Common Questions
About Arthroscopy
Arthroscopic surgery is a very commonly performed orthopedic procedure over major joints like knee, shoulder; ankle etc for diagnostic / therapeutic purpose .it is routinely a day care procedure. It is performed under regional anesthesia, with the use of fine instruments like cannula, probe, scope, camera and light source.
Although the inside of nearly all joints can be viewed with an arthroscope, six joints are most frequently examined with this instrument. These include the knee, shoulder, elbow, ankle, hip, and wrist.
Knee arthroscopy is used for:-
Diagnostic purposes -biopsy, visualization of joint in unexplained joint pain
Therapeutic Purposes– ACL, & PCL, reconstruction, Menisectomy, Meniscus tear repair, loose body removal, synovectomy etc.
The ACL is one of the two main crossed ligaments in the middle of the knee joint that connects the femur (thigh bone) with the tibia (shin bone). It controls the rotation of knee and prevents giving out of the knee with pivotal motions of the leg.
Very often Patients history of sudden giving away during sport activity and after that repeatedly during any pivoting movement is the most confirmatory sign of ACL tear.Doctor will further confirm laxity by performing few tests, Further on MRI of knee joint is must to confirm the ACL tear isolated or associated with any other ligament injury like PCL, Meniscus, Collateral ligaments.
It does not matter whether the ligament is partially or completely torn.If the knee is lax, as can be measured by clinical examination, the ACL is not functioning to protect the knee against pivotal motions. The MRI can determine if the ligament is completely torn, but cannot differentiate the degree of laxity.
LAXITY IS THE INDICATION FOR SURGERY THAN PARTIAL/ TOTAL TEAR.
After the initial injury, there is a 50% chance of damage to the meniscus.In the acute situation, the meniscus tear may be repaired. In theChronic situation, the incidence of meniscal tear is 75%, and the torn portion of the meniscus usually has to be removed.
Initially physiotherapy and muscle strengthening exercises are tried in non- sports persons and even after good trial if sensation of giving away still persists than arthroscopic ACL repair is done.
The allograft is obtained from a cadaver, so a minimal risk of disease transmission exists. In addition, the graft takes longer to incorporate and often has tunnel enlargement as a result. Long-term results have shown more failures.
You only need to have an ACL reconstruction if you are physically active in pivotal sports such as basketball, volleyball, or soccer. Only approximately 10% of patients who have injured their ACL can return to these sports without an ACL reconstruction. Some patients can use a brace, modify their activities, and resume sports without surgery. The best option for the young, pivotal athlete is to have a reconstruction to prevent episodes of giving way because of ACL laxity. With each reinjury, there is risk of further damage to the meniscus and articular cartilage.
The patient will probably suffer repeated giving way Episodes, accompanied by pain and swelling. During sports and later on routine daily activites and In the long term, this will cause meniscus tear & wearing of the inside of the knee (osteoarthritis). The patient who wants to carry on with vigorous pivoting sports should have an operation to reconstruct the knee.
Averagely four to six months, but sometimes, it may take as long as one year to fully return to a pivotal sport.
Light duty / table job can be joined at 2-3 weeks if the job involves physical activity, it will take three to four months or until your legs are strong enough.
Driving can be resumed when weight bearing is comfortable. This Usually is sooner when the left knee is involved.
Yes, a specially designed program is must in guidance of physiotherapist to reduce the pain and swelling, regain range of motion, and increase the strength of the muscles.
Therapy may have to be modified based on the individual’s progress Through the weeks of rehabilitation.
Grafts routinely used are the Semitendinosus or the Patellar Tendon Success of surgery depend on the technique of placing the graft in the correct position, the fixation of the graft and the postoperative rehabilitation. Dr Punit prefers semitendinous graft in all his patients excepts in athletes who wish to go back to sport early. . The patellar tendon graft is used for the athlete The earlier return to activities is based on the faster healing of the bone-to bone healing of the patellar tendon graft when compared to the tendon to-bone healing with the hamstring graft. The latter may take as long as three months to heal.
Synthetic materials are not routinely used to substitute for the ACL because of the higher incidence of failure. These materials are indicated in special situations, such as multiple ligament injuries or some reoperations.
The complications that may occur after ACL reconstruction are those that are related to any surgical procedure such as infection and deep venous phlebitis (i.e., blood clot in the calf).
The complications specifically related to the operation are loss of range of motion, anterior knee pain, persistent pain and swelling, and residual ligament laxity because of graft failure.
An injury to the nerves or blood vessels after this type of surgery is extremely uncommon.