Arthroscopy is a surgical procedure by which the internal structure of a joint is examined for diagnosis and/or treatment using a tube-like viewing instrument called an arthroscope. Arthroscopy was popularized in the 1960s and is now commonplace throughout the world. Typically, it is performed by orthopedic surgeons in an outpatient setting. When performed in the outpatient setting, patients can usually return home after the procedure.The technique of arthroscopy involves inserting the arthroscope, a small tube that contains optical fibers and lenses, through tiny incisions in the skin into the joint to be examined. The arthroscope is connected to a video camera and the interior of the joint is seen on a television monitor. The size of the arthroscope varies with the size of the joint being examined. For example, the knee is examined with an arthroscope that is approximately 5 millimeters in diameter. There are arthroscopes as small as 0.5 millimeters in diameter to examine small joints such as the wrist.
If procedures are performed in addition to examining the joint with the arthroscope, this is called arthroscopic surgery. There are a number of procedures that are done in this fashion. If a procedure can be done arthroscopically instead of by traditional surgical techniques, it usually causes less tissue trauma, results in less pain, and may promote a quicker recovery. Get the best Arthroscopic Surgery in Chennai. Contact http://www.allaboutjoints.com/Contacts.html
Arthroscopy is a surgical procedure by which the internal structure of a joint is examined for diagnosis and/or treatment using a tube-like viewing instrument called an arthroscope. Arthroscopy was popularized in the 1960s and is now commonplace throughout the world. Typically, it is performed by orthopedic surgeons in an outpatient setting. When performed in the outpatient setting, patients can usually return home after the procedure.
The technique of arthroscopy involves inserting the arthroscope, a small tube that contains optical fibers and lenses, through tiny incisions in the skin into the joint to be examined. The arthroscope is connected to a video camera and the interior of the joint is seen on a television monitor. The size of the arthroscope varies with the size of the joint being examined. For example, the knee is examined with an arthroscope that is approximately 5 millimeters in diameter. There are arthroscopes as small as 0.5 millimeters in diameter to examine small joints such as the wrist.
If procedures are performed in addition to examining the joint with the arthroscope, this is called arthroscopic surgery. There are a number of procedures that are done in this fashion. If a procedure can be done arthroscopically instead of by traditional surgical techniques, it usually causes less tissue trauma, results in less pain, and may promote a quicker recovery.
Arthroscopy can be helpful in the diagnosis and treatment of many noninflammatory, inflammatory, and infectious types of arthritis as well as various injuries within the joint.
Noninflammatory degenerative arthritis, or osteoarthritis, can be seen using the arthroscope as frayed and irregular cartilage. Recently, for isolated cartilage wear in younger patients, repair of crevasses in the cartilage, using a "paste" of a patient's own cartilage cells harvested and grown in the laboratory, has been performed using an arthroscope.
In inflammatory arthritis, such as rheumatoid arthritis, some patients with isolated chronic joint swelling can sometimes benefit by arthroscopic removal of the inflamed joint tissue (synovectomy). The tissue lining the joint (synovium) can be biopsied and examined under a microscope to determine the cause of the inflammation and discover infections, such as tuberculosis. Arthroscopy can provide more information in situations which cannot be diagnosed by simply aspirating (withdrawing fluid with a needle) and analyzing the joint fluid.
Common joint injuries for which arthroscopy is considered include cartilage tears (meniscus tears), ligament strains and tears, and cartilage deterioration underneath the kneecap (patella). Arthroscopy is commonly used in the evaluation of knees and shoulders but can also be used to examine and treat conditions of the wrist, ankles, and elbows.
Finally, loose tissues, such as chips of bone or cartilage, or foreign objects, such as plant thorns, that become lodged within the joint can be removed with arthroscopy.
Arthroscopy is essentially a bloodless procedure and generally has few complications. The underlying health of the patient is considered when determining who is a candidate for arthroscopy. Most importantly, the patient should be able tolerate the anesthetic that is used during the procedure. A person's heart and lung function should be adequate. If there are existing problems such as heart failure or emphysema, these should be optimized as possible prior to surgery. Patients who are on anticoagulants (blood thinners) should have these medications carefully adjusted prior to surgery. Other medical problems should also be controlled prior to surgery, such as diabetes and high blood pressure.
Preoperative evaluation of a patient's health will generally include a physical examination, blood tests, and a urinalysis. Patients who have a history of heart or lung problems and generally anyone over the age of 50 will usually be asked to obtain an electrocardiogram (EKG) and a chest X-ray. Any signs of ongoing infection in the body usually postpones arthroscopy, unless it is being done for possible infection of the joint in question.
Arthroscopy is most often performed as an outpatient procedure. The patient will check into the facility where the procedure is being performed and an intravenous line (IV) established in order to administer fluids and medication. The type of anesthesia used varies depending on the joint being examined and the medical health of the patient. Arthroscopy can be performed under a general anesthetic, a spinal or epidural anesthetic, a regional block (where only the extremity being examined is numbed), or even a local anesthetic. After adequate anesthesia is achieved, the procedure can begin. An incision is made on the side of the joint to be examined and the arthroscope is inserted into the incision. Other instruments are sometimes placed in another incision to help maneuver certain structures into the view of the arthroscope. In arthroscopic surgery, additional instruments for surgical repairs are inserted into the joint through the arthroscope. These instruments can be used to cut, remove, and sew damaged tissues. Once the procedure is completed, the arthroscope in removed and the incisions are sutured (sewn) closed. A sterile dressing is placed over the incision and a brace or ACE wrap may be placed around the joint.
Immediately after arthroscopic surgery, patients may be sleepy, especially if a general anesthetic has been used. Medications are administered to control pain if needed. If a local anesthetic has been used, there may be no pain at all immediately after the procedure. If a spinal or regional anesthetic has been used, there can be numbness and weakness of the extremity that gradually resolves before the patient is sent home.
The surgical incisions from arthroscopy are small. They usually consist of several 5 mm (1/4 inch) incisions on either side of the joint, which are bandaged after surgery. The bandage may absorb some of the tissue drainage from these wound sites. The bandage should only be removed under the guidance of the treating surgeon or nurse. It should otherwise be kept as dry as possible during the first few days after surgery. Patients should notify their physician's office immediately if they develop unusual joint pain, swelling, redness or warmth, or if they injure the involved joint.
For several days after arthroscopy, patients will generally be asked to rest and elevate the joint while applying ice packs to minimize pain and swelling. After surgery, an exercise program is gradually started that strengthens the muscles surrounding the joint and prevents scarring (contracture) of surrounding soft tissues. The goal is to recover stability and strength of the joint rapidly and safely, while preventing the build-up of scar tissue. This program is an essential part of the recovery process for an optimal outcome of this procedure.
Over the years, higher quality fiber-optic equipment has allowed the development of miniature arthroscopes. This has allowed the examination of smaller joints with arthroscopy. Arthroscopy has become an integral tool for orthopedic surgery and its role will continue to expand as further improvement in arthroscopes and arthroscopic instruments continues.
The knee is a joint where the bone of the thigh (femur) meets the shinbone of the leg (tibia). The knee is the largest joint in the body. It acts like a hinge, allowing the knee to flex (bend) and extend (straighten). There are four ligaments of the joint (the medial and lateral collateral ligaments and the anterior and posterior cruciate ligaments) that provide stability and steady the knee movement.
Cartilage within the joint provides cushioning to protect the bones from the regular trauma of walking, running, and climbing. Articular cartilage lines the joint surfaces of the bones in the knee (tibia, femur, and patella, or kneecap). The medial and lateral meniscus are two thicker wedge-shaped pads of cartilage attached to the leg bone (tibia). Each meniscus is curved in a C-shape, with the front part of the cartilage called the anterior horn and the back part called the posterior horn.
If the meniscus is damaged, irritation occurs with each flexion or extension of the knee. Damage to the meniscus may occur due to a twisting or over-flexing injury. Meniscal cartilage can also deteriorate or wear out because of age and overuse.
A tear of, or rent in, the cartilage in the knee is called a torn meniscus. Tears are described by how they look and where they are located. This information is usually found during a diagnostic procedure, like an MRI or knee arthroscopy. Common meniscus tears are described according to how they look, including longitudinal, bucket handle, parrot beak, and transverse.
A forceful twist or sudden stop can cause the femoral condyle to grind into the tibial plateau and pinch and sometimes tear the meniscus. This can also occur with a deep squatting or kneeling, especially when lifting a heavy weight. Torn meniscus injuries often occur after athletic activities, especially in contact sports like football and hockey or those where pivoting and sudden stops occur like tennis and basketball.
The risk of developing a torn meniscus increases with age as the cartilage begins to wear and lose its resilience. Increasing weight also puts more stress on the meniscus with the potential for wear, degeneration, and tearing.
Because of the forces applied to the knee, a torn medial meniscus may also be associated with tears of the medical collateral ligament and anterior cruciate ligament within the knee joint.
When a meniscus is torn, there may be an acute onset of pain in the knee and it may cause a "pop" sensation. Over a period of a few hours, swelling may occur within the knee, but this may not necessarily be noticed. Sometimes, though, the patient may not be aware that an injury occurred.
After the injury, the knee joint may gradually settle down and feel relatively normal. However, other symptoms may develop, such as,
The diagnosis begins with the taking of a history and performing a physical examination. By asking appropriate questions about pain timing and location, swelling, popping and giving way, the health-care professional is often pointed to the proper diagnosis. The physical examination can confirm that suspicion.
Physical examination of the knee may include inspection, including assessing how the patient walks (gait). Feeling (palpation of) the joint may be done looking for tenderness, feeling for fluid within the joint that might cause swelling, and assessing range of motion. Stability of the joint can be determined by pushing on the knee in a variety of directions to assess the integrity of the knee ligaments.
If the diagnosis is still in question, or if there is need for confirmation of the clinical diagnosis, magnetic resonance imaging (MRI) may be considered. This type of scan is able to assess the soft tissues of the knee, including cartilage and ligaments.
Plain X-rays are not able to identify meniscal tears but may be helpful in looking for bony changes, including arthritis and loose bony fragments within the joint.
Knee arthroscopy may also be considered. Arthroscopy is an operation whereby an orthopedic surgeon inserts a small viewing instrument (scope), allowing a direct look at the structures of the knee. The added benefit of arthroscopy is that the injury may be repaired at the same time using additional tools that are inserted into the joint.
The treatment of a torn meniscus depends on its severity, location, and underlying disease within the knee joint.
Torn meniscus due to injury
Initial therapy after the injury includes rest, ice, compression, and elevation (RICE). This may be helpful in alleviating the inflammation within the joint that occurs with a torn meniscus. Antiinflammatory medications may help to relieve pain and inflammation.
Many patients choose initial conservative or nonsurgical treatment of a torn meniscus. Once the initial injury symptoms have settled down, exercise programs may be recommended to strengthen the muscles surrounding the knee to add to the stability of the joint. Maintaining an ideal body weight will also help lessen the forces that can stress the knee joint. Orthotics may be useful to distribute the forces generated by walking and running.
If conservative therapy fails, surgery may be a consideration. Knee arthroscopy allows the orthopedic surgeon to assess the tear within the meniscus and repair it. Options include sewing the torn edges together or trimming the torn area and smoothing the injury site.
Degenerative joint disease
In older patients with degenerative joint disease (also known as osteoarthritis), where the cartilage wears out, treatment options may be decided in a much slower timetable.
Exercise and muscle strengthening may be an option to protect the joint and maintain range of motion. As well, antiinflammatory medications may be considered to decrease swelling and pain arising from the knee joint.
Steroid injections into the knee joint may be a consideration to bring temporary symptom relief that can last weeks or months.
Joint replacement may be an option with substantial degeneration of the knee if conservative measures fail and symptoms of pain and decreasing joint range of motion progress.
If the tear is small and located on the outer edge of the meniscus, it is possible that rehabilitation without surgery is all that is needed for recovery.
With other meniscal injuries, if the knee is stable and if the symptoms do not persist and do not limit lifestyle, nonsurgical treatments remain an option. However, the decision to defer surgery depends upon whether the knee joint remains functional.
If a conservative, nonsurgical approach is taken, the pain and swelling of a torn meniscus should resolve within a few days. Recovery and rehabilitation becomes a long-term commitment, making certain that the muscles surrounding the knee are kept strong to promote joint stability.
If knee arthroscopy is performed, the rehabilitation process balances swelling and healing. The goal is to return range of motion to the knee as soon as possible. Physical therapy is a common part of rehabilitation, and most therapists work with the orthopedic surgeon to return the patient to full function as soon as possible.
Once the swelling in the knee joint resolves, the goal of therapy is to increase the strength of muscles surrounding the knee and to promote and preserve stability of the joint.
Rehabilitation after an operation depends upon the individual patient and the response to surgery. Specific recommendations regarding weight-bearing and exercises will be customized for the patient by the surgeon and therapist.
Usually the goal is to return the knee to normal function within four to six weeks, though aggressive sporting activities may have to wait a little longer.