provide quality Orthopaedic Care, and as such the benefits and risks of each scenario are discussed and operative procedures only are undertaken for patients who have undergone appropriate rehabilitation or when surgery is definitely the best measure. We are aware that there is a common perception that arthroscopy can be used for many procedures with the idea that these can be repeated on a regular basis. At Glenelg Orthopaedics we believe that such temporary benefit is not a measure of success, and we avoid procedures that only may have short-lived and variable results unless no other option exists.
What are the risks of knee arthroscopy?
The risks, as with any surgical procedure, are those of an anaesthetic, whether a general or spinal anaesthetic. The complications include chest infections, deep vein thrombosis, and pulmonary emboli. The individual risks of the procedure itself which can best be discussed with the anaesthetist.
There is also a risk of infection and as such we tend to use antibiotics at the time of the surgical procedure to reduce that risk. We also encourage mobilisation after surgery. The most important risk is that of not being improved by the surgical procedure or feeling as if the procedure has hastened the demise of the knee.
In general, arthroscopic surgery has revolutionised knee surgery and has become a diagnostic procedure, allowing the treatment of individual conditions with highly successful results. But arthroscopy should not be undertaken lightly and consequently at Glenelg Orthopaedics we prefer to individualise each patient and offer an arthroscopy when best indicated but as with any surgery it is always a last resort.
Whilst there has been a recent push to offer surgery quickly, in many situations a patient will settle after an injury and not require such a procedure. Whilst we are available to undertake surgery more quickly if we feel it necessary, for most patients we try non-operative measures for a period of time to see if the patient will settle on their own and avoid the surgical risks.
At Glenelg Orthopaedics you can take comfort in knowing that we like to treat patients as we would our own family. For more information about knee arthroscopy contact our friendly staff.
Post Op Physiotherapy for Knee Arthroscopy
Following a knee arthroscopy- the physiotherapy that is required is:-
1) quadriceps and hamstring co-contraction exercises ( Straight leg, working on Quads and Hamstrings with knee straight, foot extended and leg externally rotated at hip)
2) VMO tracking exercises
4)Working on regaining a normal Gait pattern
This is important as the quadriceps can weaken/ waste quickly, which can leading to patella mal-tracking and secondary patello-femoral issues. We believe that is essential that all patients that undergo a knee arthroscopy should commence this as soon as possible.