Type of Surgery
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Last updated: 11/24/2009
There are many procedures that currently fall under the general surgical category of knee arthroscopy. They fall into roughly two groups—acute injuries that destabilize the knee, and pain management for floating or displaced cartilage and...
rough bone. Acute injuries are usually the result of traumatic injury to the knee tissues such as ligaments and cartilage through accidents, sports movements, and some overuse causes. Acute injuries involve damage to the mechanical features, including ligaments and patella of the knee. These injuries can result in knee instability, severe knee dislocations, and complete lack of knee mobility. Ligament, tendon, and patella placements are key elements of the surgery. The type of treatment for
acute injuries depends in large part on a strict grading system that rates the injury. For instance, grades I and II call for rest, support by crutches or leg brace, pain management, and rehabilitation. Grades III and IV indicate the need for surgery. Acute injuries to the four stabilizing ligaments of the knee joint—the anterior cruciate ligament (ACL), the posterior cruciate ligament (PCL), the medial collateral ligament (MCL), and the lateral collateral ligament (LCL)—as well as to the "tracking," or seating of the patella, can be highly debilitating.
Treatment of these acute injuries include such common surgeries as:
- Repairs of a torn ligament or reconstruction of the ligament.
- Release of a malaligned kneecap. This involves tendon surgery to release and fit the patella better into its groove.
- Grafts to ligaments to support smoother tracking of the knee with the femur.
Pain management surgeries, on the other hand, are used to relieve severe discomfort of the knee due to osteoarthritis conditions. These treatments aim at relieving pain and instability caused by more chronic, "wear and tear" kinds of conditions and involve minor and more optional surgical procedures to treat cartilage and bone surfaces. These include arthroscopic techniques to remove detached or obtruding pieces of cartilage in the joint space such as the meniscus (a fibrous cushion for the patella), to smooth aged, rough surface bone, or to remove parts of the lining of the joint that are inflamed.
Treatment distinctions between arthroscopic surgery for acute injuries and those for pain management are important and should be kept in mind. They have implications for the necessity for surgery, risks of surgery, complications, aftercare, and expectations for improvement. Arthroscopic surgery for acute injuries is less controversial because clear dysfunction and/or severe instability are measurable indications for surgery and easily identifiable. Surgery indications for pain management are largely for chronic damage and for the milder grades or stages of acute injuries (severity Grade I and II). These are controversial due to the existence of pain management and rehabilitation alternatives. Arthroscopic surgery for pain management is currently under debate.
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Athletes commonly tear or rupture the anterior cruciate ligament in the knee and require surgery to repair it. The narrator is this 3D animation explains how the patellar tendon is used to reconstruct the ACL.
Surgeons watching a monitor showing the inside of a patient's knee during arthroscopic knee surgery. (Custom Medical Stock Photo. Reproduced by permission.)
Step A shows the anatomy of the knee from the front with the leg bent. To repair a torn meniscus, three small incisions are made into the knee to admit laparoscopic instruments (B). Fluid is injected into the joint to aid in the operation. The injury is visualized via the instruments, and the torn area is removed (C). (Illustration by GGS Inc.)
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Arthroscopy (also called arthroscopic surgery) is a minimally invasive surgical procedure in which an examination and sometimes treatment of damage of the interior of a joint is performed using an arthroscope, a type of endoscope that is inserted into the joint through a small incision. Arthroscopic procedures can be performed either to evaluate or to treat many orthopaedic conditions including torn floating cartilage, torn surface cartilage, ACL reconstruction, and trimming damaged cartilage.
The advantage of arthroscopy over traditional open surgery is that the joint does not have to be opened up fully. Instead, only two small incisions are made - one for the arthroscope and one for the surgical instruments. This reduces recovery time and may increase the rate of surgical success due to less trauma to the connective tissue. It is especially useful for professional athletes, who frequently injure knee joints and require fast healing time. There is also less scarring, because of the smaller incisions. Irrigation fluid is used to distend the joint and make a surgical space. Sometimes this fluid leaks into the surrounding soft tissue causing extravasation and edema
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New procedures like minimally invasive procedures are often subject to scrutiny, but I think that one of the biggest problems facing these innovative procedures is for people to understand exactly what we do.
-Dr. Michael Perry, Laser Spine institute
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