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Arthroscopy

Arthroscopic surgery has become the most common procedure performed by the orthopedic and sports medicine surgeon. It has now become the standard or care for treatment of torn cartilage and loose bodies within the knee, ankle, and elbow. Recent advances have also allowed for major ligament reconstruction to be performed through limited excisions utilizing an arthroscopic-assisted procedure.

Prior to the advent of knee arthroscopy, even the removal of simple cartilage tear required extensive surgery with several days of hospitalization. Rehabilitation was measured in months, with athletes often losing a full year before they returned to their regular activities. With the development of microsurgical and arthroscopic techniques, this surgery is commonly performed on an outpatient basis. With advances in anesthesia, the procedure can even be performed under a local or regional block with the patient awake watching the surgery on a video monitor.

Arthroscopic instruments have been developed which allow for minimal resection of torn cartilage. The capability is also available for repair of certain tears which are amenable to healing. Bio-absorbable sutures or fixation staples can be placed inside the knee re-approximating torn cartilage, and thus facilitating healing. Similar procedures are used to repair torn ligaments.

The arthroscopic is a small television camera attached to a narrow tube which contains a fiberoptic light source and focusing lenses. The entire apparatus fits within a sheath which is four to five millimeters in diameter. A water pump is usually used to distend the knee to facilitate visualization of the internal structures. Usually, only two or three puncture wounds are necessary in the knee to allow for placement of the arthroscope, a drainage needle for the fluid irrigation, and an additional work portal for insertion of probes or special instruments.

The inside of the knee is displayed on a large video screen, placed adjacent to the operating table. The surgeon concentrates on the video image and does not look at the patient's knee while he manipulates the camera and instruments.

The procedure is much less invasive than an arthrotomy, where the knee is opened to perform the surgical procedure. The arthroscope actually allows for better visualization. It can be placed into the recesses of the joints with much greater ease than through an open surgical incision.

Rehabilitation time is significantly shortened as there is minimal disruption of normal structures. Often physical therapy can be implemented on the first post-operative day. Return of function is accelerated since post-operative swelling and pain are usually substantially less than with older surgical methods. It is not uncommon for an athlete to undergo surgery for a torn cartilage and return two or three weeks later and resume athletic activities.