Knee Arthroscopy.

Introduction.

Arthroscopy has become one of the most frequently used procedures for diagnosis and treatment of knee injuries. It is a surgical procedure that is done as an day surgery. Dr Allen inserts the arthroscope (small telescope) into your knee through several small incisions. This allows Dr Allen to see the entire knee joint and permits the repair of some injuries.

Orthopaedic Examination.

An Orthopaedic examination of your knee joint is essential to determine the severity and type of injury you have sustained. An assessment  includes how the injury occurred, symptoms you are now experiencing, an examination of the knee and various diagnostic tests. Diagnostic tests may include:

• X-rays - provides views of the bones to determine if a fracture has occurred or to look for arthritis.
• Magnetic Resonance Imaging (MRI) - provides a detailed view of ligaments, bones, cartilage and surrounding tissue. This may be requested if the diagnosis is unclear from the clinical examination.

Anatomy.

Click on the picture above to enlarge it:

Ligaments.

There are four major ligaments which support the knee:

• Anterior cruciate ligament (ACL)
• Posterior cruciate ligament (PCL)
• Medial collateral ligament (MCL)
• Lateral collateral ligament (LCL)

Two ligaments in your knee are more prone to injury, the anterior cruciate and medial collateral ligaments.

 

A view of the anterior cruciate ligament through the arthroscope (click on picture to enlarge)

The anterior cruciate ligament (ACL) is a rope-like ligament which controls the knee's movements and stability. The ACL crosses from the back of the femur (thigh bone) to the front of the tibia (shin bone). The ACL may be injured when twisting movements (such as football or skiing) force the knee beyond its normal range of motion. You may hear or feel a "pop", experience pain, swelling or too much "play" in your knee causing your knee to buckle. Partial tears occur, but are less common.  Medial collateral ligament (MCL) injuries are common with ACL injuries.

Ligament reconstruction involves replacing the torn ligament with a tendon (graft) from your knee cap tendon or hamstring tendons.  This procedure is performed with the aid of the arthroscope. The anterior cruciate ligament (ACL) is the most common ligament requiring reconstruction procedures.

Meniscus Cartilage.

A view of the meniscal cartilage as seen through the arthroscope (click on the picture to enlarge)

There are two menisci (cushion cartilages) in the knee. One on each side.

The meniscus is a “C-shaped” cushion pad in the knee between the thigh bone (femur) and the lower leg bone (tibia). It acts as a shock absorber and makes the motion of the knee smooth. It may be torn by twisting or bending in sports or daily activities.

A view of a torn meniscal cartilage as seen through the arthroscope (click on the picture to enlarge)

A meniscal tear results in knee swelling, locking, clicking and giving way. It may cause pain with bending, squatting, twisting, stair climbing or getting up from a seated position. 

The arthroscope allows Dr Allen to view the location and anatomy of the tear. If the tear is in the outer third of the meniscus and is smooth and straight, then there is usually an adequate blood supply to allow repair of the tear with small stitches. This is uncommon.

If  the meniscal tear is in the inner two-thirds or is shredded, then minimal blood supply is present. These tears require removal. The removed portion of the meniscus does not grow back, but if the damaged portion is left in the knee joint, it can cause further joint destruction. In the past, the entire meniscus was removed for tears. Modern techniques through the arthroscope allow us to minimize the amount of meniscal tissue removed.

Joint Cartilage.

Arthroscopy also allows Dr Allen to visualise the cartilage lining the ends of the leg bone (tibia) and the thigh bone (femur). This allows Dr Allen to evaluate the site and extent of any wear (arthritis) of this important lining cartilage.

Risks of Surgery.

Results of surgery will vary from person to person depending on the reason for the arthroscopy, the problem with the knee, its general condition (degree of pre-existing damage or arthritis) and the actual surgery performed.

Arthroscopy is a very common procedure performed on thousands of patients each year with very few complications. The following are a list of some of the most often quoted complications. This does not aim to be a comprehensive list of all possible complications.

Risks for any anaesthesia.

Reactions to Medications. Reactions to drugs used for anaesthesia may occasionally occur. Please inform the anaesthetist of and medications you have had a prior reaction to or any allergies you have. Also tell the anaesthetist what medication you are currently or have recently been taking.

Heart or Lung problems. Heart or lung problems may occur rarely with anaesthesia. Please inform the anaesthetist of any heart or lung conditions you have as anaesthesia my affect a pre-existing condition.

Risks of Surgery.

Bleeding: Everyone will have some bleeding from the incisions around the knee. This usually settles in the first few days. Firm pressure over the site is usually all that is needed.

Fluid Discharge: About one in twenty people may have some discharge of fluid from the incision during the first couple of weeks. This usually settles without intervention.

Infection: As with any other operation infection may occur. This happens in less than 1% of patients. Signs of infection are fever (high temperature), increasing pain, increasing swelling and heat in the knee. 

Blood clots (DVT). Any surgery to the knee carries the risk of Deep Vein Thrombosis (blood clots) in the legs. The risk of DVT is increased in patients who have had a previous DVT, those with a strong family history of DVT and women taking female hormones. Please ensure that you inform the anaesthetist and the surgeon if this applies to you. In some cases anticoagulation (blood thinning medication) may be used. Anticoagulation is not used routinely (as it carries its own risks).

Preparing for Surgery

Changes in your general health will affect your surgery. If at anytime prior to your surgery any of the following conditions develop, please notify us.

• Symptoms of cold , fever and/or chills
• Irritation of eyes, ears, throat, or gums, and any dental problems
• Boils, or skin abrasions or cuts - especially on the leg to be operated on.
• Stomach or intestinal illness such as, diarrhoea, nausea, and vomiting or blood in stool.
• If there is any possibility that you may be pregnant

Before Surgery

It is very important that you observe the following instructions:

• If you have crutches, a knee immobiliser, or a brace, please bring them to the hospital the day of surgery. You may need these after surgery.
• Arrange to have an adult (someone over 18) available to drive you home after discharge, and have someone stay with you at least 24 hours once you are home. You will not be allowed to leave the hospital alone.
• If you are having surgery at the  John Flynn Hospital please ring my office the day before surgery to obtain your check-in time for the day of surgery. You will also be told when to fast from.
• If you are having your surgery at the Public Hospital the preadmission staff will contact you to let you know when to arrive at the hospital and when to fast from.
• Do not eat or drink anything after the time you have been instructed to starve from. Your surgery may be cancelled if you eat or drink after this time.

After Surgery

When surgery is completed, you will be taken to the recovery room. The usual length of stay in the recovery room is less than 1 hour, but may be longer according to the surgical procedure and the type of anaesthesia.

While you are in the recovery room, the nurses will be checking your blood pressure, pulse, respirations, and temperature frequently. They will also be checking the sensation and circulation in your operated leg.

You may have a large bandage on your knee.

 Discharge is based upon your recovery from the effects of anaesthesia, and when  your pain is under control.

You will be given a sheet of post-operative instruction to go home with after your surgery. A copy of the instructions is included below.

Please remember to bring all your x-rays and any arthroscopic pictures of your knee with you to your post-operative appointment.

 
Home | About Your Condition

The information on these pages is presented as a rough guide to help you understand your condition better. The information is in no way intended to be a comprehensive coverage of the subject. As all patients and their conditions are different, the treatment may vary from time to time. All patients are encouraged to take steps to ensure that they are as well educated about their conditions as possible. Other sources of information inc

Philip Allen Orthopaedic
P PO Box 1089, Coolangatta, QLD, 4225, Australia
T +61 7 55980977  F +61 7 55980016 E allen@bonedoctor.com.au
www.bonedoctor.com.au