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2023 Author: Alfred Shackley | [email protected]. Last modified: 2023-05-21 13:14
Arthroscopic surgery on the knee joint is performed to determine the cause of pain in the organ, if it is difficult to differentiate, to clarify the diagnosis and course of the disease, to identify the location of ruptures and to assess the state of the tissue after injuries and inflammations.
Such an accurate diagnosis of the joint allows the surgeon to examine the damage inside it to the smallest detail, and then prescribe the correct and effective treatment.
The arthroscopic method of examining the intra-articular cavity has a number of advantages over others:
- High accuracy;
- Closed way of research;
- The ability to perform surgery on various parts of the body;
- Continuous improvement of equipment and tools;
- Outpatient study availability;
- Short rehabilitation period;
- A small percentage of complications;
- Minimal amount of tissue damage.
The main indications for the use of arthroscopy of the joints
The main purpose of arthroscopy is to remove all damaged tissue / inflammatory agents from the cavity and improve mechanical function. Even despite the impossibility of complete treatment of a diseased joint, arthroscopy restores fullness of motion through the removal of damaged tissues and elimination of synovitis.
Arthroscopic surgery is performed in the following cases:
- If the meniscus is torn or damaged by a knee injury;
- In case of injury to cartilage and ligaments;
- If the anterior or posterior cruciate ligament of the knee is torn or damaged;
- With inflammation or damage to the synovial membrane of the joint;
- With Baker's cyst;
- In the presence of bone fragments in the joint after injury;
- When cartilage is damaged;
- With dislocation or fracture of the patella;
- For severe joint injury.
Research using arthroscopy is carried out for chronic synovitis that does not respond to drug treatment for six months or more. It was shown that after removal of the synovial fluid, the destruction of cartilage was slowed down. Thus, it is possible to use arthroscopy to treat and prevent the destruction of connective tissue at an earlier date.
How is arthroscopic diagnosis of joints carried out?
Despite the minimal violation of the integrity of the organ, the procedure is still an operation, and before it is carried out, the patient's condition is necessarily examined.
Operational and anesthetic risks are assessed.
To fix the tissues during the operation, a special pneumatic turnstile is used in the patient's supine position. The knee (or other part of the body) is secured with a brace at an angle of 90 degrees. For the procedure, the orthopedic surgeon makes two small incisions in the skin. Saline is injected through one of the incisions to better open tissue and optimize visibility.
Then a special device in the form of a tube with a high-resolution micro-video camera is introduced. The camera displays the image on the monitor in the operating room.
The patient can see the state of the organ together with the surgeon, who uses endoscopes to diagnose it. The surgeon will find out where the damage to the ligament or synovium is located, if there are fragments of bones that interfere with movement, what is the current state of the anterior cruciate ligament, etc. At the end of the procedure, saline is removed from the joint, the incisions are sutured.
The operation is carried out mainly under general anesthesia with constant monitoring of the state of the patient's heart and his breathing. In case of intolerance to general anesthesia, the patient is given spinal anesthesia, when the patient watches the operation with open eyes, but does not feel pain. In this pain relief, anesthesia and antioxidants are administered to the patient through the lumbar vertebrae. This anesthesia is used for the lower extremities.
This technique is a very accurate method for diagnosing and treating a diseased joint, while damaging a minimum amount of tissue. With the help of the intervention, it is possible to completely and very accurately visualize the entire picture of damage in the tissues and to plan a more perfect tactics of conservative therapy / surgical treatment.
It is very useful to record the diagnosis on tape for further observation. Instant correction of the detected defects is considered a great advantage - then the diagnostic operation becomes a medical procedure.
With degenerative changes, the technique is used for the following purposes:
- Rehabilitation and lavage of the joint;
- Stimulation of the restoration of integumentary cartilage;
- Cartilage transplant.
Sanitation and lavage are designed to remove all damaged connective tissue structures, cartilage particles or inflammatory agents with a stream of water.
The second group of operations promotes the growth of integumentary cartilage using new medical technologies.
The third method is used to restore real hyaline cartilage by transplanting allogeneic or autogenous cartilage tissue onto the damaged surface.
Contraindications for arthroscopy
Arthroscopy is not performed in the presence of various kinds of inflammation and rashes on the skin in the area of the operation. Infectious arthritis is not currently a contraindication. Conversely, arthroscopy for infectious arthritis slows down the destruction of cartilage and improves joint mobility. The last, fourth stage of arthrosis becomes a contraindication to the intervention, due to the technical difficulties in carrying out such an operation.
Features of care after the procedure: rehabilitation
An important advantage of the method is the speed of rehabilitation and rare cases of developing complications. Isometric exercises and active limb movement are allowed immediately after the operation. Since the surrounding tissue was not affected, the joint quickly returns to its normal range of motion.
Full activity in the tissue is resolved after postoperative wound healing, in the absence of swelling and pain. Sometimes physiotherapy is prescribed to accelerate the regeneration of structures and relieve puffiness. Most patients return to normal life after knee synovectomy within 7-10 days.
The results of joint improvement after arthroscopy last from 3 to 5 years. Many rheumatologists have recorded remission in patients with rheumatoid arthritis within 2-3 years after arthroscopy. Given the minimal trauma and a small percentage of complications, synovectomy can be used for persistent synovitis that cannot be treated otherwise.
Possible complications after surgery
The comparative picture of complications of arthroscopy with other methods of treatment and diagnosis of this type is quite positive. Complications occur in 1-2 percent of cases. The most common complication in the postoperative period is joint hemorrhage, in second place in terms of incidence is the addition of an infection.
There are also anesthetic problems and thromboembolism, which occur 1 time in 1000 operations. There is also a risk of damage to the nerve, blood vessels, thrombophlebitis, stiffness and loss of range of motion, damage from being squeezed by a tourniquet. Patients are warned of all complications in preparation for the operation.
It should be understood that unauthorized treatment of rheumatic diseases almost always leads to disastrous consequences. You should not be afraid of the operation if a competent specialist has appointed it to you. Perhaps this is your only chance to relieve the condition and activate the healing processes.
Traditional methods of treatment are best used in combination, since they do not work by themselves. Do not run the disease and consult a competent doctor.
Only with a responsible attitude of the patient and a high category of specialist, the procedure becomes safe and effective.