Knee Arthoscopy
Introduction
Arthroscopy is a minimally invasive technique used by orthopaedic surgeons to examine and treat the interior of a joint. Two greek words make up arthroscopy including 'arthro' (meaning joint) and 'skopein' (meaning to look).The orthopaedic surgeon makes a small incision in the skin to begin the arthroscopic examination. Small instruments that contain a lighting system and a small lens allow the doctor to clearly see the joint. Fiber optics provide the light at the end of the arthroscope. This view is transmitted to a monitor where the doctor can make a more accurate diagnosis without the need for a large incision to see everything. Other small incisions are made as necessary to perform the operation with additional small instruments.
Arthroscopy can diagnose and treat many knee problems including: ligament tears, meniscus tears, articular cartilage damage or defects, loose bone or cartilage, inflammatory conditions, and alignment or instability problems of the kneecap. Specific surgical procedures commonly performed arthroscopically include: ACL reconstruction, PCL reconstruction, meniscus tear repair or partial removal, microfracture and other cartilage restoration procedures, and removal of loose bone or cartilage. Recovery and return to activities is based on the specific procedure you have performed.
Arthroscopic procedures are typically performed on an outpatient basis, meaning you go home the day of surgery. Advantages of arthroscopy include smaller incisions with less surgical dissection than traditional open procedures, which should result in less pain and a faster recovery from surgery. Please see our patient information section for further details on post operative instructions and rehabilitation after arthroscopic surgery.
The need for arthroscopic surgery is based on your medical history, clinical examination, diagnostic tests, and response to other treatments. Diagnostic testing may include x-rays and magnetic resonance imaging (MRI). Other treatments may include medications, injections, physical therapy, activity modifications, and home exercise. This information should be discussed with your orthopedic surgeon to determine if you are a good candidate for an arthroscopic procedure. For discussion of a particular injury or the possible need for surgery, please contact us to schedule an appointment with Dr. Michael Burris, a local Austin orthopedic surgeon.
Meniscus Tears
The meniscus is a cartilage structure inside the knee joint which serves as a shock absorber. Each knee has a medial and a lateral meniscus, either of which can be torn. Meniscal injuries in athletes typically occur by a twisting or pivoting type of mechanism, and often occur in conjunction with ACL injuries. Degenerative type meniscal tears are also very common, occurring in arthritic knees. The treatment protocols for these very different types of injuries to the same structure are different. Treatment for meniscal tears can range from non-operative, to partial removal of the meniscus (menisectomy), to meniscal repair.
The decision to proceed with repair vs. partial removal is made at the time of arthroscopy and is based on a combination of factors. These include the type of tear (simple vs. complex), the location of the tear, the size of the tear, patient age, and the chronicity of the tear. The location of the tear predicts the blood supply to the torn meniscus which is a large determinate of healing potential. Partial removal is often necessary and does result in a much quicker recovery and return to sports. The removed meniscus however will not grow back and meniscus removal is associated with future arthritic changes to the knee. The more meniscus is removed, the greater chance for significant arthritic changes.
Every attempt is made to repair the meniscus in younger patients with significant tears and certainly in adolescent patients. In my opinion, the benefits of retaining the meniscus clearly outweigh the risk of returning to surgery for a non-healing repair in this age group. These patients typically have more healing potential, will place more demand on the knee, and have a greater time period for arthritic symptoms to develop. Meniscus repair requires more significant post-operative restrictions, such as limited weight bearing with crutches and typically 3-4 months before returning to sports. Please see Post-Operative Instructions: Meniscal Repair and Rehab Guidelines: Meniscal Repair for more detail.
Degenerative, complex, and chronic tears have far less potential for healing and are almost always treated with partial removal of the meniscus. Partial menisectomy involves removing any torn or unstable pieces of meniscus while preserving as much remaining normal and/or stable meniscus as possible. The risk of returning to surgery in this situation now outweighs the benefits of attempted meniscus repair. Recovery typically takes around one month following this procedure but does vary from patient to patient. The condition of the adjacent articular cartilage or cartilage covering the bone including arthritic changes is predictive of the overall success with this procedure. Those with more significant arthritic changes will typically have more residual symptoms.
Non-operative treatment also plays a significant role in the treatment of degenerative type meniscal tears. This may include exercise, physical therapy, medications, cortisone injections, weight loss, and observation. Many asymptomatic tears of this nature are identified with MRI’s and do not necessarily require surgical treatment. Symptomatic treatment without surgery can often result in resolution of pain.
Resources on Knee Arthroscopy
More information is available through the website of The American Academy of Orthopaedic Surgeons.
A 3D animation library provided by the The American Orthopaedic Society for Sports Medicine and Understand.com is available at 3D Animation Videos. After clicking on the link, move the mouse over Knee Arthroscopy to view the available animations.
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