Miller: So, if you have a meniscal tear and you either figure that out based on the examination or the MRI, what role would arthroscopy play nowadays? Thomas: If the patient has significant symptoms that aren't resolving with conservative measures and it prevents them from doing their regular activities, arthroscopy can assist the restoration of function and decrease in pain. It's a small out-patient surgery with, usually, two or three very small incisions, and the meniscus is either repaired or the damaged portion trimmed out, depending on the findings at surgery.
Miller: So, what you said I think is important, is that you don't do the arthroscopy immediately, you try some conservative measures first.
Thomas: I believe that's the standard, because many people can function with a meniscus tear. The older literature suggested that an untreated meniscus tear will lead to earlier arthritis. Subsequent studies are less clear on that, and it depends much on the size, location, geometry of the tear, as well as the patient's activity level.
Miller: You know, many years ago they used to go in, when you had a meniscal tear, and they just took out a lot of the meniscus, a large percentage of it, and I think that was the standard back in the day.
Is that right? Before the invention of arthroscopy, an open procedure would be made and the entire meniscus would be removed. And there are some papers that suggest that those patients would have end-stage arthritis within seven years of that procedure.
Miller: So the concept was, if you used an arthroscope, you could go in and take smaller pieces of the meniscus near where it was damaged, and that that might result in improved function, less pain. Thomas: True. That's true. It will decrease their pain, improve their function, and if we can save even a rim of 3mm or 4mm, that's been shown to still function in preventing arthritis for the patient.
Miller: What were some of the things that patients received arthroscopy for in the not-too-distant past that are no longer done? For instance, I know that some patients have had an arthroscope to wash out the knee joint.
The primary knee injury symptoms are:. If your injury is acute, the primary symptoms you'll experience will likely be knee swelling and pain. If your injury is from overuse or is chronic, your symptoms of popping, clicking, and intermittent pain will be more intense.
The good news is that you can usually treat it with weight loss, physical therapy and other techniques. In some cases, when it's more serious, your doctor might recommend surgery. But how will you know when surgery is your best option? This is something you'll need to talk to your doctor about. Surgery can't repair all knee problems, and not everybody is an ideal candidate. You might be a knee arthroscopy candidate if you're experiencing:.
If you're only experiencing one of these four signs, begin with the basics — physical therapy, rest and some low-stress, consistent exercise. You may even want to try some anti-inflammatory medication. This might be all that's required.
However, if you're experiencing two or more signs, while a conservative approach may do, it might not be enough. If you're experiencing all of these signs, surgery may be your best approach. Gombera uses knee arthroscopy to conduct a broad range of surgical procedures on the knee joint.
These procedures can include:. Our goal is to perform a suitable surgical procedure to repair or improve your knee problems.
An arthroscope enhances our ability to perform these procedures. You can expect different results from a knee arthroscopy procedure depending on what is wrong with your knee, what we can do inside your knee to improve the problem and your effort at rehabilitation after the surgery.
If you don't have insurance, and you're trying to decide if you should have knee arthroscopy surgery performed, make sure you let your doctor know you'll have to pay for the procedure out of pocket.
Often, doctors will work with you by offering a payment plan or a non-insurance option. Even so, the amount you'll pay for knee arthroscopy depends on what you and the doctor decide. Therefore, you'll want to sit down and discuss fees up front. Always let your doctor know if you're taking any medications, even herbs or supplements bought over-the-counter.
Before surgery, we will place you under either general anesthesia. There is a great deal of equipment that surrounds the operating table, including the TV screens, cameras, light sources and surgical instruments.
We begin the operation by making two small openings into the knee, called portals. These portals are where we place the arthroscope and surgical instruments inside the knee. We take care to protect the nearby nerves and blood vessels. We then insert the arthroscope into the knee joint and fill the joint with sterile fluid. We then address any areas of damage or injury with specialized arthroscopic instruments. Over the years since the invention of the arthroscope, many very specialized instruments have been developed to perform different types of surgery using the arthroscope to see what is going on while we use the instruments.
Today, many surgical procedures that once required large incisions for the surgeon to see and fix the problem can be done with much smaller incisions. After the surgery, we will close the arthroscopic portals and surgical incisions with absorbable sutures no sutures need to be removed.
A large bandage will be applied with a compressive wrap to reduce swelling and prevent blood clots in the leg. Your recovery time and prognosis will depend on the severity of the knee problem and the complexity of the required procedure.
Your doctor might have already diagnosed the condition causing your pain, or they may order the arthroscopy to help find a diagnosis. In either case, an arthroscopy is a useful way for doctors to confirm the source of knee pain and treat the problem. Your doctor or surgeon will advise you how to prepare for your surgery.
You may need to stop taking certain medicines, such as aspirin or ibuprofen, for weeks or days before the procedure. You must also refrain from eating or drinking for six to 12 hours before the surgery.
In some cases, your doctor may prescribe you a pain medication for any discomfort you experience after the surgery. You should fill this prescription ahead of time so that you have it ready after the procedure. The surgeon will begin by making a few small incisions, or cuts, in your knee.
Sterile salt water, or saline, will then pump in to expand your knee. This makes it easier for the surgeon to see inside the joint. The arthroscope enters one of the cuts and the surgeon will look around in your joint using the attached camera. Top of the page. Your Recovery Arthroscopy is a way to find problems and do surgery inside a joint without making a large cut incision. How can you care for yourself at home? Rest when you feel tired. Getting enough sleep will help you recover.
Use pillows to raise your ankle and leg above the level of your heart. Try to walk each day, after your doctor has said you can. Start by walking a little more than you did the day before. Bit by bit, increase the amount you walk. Walking boosts blood flow and helps prevent pneumonia and constipation. You may have a brace or crutches or both. Your doctor will tell you how often and how much you can move your leg and knee.
If you have a desk job, you may be able to return to work a few days after the surgery. If you lift things or stand or walk a lot at work, it may be as long as 2 months before you can return. You can take a shower 48 to 72 hours after surgery and clean the incisions with regular soap and water. Do not take a bath or soak your knee until your doctor says it is okay. Ask your doctor when you can drive again. If you had a repair of torn tissue, follow your doctor's instructions for lifting things or moving your knee.
You can eat your normal diet. If your stomach is upset, try bland, low-fat foods like plain rice, broiled chicken, toast, and yogurt. Drink plenty of fluids, unless your doctor tells you not to. You may notice that your bowel movements are not regular right after your surgery. This is common. Try to avoid constipation and straining with bowel movements.
You may want to take a fibre supplement every day. If you have not had a bowel movement after a couple of days, ask your doctor about taking a mild laxative.
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