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Arthroscopic / Key Hole Knee / Shoulder Surgery

Arthroscopy

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 orthopedic 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, for knee arthroscopy for example, only two small incisions are made — one for the arthroscope and one for the surgical instruments to be used in the knee cavity to fully remove the knee cap. 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.

The surgical instruments used are smaller than traditional instruments. Surgeons view the joint area on a video monitor, and can diagnose and repair torn joint tissue, such as ligaments and menisci or cartilage.

It is technically possible to do an arthroscopic examination of almost every joint in the human body. The joints that are most commonly examined and treated by arthroscopy are the knee, shoulder, elbow, wrist, ankle, foot, and hip.


Knee arthroscopy

Lateral meniscus located between thigh bone (femur, above) and shin bone (tibia, below). The tibial cartilage displays a fissure (tip of teaser instrument).

Knee arthroscopy has in many cases replaced the classic arthrotomy that was performed in the past. Today knee arthroscopy is commonly performed for treating meniscus injury, reconstruction of the anterior cruciate ligament and for cartilage microfracturing. Arthroscopy can also be performed just for diagnosing and checking of the knee; however, the latter use has been mainly replaced by magnetic resonance imaging.

During an average knee arthroscopy, a small fiberoptic camera (the arthroscope) is inserted into the joint through a small incision, about 4 mm (1/8 inch) long. A special fluid is used to visualize the joint parts. More incisions might be performed in order to check other parts of the knee. Then other miniature instruments are used and the surgery is performed.

Arthroscopic Shoulder Surgery

What is shoulder joint ?

Shoulder joint is the joint formed between the bone of the arm known as humerus and the upper arm girdle bone called the scapula. The collar bone or clavicle also forms an important part of the shoulder joint system .

What is arthroscopic shoulder surgery?
Arthroscopic surgery is performed through small incisions using a camera to visualize the inside of a joint. Through several small incisions (about 1 centimeter each) t a camera is inserted into one incision, and small instruments through the other incisions.

Is arthroscopic surgery better than traditional "open" surgery?
Open surgery, a procedure using larger incisions and enabling the surgeon to look inside the joint, may be better for certain procedures under certain circumstances.

Arthroscopic surgery has some advantages--smaller incisions, less tissue damage--but these are usually helpful if the overall procedure can be performed well. You need to discuss with your surgeon if a particular procedure can be done arthroscopically.

What conditions can be treated with arthroscopic shoulder surgery?


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Rotator Cuff Tears
Treatment of rotator cuff tears with shoulder arthroscopy is controversial. Some orthopedic surgeons treat all rotator cuff tears arthroscopically, some choose particular tears, and others treat them all open. There is no consensus which one is better. For more information about the procedure consult your surgeon .

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Shoulder Instability - Labral Tears - Slap Lesions
Labral tears, such as Bankart lesions and SLAP tears, are commonly treated with arthroscopy. It is very important that patients who have arthroscopic surgery for these procedures follow their post-operative rehab protocol very closely. Patients are often tempted to do too much too soon!

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Impingement Syndrome
Patients with impingement syndrome that is not cured with conservative treatments may consider a procedure called an arthroscopic subacromial decompression. This procedure removes the inflamed bursa and some bone from the irritated area around the rotator cuff tendons. By removing this tissue, more space is created for the tendons and the inflammation often subsides.

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Biceps Tendonitis
The biceps tendon can become irritated and inflamed as an isolated problem or in association with problems such as impingement syndrome and rotator cuff tears. When the biceps tendon is damaged and causing pain, a procedure called a biceps tenodesis can be performed. This procedure usually causes no functional difference, but often relieves symptoms.

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Frozen Shoulder
Frozen shoulder seldom requires operative treatment, and treatment for many months or years is often necessary before considering operative treatment. When frozen shoulder must be treated surgically, it is of utmost importance to begin aggressive physical therapy immediately following surgery. Without this, it is likely the problem will return.

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AC Joint Arthritis
The AC joint, or acromioclavicular joint, is occasionally affected by arthritis. When arthritis of the AC joint is severe, the end of the clavicle (collarbone) can be removed. By removing the damaged joint, the symptoms of AC arthritis are often relieved.

What is the recovery from shoulder arthroscopy?
The recovery depends on what type of surgery is performed. One of the problems with shoulder arthroscopy is that the procedure hurts much less than open shoulder surgery, and therefore patients may tend to do too much, too soon. It is very important that you only perform activities that your surgeon recommends following a shoulder arthroscopy. Even though your shoulder may feel fine, you need to allow time for repaired tissues to adequately heal. This is especially important for patients who have rotator cuff repairs and labral repairs.

Knee Arthroscopy?
Description

Arthroscopy is done through small incisions. During the procedure, your orthopaedic surgeon inserts the arthroscope (a small camera instrument about the size of a pencil) into your knee joint. The arthroscope sends the image to a television monitor. On the monitor, your surgeon can see the structures of the knee in great detail.

Your surgeon can use arthroscopy to feel, repair or remove damaged tissue. To do this, small surgical instruments are inserted through other incisions around your knee.



Preparing for Surgery

Arthroscopic picture of torn anterior cruciate ligament [yellow star].

Before surgery, tell your orthopaedic surgeon about any medications or supplements that you take. He or she will tell you which medicines you must stop taking before surgery.

To help plan your procedure, your orthopaedic surgeon may order pre-operative tests. These may include blood counts or an EKG (electrocardiogram).

Surgery
Almost all arthroscopic knee surgery is done on an outpatient or Day Care Surgery basis.

Anesthesia
When you first arrive for surgery, a member of the anesthesia team will talk with you. Arthroscopy can be performed under local, regional, or general anesthesia.

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Local anesthesia numbs just your knee.

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Regional anesthesia numbs you below your waist.

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General anesthesia puts you to sleep.

The anesthesiologist will help you decide which method would be best for you.

If you have local or regional anesthesia, you may be able to watch the procedure on a television monitor.

Procedure
The orthopaedic surgeon will make a few small incisions in your knee. A sterile solution will be used to fill the knee joint and rinse away any cloudy fluid. This helps your orthopaedic surgeon see your knee clearly and in great detail.

Your surgeon's first task is to properly diagnose your problem. He or she will insert the arthroscope and use the image projected on the screen to guide it. If surgical treatment is needed, your surgeon will insert tiny instruments through another small incision. These instruments might be scissors, motorized shavers, or lasers.

This part of the procedure usually lasts 30 minutes to over an hour. How long it takes depends upon the findings and the treatment necessary.

Arthroscopy for the knee is most commonly used for:

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Removal or repair of torn meniscal cartilage.

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Reconstruction of a torn anterior cruciate ligament.

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Trimming of torn pieces of articular cartilage.

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Removal of loose fragments of bone or cartilage.

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Removal of inflamed synovial tissue.

Your surgeon may close your incisions with a stitch or steri-strips (small bandaids) and cover them with a soft bandage.

You will be moved to the recovery room and should be able to go home within 1 or 2 hours. Be sure to have someone with you to drive you home.

Recovery
Recovery from knee arthroscopy is much faster than recovery from traditional open knee surgery. Still, it is important to follow your orthopaedic surgeon's instructions carefully after you return home. You should ask someone to check on you the first evening you are home.

Swelling

Keep your leg elevated as much as possible for the first few days after surgery. Apply ice as recommended by your doctor to relieve swelling and pain.

Dressing Care
You will leave the hospital with a dressing covering your knee. Keep your incisions clean and dry. Your surgeon will tell you when you can shower or bathe, and when you should change the dressing.

Your surgeon will see you in the office a few days after surgery to check your progress, review the surgical findings, and begin your postoperative treatment program.

Bearing Weight
Most patients need crutches or other assistance after arthroscopic surgery. Your surgeon will tell you when it is safe to put weight on your foot and leg. If you have any questions about bearing weight, call your surgeon.

Driving
Your doctor will discuss with you when you may drive. This decision is based on a number of factors, including:

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The knee involved.

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Whether you drive an automatic or stick shift.

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The nature of the procedure.

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Your level of pain.

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Whether you are using narcotic pain medications.

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ow well you can control your knee.

Typically, patients are able to drive from 1 to 3 weeks after the procedure.

Medications
Your doctor will prescribe pain medication to help relieve discomfort following your surgery. He or she may also recommend medication such as aspirin to lessen the risk of blood clots.

Exercises to Strengthen Your Knee

You should exercise your knee regularly for several weeks after surgery. This will restore motion and strengthen the muscles of your leg and knee.

Therapeutic exercise will play an important role in how well you recover. A formal physical therapy program may improve your final result.

Outcome
Unless you have had a ligament reconstruction, you should be able to return to most physical activities after 6 to 8 weeks, or sometimes much sooner. Higher impact activities may need to be avoided for a longer time. You will need to talk with your doctor before returning to intense physical activities.

If your job involves heavy work, it may be longer before you can return to your job. Discuss when you can safely return to work with your doctor.

The final outcome of your surgery will likely be determined by the degree of damage to your knee. For example, if the articular cartilage in your knee has worn away completely, then full recovery may not be possible.You may need to change your lifestyle. This might mean limiting your activities and finding low-impact exercise alternative.

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