Arthroscopy of the knee: indications, features of the operation, postoperative period, consequences

Arthroscopy of the knee joint is one of the methods of treatment and diagnosis, often used in all world clinics. Using this method, you can help patients with joint problems with high-quality and with minimal injuries. An optical system is inserted into the joint cavity, thanks to which damaged and inflamed structural cartilages, synovial membranes and ligaments can be examined.

A bit of history

Not everyone knows what knee arthroscopy is. This invasive surgery has been known to the medical community since the beginning of the 19th century. The founder was a doctor from Denmark, Severin Norrentoft. Despite many conflicting opinions, some surgeons 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.

Areas of use

Arthroscopy of the knee joint is a technique that allows a series of diagnostic and surgical measures to be performed without surgery.

1. Diagnostic arthroscopy is a gentle study method that allows you to visually examine the internal components of a joint. It makes it possible to monitor the condition of the knee and perform a tissue biopsy.
2. Arthroscopic arthrolysis is a surgical operation aimed at the treatment of arthrofibrosis by excision of the fibrous joints in the articular cavity.
3. Arthroscopic debridement is an event when the internal joint is cleaned of blood or purulent accumulations and serous effusion. According to reviews of knee arthroscopy, antiseptic drugs are injected into the cavity to prevent new infection, which is a very effective prevention method.
4. Arthroscopic medullary shunting - the technique is that a shunt is inserted into the bone tissue of the joint. This is a hollow thin tube (diameter of only 8 mm) made of titanium alloy. The shunt has holes through which bone fat enters the joint, which is a wonderful lubricant for ligaments. Using this method, you can recover from severe pathologies of the musculoskeletal system. This problem occurs at a time when cartilage lubrication deteriorates in the affected joints, inflammatory reactions intensify and develop, and cartilage tissue defects form, which makes movement difficult.

Indications

The attending physician of the patient can prescribe him an operation for arthroscopy of the knee joint in the following cases :.

1. A biopsy of the tissues of the damaged joint is required, which should help the doctor identify the cause of infection of the knee joint.
2. Determination of types of articular pathological processes. These may include inflammatory and traumatic diseases, rheumatological and autoimmune processes, and degenerative-dystrophic changes.
3. Removing the effects 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.
4. If you suspect the presence of neoplasms of any nature.
5. To restore the basic functions of the joint in rheumatoid arthritis.
6. Research, as well as further resuscitation of the destruction of the various nature of the knee joint. Thanks to arthroscopy of the knee joint, you can consider all the abrasions of the cartilage tissue and the destruction that takes place in it.

Benefits

If you compare this procedure with other methods of surgical intervention, then arthroscopy has many positive aspects:

1. Low invasiveness, as the opening of the joint cavity is not required. Periarticular tissue is minimally damaged. For the procedure, 0.3-0.5 cm of the incision is sufficient. Most often, it does not even require stitching, heals on its own.
2. According to reviews of arthroscopy of the knee joint, patients are much easier to tolerate this procedure, since consequences such as effusion, edema and pain are less pronounced.
3. After such an intervention, most often the patient is discharged on the day of surgery, and after open introduction for rehabilitation it takes 10-14 days to spend in the hospital.
4. Rarely enough, postoperative complications (infection of the joint cavity, scars and bleeding) develop.
5. There is no need for prolonged immobilization of the joint with a plaster cast, as in the case of open arthrotomy.
6. The minimum period of rehabilitation. The patient quickly recovers, after which he returns to normal activities.
7. The trace after the intervention is small and inconspicuous.

Preparation for surgery

Atoroscopy is one of the small surgical invasions, but the preparatory stage for it must be carried out. A few days before surgery for arthroscopy of the knee joint, the patient undergoes research and passes tests:

• Chest x-ray.
• Blood tests, as well as a coagulogram, which is aimed at examining blood coagulation.
• Cardiogram of the heart.
• Consultation with an orthopedist, general practitioner and anesthetist is required.
• Analysis of urine.
• It is also necessary to perform all examinations that are associated with a specific disease.

All studies performed will help the anesthetist choose the best methods of pain management.

In order not to feel pain during arthroscopy of the knee joint, the following types of anesthesia are done:

1. Local anesthesia. It is rarely used due to the short duration of its effects and the presence of postoperative consequences. Such anesthesia is mainly used for diagnostic implants.
2. Spinal. It is the best option for such a procedure. Its main advantage is that the doctor can maintain contact with the patient, as well as the fact that after the operation the patient feels much better than after general anesthesia.
3. Conduction anesthesia A one percent solution of lidocaine is introduced. This drug helps to block some groups of nerves.
4. General anesthesia. It is used very rarely, most often for the treatment of severe and serious pathological diseases.

To improve the recovery processes after surgery for arthroscopy of the knee joint, doctors recommend stopping the use of medications 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. 12 hours before the start of the procedure, you need to refuse food.

Features of the operation

Regardless of simplicity, invasive surgery is performed only under anesthesia. This is done for the doctor to work comfortably and to neutralize the pain syndrome 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.
• An analog of an endoscope is an arthroscope.
• Cannulas are used to pump out painful joint fluids of different directions by pumping.
• An arthroscopic probe with a video camera is used to study the inner portion of the articular elements.

All instruments are thoroughly inspected and disinfected. The time for the procedure is from 15 minutes to 2.5 hours. The duration of the surgical intervention depends on which joint is being operated on, as well as the complexity of the damage.

The patient is placed on the operating table. Next, anesthesia is performed under the supervision of an anesthetist. Using a trocar, local tissue is pierced. Joint fluid is pumped out by cannulas and an arthroscopic probe is inserted, with which the procedure is performed.

Postoperative period

If there is no swelling after arthroscopy of the knee joint or other complications, then the patient is allowed to walk on the same day without using any auxiliary accessories. If the knee joint is replaced, the first time you need to walk with crutches. In cases when there were no complications during transplantation of the knee joint, 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 splicing of ligaments and other parts of the joint.

Also, the following complications of the postoperative period are sometimes found:

1. Swelling and swelling in the patella area. This problem occurs due to fluid accumulation and inflammation. Edema is also provoked by vascular pathologies that cause local bleeding in the knee joint.
2. The temperature rises at the site of the operation. If this symptom is detected, it is necessary to check the general body temperature. Most often, this consequence occurs due to infection in the joint.
3. Change in 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.
4. 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 coagulation.
5. Damage to nerve fibers.
6. Soreness at the time of movement or during palpation.

If postoperative symptoms are present, then an X-ray, ultrasound or MRI scan is necessary to determine the cause of the problem.

Rehabilitation

It should be noted that after arthroscopy of the knee joint, sick leave is not always issued. This applies to cases of diagnosis using this method. If the operation was performed, the sick leave is issued for 21 days to people whose work is sedentary. And for patients whose work is physically more complicated, exemption from work is issued for a period of 42 days.

Only after replacing the joint, the patient is advised not to load the operated leg for an unlimited time until a complete recovery, which is determined by the doctor. For this, the patient undergoes certain studies. Most often, after implantation of the knee joint, patients are given disability. Until complete recovery, the patient needs to use the means of support (cane, crutches or walkers) for the proper fusion of all articular elements.

If the operation is performed on the cruciate ligament, a month will be required for rehabilitation. Most often, to reduce the load, the doctor prescribes the wearing of a fixing knee pad. In the case of arthrosis, recovery is faster, painkillers and non-steroid drugs, as well as supporting elements, may not be needed. It is considered appropriate to wear an elastic patella.

For any arthroscopic implants, knee development is indicated. It is also necessary to perform massage using creams and therapeutic ointments. During massage using various healing components, the regeneration process can be accelerated.

The 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:

• The formation of neurological diseases.
• Problems with the vascular system.
• Stretching of the lateral ligaments.

These problems rarely appear, but the anesthesiologist must warn the patient about them.

Even after surgery, the following symptoms often appear:

• Chills and fever.
• Severe pain occurs in the joint, accompanied by redness of the knee.
• There is discomfort at the slightest movement.
• Significant swelling of the operated joint develops in the area of ​​the knee.
• Discomfort in the chest is formed, which is accompanied by shortness of breath and shortness of breath.

All these consequences indicate the development of infection in the joint.

Exercises after arthroscopy of the knee

Various types of exercises are used as rehabilitation after the procedure. It is important to know that they should not be performed without a preliminary examination and consultation of a doctor.

1. Bending the knees. It is required to lie on your back and bend your legs slightly, to fix your socks on the ceiling. Next, you need to bend the knees and pull the heels to the buttocks. You need to continue until the heels are as close to the buttocks as possible without the appearance of pain. This pose is held for several seconds. After that, the legs return to their original position. Repeat as many times as prescribed by the doctor.
2. Contraction of the muscles of the hips. Lie on your back, put a roller under the knee. Next, strain the muscles of the legs, pressing on the roller. Hold this position for 5 seconds. Repeat 10 times.
3. Physiotherapy exercises (LFK) after arthroscopy of the knee joint involves performing exercises to improve blood circulation. The patient lies on his back, straightens both legs, socks rushes to the ceiling. Further makes soft movements of the foot forward and down until it stops. Perform 10 times every hour.
4. Leg raises. It is required to lie on your back, straighten your sore leg. The operated leg rises cautiously by 15-30 cm. It is held in this position for 5 seconds, then gently drops down. Perform 10 times.
5. Partial squat with a chair. The initial standing position is taken, and a chair is used as a support. To perform, you need to hold on to the back of the 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.
6. Walking. To strengthen the injured knee, this procedure is an excellent exercise.
7. Exercise bike. Training starts from 10 minutes a day. The seat is fixed as high as possible, but the legs should touch the pedals. The minimum resistance is set (with time it increases). Every day, the procedure time is increased by 1 minute. This simulator is used only 6-8 weeks after surgery.

Where do knee arthroscopy

Everyone who wants to perform this operation needs to know that arthroscopy is now being performed in many large cities of Russia. It is conducted in both public and private clinics. The cost of the procedure in them is different. Research institutes in Moscow and St. Petersburg can offer their customers a fixed payment. Diagnostic measures start at 4,700 rubles, but surgical intervention costs from 12,000 rubles. In state institutions of large cities, arthroscopy of the knee joint can be performed according to the mandatory medical insurance 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, but the level of service is better. Basically, pricing varies from these prices:

• Consultation with a traumatologist - from 1650 rubles.
• Diagnostics - from 13,200 rubles.
• Surgical arthroscopy - from 24,750 rubles.
• Arthroscopic meniscectomy - from 33,000 rubles.

However, there are operations on the knee 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 trauma.
• Almost invisible scars on the knee.
• Improving joint mobility.
• The disappearance of pain during movement.

Among the shortcomings, most patients are called:

• Long rehabilitation.
• High price.

Some patients note that their positive effect lasted only a few years, after which a new operation was required.