What is Arthroscopy?

The new era of Arthroscopy provides you with the latest in the surgical field with keyhole surgeries being used to tackle many sports injuries. Arthroscopy can be used to do Ligament Reconstructions (ACL, PCL) in the Knee, Synovial Biopsies, Synovectomy for arthritis, Debridements and Meniscal Repair or Menisectomy for meniscal problems. It can be utilized to do Shoulder Arthroscopy surgeries for Recurrent Shoulder Dislocations and Rotator cuff injuries.

Why Arthroscopy?

Arthroscopy provides many advantages like the following Scar less or a Minimum Scar

Lesser Operative time
Less Blood Loss
Early Mobilization
Quick Healing
Scar less or a Minimum Scar

Types of Arthroscopic Surgeries:

Knee scopy
shoulder scopy
Hip scopy Other scopy

Knee Arthoscopy

Knee scopy is the commonly performed surgery amongst all types of arthroscopies

Commonly performed Knee Arthroscopy surgeries:

ACL SURGERIES
PCL SURGERIES
MENISCAL SURGERIES
SYNOVIAL DEBRIDEMENT
OTHER PROCEDURES

ACL SURGERIES

Anatomy of ACL
How does ACL tear occur ?
Symptoms
How to diagnose ?
How to correct it ?
How will your post operative period be ?

Anatomy of ACL:

ACL is the strong ligament inside your knee joint connecting the thigh bone and the leg bone. It acts like a stabilizing structure inside the joint when walking , running , climbing , etc.

ACL also has proprioceptive functions. i.e., senses the position of the leg

How does ACL tear occur:

ACL getstorn mostly in rotational injuries of contact sports and in road traffic accidents.

What are the types of ACL injury :

There are two types of ACL injury

ACL TEAR : ACL can either be torn in the mid part or in the thigh bone attachment and it can be a partial or complete tear.
ACL AVULSION : When the ACL gets detached along with a chunk of bone from its lower side attachment on the tibia bone it is called Avulsion injury .

Symptoms :

You may feel the sensation of giving away in your knee and sometimes a popping sound
Running and sports activities might be painful
Later stages pain while walking occurs

How to diagnose ?

A good clinical examination and a careful history will fetch the diagnosis in most cases . MRI usually gives the complete answer

How to diagnose ?

ACL tear is mostly treated by Arthroscopic Surgical Reconstruction

It is the surgical method by which the torn ACL is replaced by a new ligament harvested from near the knee joint (called the Graft ) and is introduced into the tunnels made in the leg bone and the thigh bone and fixed on either side by means of Implants .

What are the types of GRAFT ?

There are 2 types of GRAFT

HAMSTRING GRAFT

BONE PATELLA TENDON BONE GRAFT (BPT)

1. Meniscus

The meniscus is the soft cushion-like structure inside your knee joint which acts as a shock absorber between the leg bone and the thigh bone. There are two menisci , one on the outer aspect and one on the inner aspect of the knee.

How does meniscus get injured:

Meniscal injuries are common after a rotating injury to the knee joint . It can occur after sports injuries or even after trivial trauma in elderly persons when it is already degenerated

What are the symptoms of meniscal tear ?

you might experience a sharp pain in the knee when walking

you can have difficulty in walking and climbing stairs and sitting cross leg and squatting becomes difficult.

How do we diagnose it?

Meniscal tears are best diagnosed by a good clinical examination and the same can be confirmed with the good quality MRI.

Treatment options :

Meniscal injuries need to be categorised and treated according to the place of the tear , age and requirement of the patient. Some might require conservative management and some might require Surgical Management in the form of arthroscopic meniscal surgeries.

Arthroscopic meniscectomy

It is a procedure by which the torn meniscal free fragments and the degenerated dead tissue is removed and the remaining ligament is balanced according to the knee joint anatomy.

Meniscal repairs

In the recent era certain meniscal tears which are amenable to repair are repaired using arthroscopic technique. Good results have been found with adequate meniscal repair which will help in retaining the cushioning effect inside your knee joint.

OTHER PROCEDURES :

1.Arthroscopic debridement for Arthritis :

this procedure is commonly done in osteoarthritis knee where the dead tissue and degenerated part is shaved and removed from the knee joint and washed and debridement is done.

ideal candidates :

In this procedure pain relief is expected to be good in patients with osteoarthritis in the early stages.

the idea behind this procedure is we are removing the dead tissue which gives rise to inflammatory markers which in turn causes pain inside the joint.

2. Arthroscopic synovectomy :

What is synovium ?

Synovium is a soft tissue structure which surrounds the knee joint and secretes a fluid called Synovial fluid which provides lubricant action inside the joint.

how does it harm our joint ?

There are certain inflammatory conditions in which the synovium proliferates inside our joint. for example rheumatoid arthritis, tuberculoussynovitis , non specific arthritis etc

advantages

in the era before arthroscopy was invented synovectomy was done by open technique in which the whole knee joint was opened and recovery will take a minimum of 12 weeks. after the advent of scopy partial or near total synovectomy has become a very useful procedure by which the surgoen is able to clean your knee joint through small holes and the postoperative pain and recovery are excellent.

it also provides us a chance to do a Synovial biopsy in which the part of the synovium which is removed is sent for histopathologic examination.

3. Loose body removal

Loose body is a freely moving structure inside the joint which could have arisen from osteophytes. they could have broken during the degenerative process.

symptoms :

Sensation of locking inside the joint
Severe pain

treatment :

The loose bodies can be removed by arthroscopic technique and also it allows visualisation of the cartilage for any damage that has been created by the Loose body .

4. Meniscal cyst decompression

meniscal cyst can arise inside our joint due to chronic inflammation or it can be a post traumatic event procedure.

arthroscopy can be used to decompress the ganglion cyst in the meniscus and also to visualise the integrity of the meniscus and the cartilage while doing the procedure.

5. Arthroscopic ACL decompression

this technique is used to to the decompress the ACL which had become bulky and lax due to mucoid degeneration or due to a ganglion cyst inside ACL.

The procedure involves debulking the ACL and removal of the ganglion cyst and the degenerated part. If the integrity of the remaining fibres is more than 50% the native element can take up the activity of the previous.

If the integrity of the remaining fibres is less than 25% it is better to go for augmentation using hamstring graft and doing a ACL reconstruction surgery.

6. ARTHROLYSIS :

It is done for releasing the adhesions inside the joint mostly post traumatic cases

It’s a simple and reliable method for gaining of movements compared to manipulation .

7. PATELLO FEMORAL DISORDERS

MPFL tears can be diagnosed by scopy and are an useful tool intra operatively while doing ligament reconstruction.

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