As arthroscopy equipment, techniques, and surgical skills have improved, the role of arthroscopy in diagnosing and managing various knee pathologies has expanded.
Regardless of the planned arthroscopy procedure, the surgeon should perform at least quick diagnostic arthroscopy. Performing the examination methodically helps to avoid missed pathology.
1.Synovectomy in the Knee: Synovium is specialized mesenchymal tissue that is essential to proper join function. Synovial disorders comprise various conditions that can affect multiple joins. These vary from the massive, total joint involvement of rheumatoid arthritis to the isolated lesion of plicaArthroscopic synovectomy has proved to be effective in patients with rheumatic arthritis, reducing both pain and swelling.
Complication: include recurrent hemarthrosis requiring aspiration, and join stiffness.
2.Meniscus: Arthroscopy Meniscectomy: the meniscus is a semicircular fibro cartilaginous structure with bony attachments at its anterior and posterior aspects to the tibial plateu. Indications for surgery include; daily symptoms of meniscal injury that can affect sports or activities of daily living or work, physical findings consistent with meniscal tear, failure of no operative management, and absence of other causes of knee pain. Almost all meniscal tears should be managed with Meniscectomy, with the following exceptions: short, stable, vertical longitudinal tears(<10cm), stable partial-thickness tears (<50% of meniscal thickness), and small radial tears (<3cm).
Results: Arthroscopy has had a tremendous impact on the ability to treat meniscal injuries while reducing morbidity. Meniscal repair has been shown to be successful in healing the tear and retaining the meniscus.
Complications: as with other surgeries, potential complications include infection, bleeding, arteriovenous fistula and nerve injury.
3.Cartilage: Debridement and Micro fracture of Articular Cartilage in the Knee: articular cartilage is vulnerable to irreversible traumatic injury and degenerative disease. Damaged articular cartilage has a limited ability to heal without intervention owing to two primary factors: lack of a vascular response, and relative absence of an undifferentiated cell population to respond to injury. The surgical management of articular cartilage defects is based on several underlying principles, including the reduction of symptoms and prevention of additional cartilage damage.
Debridement: palliative procedures such as debridement are reserved for lower demand patients with incidentally discovered chondral lesions or those with small lesions (<2cm to 3cm).
Micro fracture: can be used for patients with small to moderate sized lesions (1cm to 5cm). This technique is used to stimulated fibro cartilage ingrowths into the chondral defect.
Complications: the most common complication is incomplete resolution of symptoms or recurrence pain.
4.Anterior Cruciate Ligament, Hamstring Tendons for ACL Reconstruction: Injury to the anterior cruciate ligament can be desvasting. It generally occurs in younger patients, and misdiagnosis, delayed diagnosis, recurrent injury, and improper surgical technique may leave a teenage athlete with a knee that is destined to devoped premature arthritis. The importance of using high – strength and high – stiffness fixation devices, such as the bone mulch screw and washerloc combination with hamstring grafts, is supported by clinical studies. These types of devices stabilized nearly all knees. The use of hamstring tendons secured with the bone mulch screw and washerloc provides fixation construct with biomechanical properties superior to those of interference screw fixation using both hamstring and patellar tendon grafts.
Surgical Consideration and Indication:
- Active lifestyle
- Hard-Cutting decelerating sports
- Associated repairable meniscal tear
- Recurrent instability
- Social Consideration
5.Posterior Cruciate Ligament, Diagnosis and Decision Making: PCL injury may occur as an isolated injury or in combination with other knee ligament injury or pathology. Isolated PCL injury may have minimal swelling and pain. The most common mechanism of injury to the PCL is an anterior blow to the proximal tibia. Hyper flexion is the most common cause of PCL injury in sports. Primary repair of midsubstance PCL tears has not been consistently successful, however, PCL avulsions (bony or ligamentous) can typically be repaired with good results.
Total Knee Replacement
Your doctor may recommend knee replacement surgery if you have severe knee pain and disability from rheumatoid arthritis, osteoarthritis, or traumatic injury. A knee replacement can relieve pain and help you live a fuller, more active life.
During the surgery, a surgeon will replace your damaged knee with an artificial device (implant). Although replacing the total knee joint is the most common procedure, some people can benefit from just a partial knee replacement.
Implants are made of metal alloys, ceramic material, or strong plastic parts, and can be joined to your bone by acrylic cement. There are many different types of implants. Your surgeon will discuss with you the type of implant that best meets your needs.
A knee replacement (also called knee arthroplasty) might be more accurately termed a knee "resurfacing" because only the surface of the bones are actually replaced.
There are four basic steps to a knee replacement procedure.
Prepare the bone. The damaged cartilage surfaces at the ends of the femur and tibia are removed along with a small amount of underlying bone.
Position the metal implants. The removed cartilage and bone is replaced with metal
Resurface the patella. The undersurface of the patella (kneecap) is cut and resurfaced with a plastic button.
Insert a spacer. A medical-grade plastic spacer is inserted between the metal components
The knee has three compartments: an inside (medial), outside (lateral), and a front (patellar) compartment for the kneecap. Most often, it is the medial or inside compartment that becomes affects by arthritis. If the other compartments have healthy, normal cartilage, a unicompartmental (partial) knee replacement may be performed.
Partial Knee Resurfacing is an innovative a procedure designed to improved surgical outcome for patients with osteoarthritis in only one surface of the knee and possibly provides quicker recovery.
- Material Criteria
- The construction materials used must meet several criteria:
- They must be biocompatible
- They must be able to duplicate the knee structures they are intended to replace
- They must be able to retain their strength and shape for a long time.