Arthroscopic Knee Surgery

Pain in the knee, swelling, feeling of instability, limited range of motion – all these are signs which indicate that you should pay a visit to an orthopaedic doctor.

If the problem cannot be resolved using conservative methods (physical therapy), knee joint arthroscopy will be performed.

Arthroscopy is an orthopaedic technique i.e. minimally invasive type of surgery which can be used to perform numerous procedures on joints and extra-articular areas.

Operation is carried out through small incisions through which an orthopaedic surgeon inserts the arthroscope and necessary instruments. The orthopaedic surgeon enters the joint through a small incision, 1 cm at most, with the help of an arthroscope, and is able to see inside the knee. Arthroscope is a special instrument which consists of a source of light and a lens while the camera attached to the arthroscope enables the whole image i.e. procedure to be followed on the monitor. The surgeon inserts specially designed orthopaedic instruments needed to perform the surgery through the remaining small incisions. As opposed to classic surgery and large incisions i.e. opening the operating field, damage and trauma to the surrounding tissue in arthroscopic surgery is minimal; therefore, the recovery is faster and better.

Modern arthroscopy was first performed in late 1960s. As technology advanced, this procedure became very efficient both for precise diagnostics and adequate treatment. Today, arthroscopy is one of the most common orthopaedic procedures. There are some 4 million knee arthroscopies performed annually worldwide.

Whether you have just started doing research into possible treatment options for your knee problems or you have already made a decision with your orthopaedic surgeon that you will undergo arthroscopy, this brochure offers you useful information and helps you better understand and get familiar with the procedure.

Knee structure

The knee is the largest and the most complex joint in the human body which also is very prone to injuries.

The knee joint consists of the lower part of thigh bone (femur), the upper part of shinbone (tibia) and the kneecap (patella). The harmony between the thigh and shinbone joint surfaces is achieved thanks to two fibrocartilaginous, crescent-shaped structures, menisci (medial and lateral). Menisci and joint cartilage maintain the tension of ligaments and absorb the forces which the bone is exposed to. They also contribute to the stability of the joint. Joint capsule encloses the knee joint. Synovial bursae, which protect the tissue from other solid surfaces, reduce friction and facilitate movement, are located between the articular capsule and the surrounding ligaments. Cruciate (anterior and posterior) and collateral (medial and lateral) ligaments connect the tibia and femur and are important for the stabilization of the knee. Firm thigh muscles give the knee its strength and mobility.

Injuries to the knee joint occur at work, in traffic, and especially while engaged in sport activities. Overuse syndromes or chronic damage of muscle tendons, bursae, and cartilage are frequent in the knee joint. The result is pain and limited knee joint function.

Therefore, arthroscopy is applied both in diagnostics and for treating the following problems:

  • Meniscus tears
  • Loose cartilage or cartilage-bone fragments
  • Damage to joint cartilage
  • Inflammation of the synovial membrane
  • Instability of patella
  • Anterior and posterior knee ligament tears

Orthopaedic examination of the knee includes:

Medical history (general information about the patient, medical history)

Physical examination – orthopaedic surgeon uses clinical tests to examine the range of motion in the knee, muscle strength, ligament integrity, meniscus injuries, cartilage damage and makes a diagnosis.

In order to confirm the problem, the orthopaedic surgeon can request you do additional examinations:

  • X-ray
  • Magnetic resonance imaging
  • Ultrasound examination
  • Laboratory testing

After examining the knee, the orthopaedic surgeon will make a diagnosis and inform you about further treatment. If physical therapy and medication do not suffice for treating the problem, you will need to undergo a surgical procedure i.e. arthroscopy. In addition, the physician will warn you about certain risks and complications which can occur during surgery or after.

If you have decided to undergo arthroscopy, you have to do an ECG and a full blood exam before operation.

After completion of preoperative testing, the patient goes to the Special Hospital for neurosurgery and orthopedics Aksis, Petrovaradin 1, for a scheduled appointment. There, an anesthesiologist will immediately examine you and check your test results. In our clinic, all arthroscopic knee surgeries apart from knee ligament reconstruction are performed in LOCAL anaesthesia – anaesthesia which is applied to the knee area only. The operation is painless, local anaesthesia practically does not have any side-effects, and after the procedure, you can almost instantly leave the clinic and go home „on your own feet“ without using any walking aid. At patient’s request, the procedure can be followed on a TV screen and primarius Miškulin will explain in detail everything that he is able to see in the knee joint as well as each step of the operation.

The duration of the procedure is approximately 45 minutes.

It is very important that you carefully observe the instructions given by your orthopaedic surgeon in order for the recovery to be as successful as possible.

The patient has to observe the following:

  • As soon as you start feeling pain i.e. when local anaesthesia subsides, it is necessary to start using painkillers – these include painkillers that you normally take. Our advice is DicloDuo pills, two to three times a day take one pill on a full stomach. Caution is necessary in case of allergies to the mentioned drug or if you suffer from chronic gastritis, or stomach or duodenal ulcer;
  • While resting, the leg should be held up, with a pillow underneath the heel, but never underneath the knee because there would be a chance of developing contracture;
  • An ice bag should be placed several times a day (every 2 to 3 hours) in the knee area; the knee should be cooled down well and exercised as instructed;
  • If the elastic band is too tight, easily release the pressure and change the bandage;
  • After surgery, blood spots can appear on the bandages – this is not a reason for worry; you should pay a visit to your general practitioner the next day and they will change the bandage.

Complications:

We can say that, today, the risks of knee arthroscopic surgery are minimal. The most common complication, as is the case with other operations, is knee infection with less than 0.1% incidence.

Warning signs which should alert patients to contact their doctor:

  • Fever
  • Shivering
  • Very red and hot knee
  • Very severe pain which worsens and does not subside after taking medication
  • A very large swelling
  • Increasing pain in the calf
  • Chest pain or lack of air

It is very important to start with physical therapy after surgery in order for patients to return to their everyday or sports activities as soon as possible. Physical therapy helps:

  • Reduce pain and swelling
  • Restore the joint’s range of motion
  • Restore muscle strength
  • Develop proprioception and joint stability

Complete return to everyday activities is expected in some ten days and to sports in several weeks.