Arthroscopy

 

What is an arthroscopy?

An arthroscopy is the examination of a joint using a special instrument called an arthroscope. This is like a thin telescope, which uses particular lenses and sometimes fibre-optic techniques allowing the specialist to see inside a joint. It enables examination of the surfaces of a joint and also treatment of certain problems such as persistent pain, swelling, or where the specialist thinks that a ligament or cartilage has been damaged and may need repair without the need to cut the joint open. Although arthroscopy can be used on almost any joint including the shoulder, elbow, wrist and hip it is most commonly used for diagnosis and treatment of knee conditions.

What does arthroscopy involve?

Most arthroscopies are performed as a 'day case' procedure i.e. the patient goes into hospital in the morning and goes home the same day although this may not be the case if the surgeon is planning to do more extensive surgery on the joint. The patient is starved before surgery, in case a general anaesthetic is needed, and is then taken to theatre. In most instances a general anaesthetic is given although it is possible to perform some arthroscopies under local anaesthetic.

Once the individual is anaesthetised, the surgeon makes a small cut into the skin over the joint and then inserts the arthroscope into the joint. The arthroscope is usually about 8 inches long, rigid and about the width of a pen and it has its own light source enabling the surgeon to essentially 'see' into the joint. Often an extra small hole is made to allow the insertion of a probe, further instruments or a tube to allow the joint to be flushed with sterile water. All these things assist the surgeon to see and operate on the structures within the joint.

 

What happens after an arthroscopy?

At the end of the procedure the arthroscope and all other instruments are removed from the joint and the holes are either stitched (usually with dissolvable sutures) or sometimes they are close with special sticky strips called 'steristrips'. Occasionally no closure material is used and the cuts are allowed to heal naturally. A firm bandage is generally applied. If the patient is a day case checks will be made to ensure that they are well before they are allowed home. They will have been informed beforehand that they are not fit to drive home and not for 24 hours afterwards until the anaesthetic has fully worn off and will therefore need a friend or relative to take them home. Sometimes the individual will be referred to a physiotherapist for special exercises to help the joint to return to normal.

How long does it take to recover from an arthoscopy?

Recovery from arthroscopy is much faster than traditional operations where the joint was opened up through a surgical incision but the exact recovery time will depend on the joint involved and what procedure was carried out. For instance, if the arthroscopy was on the knee and was simply to examine the joint internally and wash out debris, the patient may be able to return to work within a week or so, once the discomfort and any swelling has subsided.

On the other hand, if a cruciate ligament repair (ligaments inside the knee which can rupture) and particularly if the individual does manual work they may be advised to remain off work for a few weeks to allow healing of the ligament. The surgeon will advise accordingly.

What are the possible complications of arthroscopy?

Arthroscopies are now a very common procedure and have very few complications. There is always a small risk of complications from the anaesthetic. In addition there is a chance of infection of the cut into the joint or of the joint itself although this is rare. Occasionally a thrombosis (blood clot or DVT) may result in the leg following arthroscopy of the knee, which may require drug treatment to thin the blood. Again this is an unusual complication.

Are there alternatives to arthroscopy?

The answer to this depends on why the arthroscopy is being suggested. If the reason is that the patient is likely to have a cartilage or ligament problem which can be repaired at the time of the arthroscopy then the answer is probably 'No' unless the individual is happy to continue with their symptoms.

On the other hand, if the arthroscopy is proposed in order to investigate ongoing pain or swelling in a joint then a possible alternative is a CT (computerised tomography) or MRI (magnetic resonance image) scan. These have the advantage that they can provide the specialist with clear images of the inside of the joint (although not as clear as the direct visualisation via an arthroscope) without the need for an operation or anaesthetic. Obviously, it may be the case that the finding of these scans reveal that an operation is subsequently needed but in some cases an operation of any sort will be avoided.

 

What is an arthroscopic meniscectomy?

An arthroscopic meniscectomy is one of the more common types of operation performed on the knee using an arthroscope. Inside the knee there are two discs of cartilage called the menisci by doctors but are commonly referred to as the 'cartilages' by many people. These structures act to pad the shock waves through the knee during activity and help to assist the smooth gliding of the lower leg bone (the tibia) against the upper leg bone (the femur). A common knee injury is where one of these menisci becomes torn. This tends to cause knee pain and sometimes locking or giving-way of the knee.

Before arthroscopes were invented this injury would have required the whole knee joint to be surgically opened with all the possible complications and extended recovery time associated with a major operation. An arthroscopic meniscectomy means that part or all of the affected cartilage can be removed using instruments inserted through the arthroscope itself or through the second incision mentioned above.

After this operation it is important for the patient to follow the instructions of the surgeon but in general the individual will be able to weight bear after only a few days and return to work within a week or so depending on whether the job involves heavy lifting or not.

 

What is an arthroscopic cruciate ligament repair?

Another fairly common knee injury is something called a ruptured cruciate ligament. One or two famous footballers have had this injury which involves the rupture (break) of one or both cruciate ligament which are ligament inside the knee joint which cross over each other -hence the name 'cruciate'. These ligament provide stability to the joint and it is therefore particularly important to repair them in sportsmen/women or those who are very active since otherwise the knee remains unstable and prone to wear and tear.

Again this operation used to require opening the knee joint. However, nowadays it is frequently done using arthroscopic techniques. The operation is quite complicated and therefore the surgeon sometimes uses additional techniques to help him see exactly what is going on inside the joint during surgery including computer graphics and the use of special dyes inside the joint. The ligament is repaired using sutures or grafts introduced into the joint such as a piece of tendon from the kneecap being used to bridge the gap in the ruptured ligament.

A period of rest and physiotherapy is again needed after this operation although a return to most normal activities is possible within about two weeks although the surgeon may restrict more vigorous activities until he is happy with the progress of the patient.

Arthroscopies are used for diagnosis and treatment of other joint conditions and have now become a very common, safe and effective form of management for a number of joint problems.

 

Further information can generally be obtained from the GP, Specialist or local hospital.