Knee Arthroscopy Both Menisci

Introduction

Knee arthroscopy may be performed to investigate problems such as inflammation or injury, or to repair damaged tissue and cartilage. It can also be used to take small tissue samples (biopsies), which can help to diagnose problems such as infection.

Knee arthroscopy is performed through small puncture wounds in the skin, using a special telescope (arthroscope) attached to a video monitor. Compared with open surgery, arthroscopy has a faster recovery time. The common indication for arthroscopy is meniscal tear.

This surgery removes the torn tissue and saves the healthy meniscus. Without surgical repair, the fragments of the torn meniscus may damage the smooth articular cartilage of the knee. This can lead to pain as well as early-onset arthritis.

Preparing for a knee arthroscopy

1. The surgeon will explain how to prepare for the operation. For example if the patient smokes, he will be asked to stop, as smoking increases the risk of getting a chest and wound infection, which can slow the recovery.

2. The operation is usually done as a day care procedure under general anesthesia. It can also be done under local or regional anesthesia. A sedative can also be given with a local or regional anesthetic, which relieves anxiety and relaxes the patient during the operation.

3. In case of general anesthesia, patient should not eat or drink any thing for about six hours before the procedure.

4. At the hospital the nurse may check the heart rate and blood pressure, and some blood tests are ordered.

5. The surgeon discusses the procedure, any risks and also the possible complications with the patient. Then the patient is asked to sign a consent form for the procedure, giving permission to go ahead.

6. You may be asked to wear a compression stocking on the unaffected leg to help prevent blood clots forming in the veins in of the legs.

Procedure:

Surgery for meniscus tears includes meniscus removal (meniscectomy), meniscus repair, or meniscus replacement. For most patients meniscus repair is successful and there are very low rates of complications. Arthroscopic meniscus repair surgery is best performed within two months after the injury.

After about two hours in the recovery room, patient typically leaves the hospital.

Arthroscopic meniscal surgery usually takes about one to two hours. As the anesthetic takes effect, the surgeon makes small cuts in the skin around the knee joint. Sterile fluid is pushed into the joint to produce a clearer picture and then the arthroscope is inserted.

The surgeon will examine the knee joint by looking at images sent by the arthroscope to a monitor and explores the torn menisci. Then he or she inserts instruments to repair damaged meniscus or remove any loose fragments that interferes with movement or causes pain in the knee.

After this, the surgeon drains the fluid out and closes the cuts with stitches or adhesive strips. Then the wounds are covered by applying a dressing and bandage around the knee.

Recovery after meniscal repair:

After about two hours in the recovery room, patient typically leaves the hospital. Arthroscopic meniscus repair can cause pain and discomfort after surgery. Therefore, pain medications are provided for up to three days after surgery.

To reduce the swelling and control pain, a knee brace and cold packs are used after surgery. The brace keeps the leg straight. Depending on the extent of the tear, patients may bear weight immediately or within one to two days.

The surgeon will provide detailed instructions to follow. Limb elevation in the days after surgery can also speed healing.

Physical therapy usually begins quickly after surgery. The main objectives are to decrease swelling, regain full range of motion and build muscle strength. The typical plan includes six weeks in the brace, performing non weight-bearing, range of motion exercises. After six weeks, patients can begin weight bearing and other exercises for another six weeks. Light exercise is advised after 12 weeks, with heavy exercise added at 16 weeks.

For return to sporting activities, however, the patient requires clearance from doctor.

Risks:

Knee arthroscopy is commonly performed and generally safe. However, some side effects are possible which are:

• Nausea and vomiting

• Small scars on the knee from the cuts.

Complications:

This is when problems occur during or after the operation.

Arthroscopy complications are:

• Damage to the joint

• Infection

• Bleeding into the joint

• Numbness of skin over the knee

• Failure of procedure leading to revised surgery