Arthroscopy

An arthroscopy is a surgical procedure in which a surgeon inspects a joint through a tiny camera. Arthroscopies can be helpful to diagnose joint conditions, or treat an already diagnosed problem. It is considered a minimally invasive surgery. Minimally invasive surgeries use only small incisions to gain access to the surgical site. It is an outpatient procedure, meaning that the patient will go home after the surgery and not have to stay in the hospital to recover.

Arthroscopies are done by orthopedic surgeons and can be performed on many parts of the body, including the:
• Shoulder
• Wrist
• Elbow
• Hip
• Knee
• Ankle
The most commonly performed arthroscopies are on the shoulder and knee.

Procedure
An arthroscopy can be performed in a hospital or surgery center. The patient isn't allowed to eat or drink anything after midnight the night before surgery. Patients typically arrive one to two hours before their scheduled surgery start time. This allows for the patient to be evaluated by the surgical team (nurse, surgeon, and anesthesiologist) before the surgery begins. The patient and anesthesiologist will decide what type of anesthesia will be best for the patient. The patient could be under general anesthesia, where the patient is completely asleep. The patient could also ask for aregional block, which means that they are awake during the surgery but cannot feel anything past the point where medication was injected. Once the patient is in the room, the anesthesiologist will begin to administer anesthetics, and the nurse begins to position the patient and clean the area being operated on. A surgical drape is placed over the affected joint, and then the surgery will begin.

Steps In an Arthroscopy
1. Surgeon makes several small incisions with a sterile knife
2. Small plastic or metal trocars are placed into the incisions
3. Sterile fluid is pumped into the area to distend the joint to create space and rinse away debris
4. A small camera is placed through one of the incisions, and the surgeon inspects the joint
5. Depending on what the surgeon sees, he/she can use surgical instruments to fix defect(s)
6. Once the defect(s) are fixed, the surgeon removes the trocar(s)
7. A small size suture is used to close the skin where the incisions were made
8. Dressing is applied to the affected joint


Why it's used
An arthroscopy might be recommended if you have problems such as persistent joint pain, swelling or stiffness, and scans have not been able to identify the cause.

An arthroscopy can also be used to treat a range of joint problems and conditions. For example, it can be used to:
• repair damaged cartilage
• remove fragments of loose bone or cartilage
• drain away any excess fluid
• treat conditions such as arthritis, frozen shoulder or carpal tunnel syndrome
An arthroscopy can be carried out to help diagnose and treat a number of joint problems and conditions.

Diagnosing joint problems
An arthroscopy can be used to help investigate:
• joint pain
• joint stiffness
• swelling of the joint
• the joint giving way or "popping" out of position

These problems are usually first investigated using X-rays,computerised tomography (CT) scans or magnetic resonance imaging (MRI) scans. If these scans don't find anything, it may be necessary to take a direct look at the inside of the joint. An arthroscopy can also be used to assess the level of joint damage resulting from an injury, such as a sports injury, or from underlying conditions that can cause joint damage, such as osteoarthritis.

Treating joint problems and conditions
Fine surgical instruments can be used along with an arthroscope to allow a surgeon to treat a range of joint problems and conditions. For example, an arthroscopy can be used to:
• repair damaged cartilage, tendons and ligaments (for example, inknee ligament surgery)
• remove inflamed tissue
• remove small sections of bone and cartilage that have broken off and are loose within the joint
• drain away an excess build-up of synovial fluid (which lubricates the joint)

Conditions that can be treated with arthroscopy include:
• arthritis – a common condition that causes pain and inflammation within a joint
• Baker's cyst – a build-up of synovial fluid inside a joint, leading to stiffness and swelling
• frozen shoulder – pain and stiffness in the shoulder that tends to get gradually worse
• carpal tunnel syndrome – a tingling sensation, numbness and sometimes pain in the hand and fingers
• arthrofibrosis – excess scar tissue caused by a previous injury that disrupts the normal workings of the joint
• bone spurs – abnormal bone growths that can cause persistent pain
• synovitis – inflammation of the joint

Knee Problems and Repairs
Knee problems can be caused by disease or by injury. Symptoms can include pain, swelling, instability, and difficulty walking. The most common knee problems are:
• a torn ligament
• a torn meniscus
• chondromalacia
• a loose body inside the knee joint

Torn Ligament:

Sudden start-stop movements and quick changes in direction are common causes of ligament injuries. Basketball and skiing are two activities where you might use start-stop movements. A torn knee ligament can cause pain, swelling or difficulty in walking. Ligament sprains can take 4-6 weeks for recovery. Ligament injuries can also be partial or complete tears. A torn ligament needing reconstructive surgery can take a year to heal. In addition, damage to the meniscus may be found and repaired during arthroscopy

Ligament Reconstruction:

Changing your activities, taking medicines and doing physical therapy all may help. If they don’t help you enough, knee arthroscopy might be needed to decide the extent of your injury. Your surgeon can repair or reconstruct the ACL with staples or stitches. The repair is made by grafting other tissue into the injured area. Damage to collateral ligaments cannot be repaired arthroscopically.

Ligaments take a long time to heal. You may have to limit the amount of weight you put on your knee for several weeks. You’ll need a cast or splint to support your knee and use crutches to get around. Strength and range-of-motion exercises will be needed to get your muscles strong enough to support your knee. It can take a year to get back to your normal activities and even then you may need to wear a brace during sports or strenuous exercise.

Torn Meniscus:

Twisting the knee joint is the most common cause of a torn meniscus. This can happen during sports or even during normal daily activity. The meniscus also becomes softer with age, making it easier to tear. Tears can occur along the edge of the meniscus or larger tears can occur deeper into the meniscus. A torn meniscus can cause catching or locking of the knee, giving way or buckling (instability) of the knee, pain or swelling. The size and location of the tear determine both treatment and recovery. Small tears need 4-6 weeks for recovery while repair of larger tears can take 3 months or more.

Meniscus Removal or Repair:

During knee arthroscopy, the damaged part of the meniscus can either be repaired or removed to prevent permanent damage to the knee joint. If the tear is near the edge, the meniscus may be trimmed to smooth the rim. In most cases, it will be repaired with stitches which can make rehab longer, but your knee will better keep its shock absorbing ability. You’ll need crutches, a brace to immobilize your knee, and limited weight bearing. A full recovery is likely for a mild injury. If the meniscus was removed, you may have more problems in the future.

Chondromalacia:
Chondromalacia can be caused by overuse or injury to the kneecap and is a condition where the articular cartilage of the knee bones softens. It is most common on the back of your kneecap where the kneecap rubs with straightening of the knee. As the cartilage softens, it wears away more easily during joint movements. The cartilage can also be damaged by directly injuring the knee. Or the cartilage may just thin with age, which can cause catching or locking of the knee, giving way or buckling of the knee (instability), pain or swelling.

In chondromalcacia, if the articular cartilage is worn or damaged, the bones will probably rub against each other. This can cause pain walking down hill or down stairs, pain after sitting for long periods, getting out of a chair or aching in the knee area.
Rest, NSAIDs and physical therapy to stretch and strengthen the hamstrings and quads should be tried before choosing to have surgery. If medicine and physical therapy don’t help, knee arthroscopy may be needed. During the surgery, your surgeon can make the damaged cartilage smooth as well as smoothing out any rough or worn surfaces on the bone.
Recovery from mild damage to the surface cartilage can take 4-6 weeks; more severe damage can take 3-4 months.

Loose Body (Joint Mouse)
Any free-floating object in the synovial fluid of the knee is known as a loose body or joint mouse. It can be a fragment of bone, cartilage, or meniscus. It can also be a piece of glass, metal or any foreign object. A loose body isn’t usually noticeable until it lodges somewhere in the joint. Your symptoms can change depending upon the exact location within your knee. A loose body can cause catching or locking of the knee, giving way or buckling of the knee (instability), pain or swelling.