Arthroscopy of the knee joint is one of the methods of treatment and diagnosis, often used in all world clinics. Using this method, it is possible to provide assistance to patients with joint problems with high quality and with minimal trauma. An optical system is inserted into the joint cavity, thanks to which damaged and inflamed structural cartilages, synovial membranes and ligaments can be seen.
A bit of history
Not everyone knows what knee arthroscopy is. This invasive surgical intervention has been known to the medical community since the beginning of the 19th century. The founder was a doctor from Denmark, Severin Nordentoft. Despite the many conflicting opinions, some surgeons have decided to try this method in their practice. A breakthrough in surgery can be considered the moment when a doctor from Japan, M. Watanabe, together with his colleagues assembled the first arthroscope.
Usage areas
Arthroscopy of the knee joint is a technique that allows you tooperations to carry out a series of diagnostic and surgical activities.
- Diagnostic arthroscopy is a gentle method of research that allows you to visually examine the internal components of the joint. It makes it possible to monitor the condition of the knee and perform tissue biopsy.
- Arthroscopic arthrolysis is a surgical operation aimed at the treatment of arthrofibrosis by excision of fibrous adhesions in the articular cavity.
- Arthroscopic sanitation is an event when the internal joint is cleared of blood or purulent accumulations and serous effusion. According to reviews of knee arthroscopy, antiseptic drugs are injected into the cavity to prevent a new infection, which turns out to be a very effective method of prevention.
- Arthroscopic medullary shunting - the technique consists in inserting a shunt into the bone tissue of the joint. This is a hollow thin tube (only 8 mm in diameter) made of titanium alloy. The shunt has holes through which bone fat, which is an excellent lubricant for the ligaments, enters the joint. Using this method, you can recover from severe pathologies of the musculoskeletal system. This problem occurs when cartilage lubrication deteriorates in the affected joints, inflammatory reactions intensify and develop, and cartilage tissue defects form, which makes it difficult to move.
Indications
A patient's doctor may prescribe a knee arthroscopy operation in the following cases:.
- Biopsy requiredtissues of the damaged joint, which should help the doctor identify the cause of the infection in the knee joint.
- Determination of types of articular pathological processes. These may include inflammatory and traumatic diseases, rheumatological and autoimmune processes, and degenerative-dystrophic changes.
- Removal of the consequences of arthroscopic debridement of the knee, namely, the elimination of serous blood effusions and purulent accumulations in the joint cavity. Then antiseptic substances are introduced.
- If you suspect the presence of neoplasms of any nature.
- To restore the basic functions of the joint in rheumatoid arthritis.
- Research, as well as further resuscitation of the destruction of various types of the knee joint. Thanks to arthroscopy of the knee joint, it is possible to examine all the abrasions of the cartilage tissue and the destruction taking place in it.
Benefits
If we compare this procedure with other methods of surgical intervention, then arthroscopy has many positive aspects:
- Low invasiveness, since no opening of the joint cavity is required. Periarticular tissues are minimally damaged. For the procedure, a 0.3-0.5 cm incision is sufficient. Most often, it does not even require stitching, it heals on its own.
- According to reviews of knee arthroscopy, patients are much more comfortable with this procedure, as there are less consequences such as effusion, swelling and pain.
- After such an intervention, more oftenthe entire patient is discharged on the day of surgery, and after an open implant, rehabilitation requires 10-14 days in the hospital.
- Postoperative complications (infection of the joint cavity, scarring and bleeding) rarely develop.
- There is no need for long-term immobilization of the joint with a cast, as in the case of open arthrotomy.
- Minimum rehabilitation period. The patient recovers rapidly and then returns to normal activities.
- The trace after the intervention is small and inconspicuous.
Preparation for surgery
Athoroscopy is one of the small surgical interventions, but the preparatory stage for it must be carried out. A few days before surgery for knee arthroscopy, the patient undergoes examinations and tests:
- Chest x-ray.
- Blood tests, as well as a coagulogram, which is aimed at examining blood clotting.
- cardiogram of the heart.
- Requires consultation with an orthopedist, general practitioner and anesthesiologist.
- Urine analysis.
- It is also necessary to complete all examinations that are associated with a specific disease.
All the studies carried out will help the anesthesiologist to choose the best methods of anesthesia.
In order not to feel pain during knee arthroscopy, the following types of anesthesia are done:
- Local anesthesia. It is rarely used due to the short duration of its effect and the presence ofpostoperative consequences. Such anesthesia is used mainly for diagnostic implants.
- Spinal. It is the best option for such a procedure. Its main advantage is that the doctor can keep in touch with the patient, as well as the fact that after the operation the patient feels much better than after general anesthesia.
- Conduction anesthesia. A 1% solution of lidocaine is injected. This drug helps to block certain groups of nerves.
- General anesthesia. It is used very rarely, most often for the treatment of severe and serious pathological diseases.
To improve the recovery process after knee arthroscopy surgery, doctors recommend stopping the use of drugs for several weeks before surgery. The only exceptions are those that support vital human systems and organs. In this case, it is necessary to warn the doctor and follow his recommendations. No food is required 12 hours before the start of the procedure.
Features of the operation
Regardless of simplicity, invasive surgery is performed only under anesthesia. This is done for the comfortable work of the doctor and the neutralization of pain in the patient. Very often, only the implantation zone is anesthetized so that the doctor and the operated person have the opportunity to keep in touch. Operation requires special tools:
- A trocar is used to pierce the upper tissues.
- Arthroscope acts as an analogue of the endoscope.
- Cannulas are used to remove painful articular fluids of various directions by pumping.
- An arthroscopic probe with a video camera is used to study the interior of the articular elements.
All instruments are carefully inspected and disinfected. The time for the procedure is from 15 minutes to 2.5 hours. The duration of the surgical exposure depends on which joint is being operated on, as well as on the complexity of the damage.
The patient is placed on the operating table. Next, anesthesia is performed under the supervision of an anesthesiologist. With the help of a trocar, local tissues are pierced. Articular fluid is pumped out with cannulas and an arthroscopic probe is inserted, with which the procedure is performed.
Post-operative period
If there is no swelling after knee arthroscopy or other complications, then the patient is allowed to walk on the same day without using any auxiliary accessories. If a knee replacement is performed, the first time you need to walk with crutches. In cases where there were no complications during knee transplantation, the recovery process can take from a couple of weeks to one month.
The most common complications are swelling of the soft tissues in the patella and pain on palpation, indicating an inflammatory process due to improper fusion of ligaments and other parts of the articulation.
The following complications of the postoperative period also sometimes occur:
- Swelling and swelling in the kneecap area. This problem occurs due to the accumulation of fluid and inflammation. Also, edema is provoked by vascular pathologies that cause local bleeding in the knee joint.
- The temperature at the operation site is rising. If this symptom is detected, it is imperative to check the overall body temperature. Most often, this consequence occurs due to infection in the joint.
- Change of skin color (cyanosis and redness). If the skin acquires a red tint, this indicates inflammation. With a bluish tint, problems with periarticular tissues are revealed.
- Sometimes there is hemarthrosis (accumulation of blood). This symptom during surgery appears due to damage to the capillaries in case of problems in the patient with blood clotting.
- Nerve fiber damage.
- Pain on movement or on palpation.
If postoperative symptoms are present, x-rays, ultrasounds, or MRIs should be taken to determine the cause of the problem.
Rehab
It should be noted that after knee arthroscopy, sick leave is not always issued. This applies to cases of diagnosis using this method. If an operation was performed, sick leave is issued for 21 days to people whose work is sedentary. And for patients whose work is physically more difficult, exemption from work is issued for a period of 42 days.
Only after joint replacement, the patient is advised not toload the operated leg for an unlimited time until full recovery, which is determined by the doctor. For this, the patient undergoes certain studies. Most often, after the implantation of the knee joint, patients are given disability. Until full recovery, the patient is required to use support means (cane, crutches or walkers) for the correct splicing of all articular elements.
If the operation was performed on the cruciate ligament, it will take a month for rehabilitation. Most often, to reduce the load, the doctor prescribes the wearing of a fixing knee brace. In the case of arthrosis, recovery is faster, painkillers and non-steroidal drugs, as well as supporting elements, may not be needed. Wearing an elastic patella is considered appropriate.
For any arthroscopic implantation, the development of the knee is shown. It is also necessary to perform massage using creams and therapeutic ointments. With massage using various healing components, you can speed up the regeneration process.
Consequences of the operation
After surgery, certain complications may occur. As a rule, they are caused by injected anesthesia. The main consequences of knee arthroscopy are:
- Formation of neurological diseases.
- Problems with the vascular system.
- Lateral ligament strain.
These problems are rare, but the anesthesiologist must warn the patient about them.
More aftersurgery, the following symptoms often appear:
- Chills and high fever.
- Severe pain occurs in the joint, accompanied by redness of the knee area.
- Discomfort at the slightest movement.
- Significant swelling of the operated joint develops in the area of the knee.
- Chest discomfort develops, accompanied by shortness of breath and shortness of breath.
All these effects indicate the development of an infection in the joint.
Exercise after knee arthroscopy
Different types of exercises are used as rehabilitation after the procedure. It is important to know that you should not perform them without a preliminary examination and consultation with a doctor.
- Bending the knees. It is required to lie on your back and bend your legs slightly, point your socks at the ceiling. Next, you need to bend your knees and pull your heels towards your buttocks. It is required to continue until the heels are as close as possible to the buttocks without pain. This position is held for a few seconds. After that, the legs return to their original position. Repeat as many times as prescribed by the doctor.
- Thigh muscle contraction. Lie on your back, put a roller under your knee. Next, strain the muscles of the legs, pressing on the roller. Hold this position for 5 seconds. Repeat 10 times.
- Therapeutic exercise (exercise therapy) after knee arthroscopy involves performing exercises to improve blood circulation. The patient lies on his back, both legsstraightens, socks rushes to the ceiling. Then he makes gentle movements of the foot forward and down to the stop. Perform 10 times every hour.
- Leg raises. It is required to lie on your back, straighten the injured leg. The operated leg is carefully raised by 15-30 cm. It is held in this position for 5 seconds, then gently lowers down. Perform 10 times.
- Partial squat with chair. The starting position “standing” is taken, and a chair is used as a support. To perform, you need to hold your hand on the back of a chair and do shallow squats. This should be done slowly, from 5 to 10 seconds, then just as slowly take the starting position. Repeat 2 to 10 times.
- Walking. To strengthen an injured knee, this procedure is an excellent exercise.
- Exercise bike. Workouts start from 10 minutes a day. The seat is fixed as high as possible, but the feet should touch the pedals. The minimum resistance is set (it increases over time). Every day, the procedure time is increased by 1 minute. This simulator is used only 6-8 weeks after the operation.
Where do knee arthroscopy
Everyone who wants to have this operation needs to know that arthroscopy is now performed in many large cities of Russia. It is carried out in both public and private clinics. The cost of the procedure varies. Research institutes in Moscow and St. Petersburg can offer their clients a fixed fee. Diagnostic measures start at 4,700 rubles, butsurgery costs from 12,000 rubles. In public institutions of large cities, you can perform arthroscopy of the knee joint under the MHI policy. In this case, the procedure will be free of charge.
There are not many private medical institutions that are engaged in such operations. The cost of the procedure in them is much higher than in the budget ones, but the level of service is better. Basically, the pricing policy varies from these prices:
- Consultation with a traumatologist - from 1650 rubles.
- Diagnostics - from 13200 rubles.
- Surgical arthroscopy – from 24750 rubles.
- Arthroscopic meniscectomy - from 33,000 rubles.
However, there are knee surgeries that cost 60,000 rubles or more.
Patient opinions
Reviews about knee arthroscopy are mixed. All patients note among the advantages of the method:
- Minor injury.
- Almost imperceptible scars on the knee.
- Improve joint mobility.
- Disappearance of pain when moving.
Among the shortcomings, most patients name:
- Long rehabilitation.
- High price.
Some patients report that the positive effect lasted only a few years, after which a new operation was required.
