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Knee Arthroscopy

The most common surgical procedure in Orthopedic Surgery is arthroscopy of the knee. The operation is performed at a hospital or outpatient surgical center and usually takes 30-45 minutes. A thin camera is inserted into the knee through 2 or 3 incisions each ¼ inch long. Sterile saline fluid is "pumped" into the knee joint for a clear view inside the knee capsule. Small hand and motorized tools are used to cut off torn flaps of meniscus, smooth rough joint surfaces, and grasp/remove loose tissue. The patient is discharged to home an hour or two later the day of surgery. Patients typically take oral pain medications for less than a week, return to desk work in 2-4 days, and are usually fully recovered in 2-4 weeks (for simple arthroscopic procedures such as menisectomy, chondroplasty, loose body removal and lateral release). I do not typically have patients use crutches after simple arthroscopic procedures.


Patient outcomes vary, but can be predicted based on age and diagnosis. Generally, patients younger than 50 with only one problem (only a torn meniscus, only a loose body, only a small area of joint surface damage) tend to have a higher rate of successful surgical outcomes. Patients over 50 with more than one disease process (most common is torn meniscus with cartilage damage – also known as arthritis) have less predictable outcomes after knee arthroscopy.

 


Arthroscopy Menisectomy:

 

Surgical procedure to remove the torn portion of a meniscus and stop mechanical symptoms such as pain with pivoting or squatting, swelling, locking or catching. Medial meniscus tears are much more common than lateral meniscus tears.

 


Arthroscopic Meniscal Repair:

 

Instead of removing a portion of the torn meniscus, meniscal sutures or anchors are used to hold the tear in place to allow natural healing of the tear. The meniscus only has blood supply (and thus the ability to heal) in the peripheral 3 millimeters.

 


Arthroscopic Chondroplasty/Microfracture:

 

Chondroplasty refers to a technique in which an arthroscopy shaver blade is used to smooth the rough edges and remove the loose articular cartilage (joint surface) around a defect in the articular cartilage. Results are highly variable.

 

Microfracture describes a technique in which the surgeon uses an ice pick-like tool to penetrate the bone surface just under the articular cartilage in a defect where articular cartilage has died and flaked off the underlying bone. The principle is based on the idea that the marrow element cells released by this "micro fracturing" will fill the joint surface defect and mature into tissue to replace the lost cells. This works best when the defect is less than 2 centimeters in diameter and the patient is less than 30 years of age. Special post op care is mandatory for a good outcome and return to sports can be many months.

 


Arthroscopic Lateral Release:

 

This is an arthroscopic treatment of patellar tracking abnormalities, specifically lateral patellofemoral compression syndrome, with or without associated patellar joint surface injury. The surgeon will use thermal or cautery to arthroscopically cut through the lateral retinaculum in order to release the tension on the tissue. In theory this will allow your patella to return to a normal position. Success is 50 %.

 


Arthroscopic Loose Body Removal:

 

Loose pieces of bone or articular cartilage or composite of both can break loose and float in the knee, causing symptoms of pain, locking and catching. Most commonly loose bodies are seen in older patients when bone spurs break off the margins of the knee joint. In younger patients loose bodies are the result of patellar (knee cap) dislocation, shear or direct blow injury, and osteochondritis dissecans. Arthroscopic loose body removal is a predictable and helpful procedure for patients. Recovery is usually quick.