in Vail, CO
Arthroscopy is a truly minimally invasive surgical method used to explore and treat problems in several different joints, including the knee.
When is knee arthroscopy necessary?
The need for looking inside the knee to make a diagnosis and discover the source of pain has become less and less common. An experienced knee surgeon can usually make the correct diagnosis by doing a complete history and physical exam and reviewing a high-resolution MRI scan of the knee.
However, there are occasional circumstances where Dr. Cunningham has to actually look inside the knee with an arthroscope to make the diagnosis and then treat the problem. Examples of this are to assess the healing of a repaired meniscus or the healing of autologous chondrocyte implantation, or for other unexplained symptoms.
Arthroscopic Knee Surgery
Knee arthroscopy is usually performed at an outpatient surgical center. The patient is usually administered a general anesthetic. If the patient wishes to be awake for the procedure, a spinal anesthetic can be administered where numbing medicine is injected around the nerve roots in the low back, thus making one's legs go numb.
A thin telescope (measuring around 12 inches long and a ¼ inch in width) with an attached fiber optic cable and an attached HD video camera is inserted into the knee. The arthroscope portrays a live video of the joint on a large monitor positioned above the patient, out of the sterile field. Through additional portals, motorized instruments or implants can be introduced to render a repair or reconstruction of a given tissue.
Common Knee Arthroscopic Procedures
Common procedures are repairing meniscus cartilage tears with suture, removing torn flaps of meniscus (partial menisectomy) when it is not repairable, smoothing rough articular cartilage surfaces (chondroplasty) that represent early arthritis, and removing loose bodies of cartilage that may be catching the knee.
An arthroscope magnifies the surgical view and thus the surgeon can see all the pathology or problems that are present much better than with the naked eye. This leads to improved ability to accurately understand the extent of the patient's condition. Moreover, the surgeon can be much more precise in repairing the tissue.
Because the surgery is completed through small incisions, there is less postoperative pain, swelling, and scarring. This leads to better range of motion, fewer complications and overall a better outcome.
Recovery and Rehabilitation
Knee arthroscopic procedures usually take less than 1 hour to complete. Patients are discharged 1–2 hours after leaving the surgical suite, making sure they are fully alert, eating, drinking and able to urinate. Patients immediately start a short course of exercises to regain range of motion and strength. Most patients can return to desk type work in 3–5 days.
Typically, patient outcomes are inversely related to how much arthritis is found in the knee. The more arthritis, the less well a patient responds to knee arthroscopy. If a patient presents with a painful knee from an unstable and torn flap of meniscus that is repaired or removed and has very little arthritis, then these patients do very well. Conversely, if a patient has complete "bone on bone" arthritis over large areas of their knee, then knee arthroscopy is of little value and Dr. Cunningham would instead recommend other non-surgical or surgical options.