Arthroscopic science knowledgeⅠ-Knee injury
What is arthroscopic surgery?
An arthroscope is a “chopstick” tube containing a set of optical fibers that transmit light into the joint and a lens that transmits images from inside the joint. Outside the joint, the optical fibers are connected to the cold light generator through a fiber optic cable, and the lens is connected to the monitor through a cable with a photoelectric conversion device. With this system, the cold light illuminates the inside of the joint, and the doctor can view the various tissues inside the joint through the monitor, just like watching a live TV broadcast. This system of cold light source, fiber optic cable, lens, cable and monitor is the arthroscope.
During an arthroscopic procedure, the surgeon makes a small incision about 5-10 mm long in the joint space to insert the arthroscope into your joint so that the surgeon can get a good view of the condition inside your joint. In addition, a small incision is made in another location to insert additional instruments to identify the lesion and treat the damage.
How do you perform an arthroscopic procedure?
Before the procedure, your surgeon or anesthesiologist will discuss the choice of anesthesia with you, and your informed consent is required.
Once the anesthesia has taken effect, your surgeon will sterilize your joint and place a sterile sheet. With muscle relaxation after anesthesia, your surgeon will examine your joint again to further confirm the diagnosis.
When your surgical site is numb or you have fallen asleep, your surgeon uses the bony anatomical landmarks on the surface of your joint to select the correct location for the arthroscopic procedure. Several small 5-10mm incisions are then made in your joint area, and through these access points, the surgeon begins the procedure for you. During the procedure, the surgeon will look at your joint on a monitor, identify the lesion, treat the damage, and repair or even reconstruct it. Some joints include multiple chambers, and a full examination and thorough cleaning may require more than three small incisions.
After the arthroscopic procedure is completed, several small incisions are closed and dressed with a dressing. Because the incisions are small, they usually heal in about a week.
After the procedure your joint may be braced, too high, and sometimes ice packs are placed on the joint to reduce pain and prevent joint swelling.
What are the advantages of arthroscopic surgery?
1. Clear observation. Arthroscopy allows dynamic observation of the lesions in the joint in a near physiological state, and certain diseases must be diagnosed under arthroscopy.
2. Fine surgery, which can preserve the physiological tissue structure intact and limit the joint trauma to a minimum by targeted surgery.
3. Minimally invasive surgery, small skin incision, small surgical incision, ligaments around the joint, joint capsule and cutaneous nerve from damage.
4.Less pain, small skin scars and beautiful.
5.Little surgical damage, less bleeding, less pain for the patient, and fast recovery after surgery.
6.Faster recovery of joint function after surgery, early activity on the ground, and less complications.
7.Short hospital stay, reduced medical costs, 2-3 days after surgery can get up and move around, early return to work.
Composition of the knee joint
The knee joint is the most complex motor joint, which functions like a hinge. The knee joint consists primarily of the two major bony ends of the tibia and femur, connected by muscles, tendons, ligaments and a joint capsule wrap. These connecting structures provide the knee joint with stability and flexibility of movement. The other bone that makes up the knee joint is the patella, also known as the knee.
Articular cartilage is a special layer of tissue that covers the ends of the femur and tibia and the back of the patella, forming the smooth surface of the joint. The articular cartilage bears weight and when broken can easily lead to arthritis.
The meniscus is a spacer of cartilage that evenly distributes the pressure between the femur and tibia, providing cushioning and stability to the knee joint, among other things.
The ligament is a strong structure that connects the femur to the tibia and stabilizes the knee joint.
The muscles and tendons encircle the knee joint and provide stability as well as support and control of joint motion.
What procedures can be performed with knee arthroscopy?
1, diagnostic knee arthroscopy: including examination of knee disorders with unclear clinical diagnosis, biopsy of intra-articular lesions, diagnostic confirmation prior to open surgery, and preoperative evaluation of total knee replacement or high tibial osteotomy for unicompartmental osteoarthritis to obtain visual information about the condition.
2. total resection, subtotal resection, partial resection, suturing and disc meniscoplasty for meniscal injury and degeneration; 3. repair or reconstructive surgery after cruciate ligament injury
4, patellofemoral joint lesions caused by patellar subluxation or subluxation with release of the lateral support band and tightening and suturing of the medial support band.
5, synovial chondromatosis and other causes of intra-articular free body (joint rat) or intra-articular foreign body removal; 6, osteoarthritis joint washout and joint cleaning and cartilage scraping, drilling and shaping.
7, synovial biopsy and synovectomy for various different types of synovitis, including rheumatoid arthritis and other synovial lesions, and synovial rugosal resection.
8, repositioning and internal fixation of exfoliative osteochondritis or intra-articular fractures.
Knee joint diseases
(i) Meniscal injury
Meniscus injury is one of the most common sports injuries. Younger patients often suffer meniscal tears due to knee sprains or falls, while middle-aged and older patients suffer tears due to physiological degeneration of the meniscus, which makes it brittle and can sometimes be caused by everyday actions without obvious trauma, such as squatting.
The most significant symptom of a meniscus tear is walking pain, sometimes accompanied by intra-articular popping or interlocking. A detailed history, symptoms and careful physical examination can make the initial diagnosis of a meniscal tear. When available, a magnetic resonance imaging (MRI) should be performed to aid in the diagnosis.
Conservative treatment of meniscal tears is limited to acute marginal vertical longitudinal tears of 5 mm or less or incomplete tears at the joint capsule junction, which were previously immobilized in a long-leg cast for 4-6 weeks and are now also immobilized with a brace. However, the vast majority of meniscal tears do not heal on their own and require surgical treatment. If symptoms persist, surgery is necessary. Minimally invasive arthroscopic surgery is now used, and the functional recovery after surgery is so dramatic that patients can often walk immediately, and our patients (except those with meniscal stitches) can usually walk out of the hospital on their own the day after surgery. However, patients with chronic tears need 2-3 months of muscle rehabilitation to gradually increase joint stability. Without surgery, one is symptomatic and affects the quality of life; two, the torn meniscal flap will quickly wear away the articular cartilage surface and cause osteoarthritis; three, each painful episode is a pull on the meniscus, which will aggravate the extent of the meniscal tear and lose the opportunity for possible meniscal suture; four, the painful symptoms will lead to reduced activity of the affected knee and suppression of the surrounding muscles, reducing joint stability and further causing symptoms and joint degeneration, creating a vicious cycle.
Many patients are concerned that the meniscus will be removed after surgery and will affect their daily life in the future. There is no doubt that meniscectomy will have an impact on the joint and the loss of the meniscus cushion will accelerate the degeneration of the articular cartilage, but, firstly, partial resection is usually done nowadays and no one will go for full resection anymore, which will minimize the impact on the joint. This chance is very small (about 10%), even if the meniscus can not be sutured, it is possible to retain as much meniscal tissue as possible; finally, whether you can resume normal vigorous activity after surgery depends largely on postoperative rehabilitation, we do professional athletes meniscal injury, the same can continue professional sports career after surgery, but if the long period of reduced activity of the affected knee, it will cause the entire knee around the muscles, the contracture and atrophy of soft tissues such as ligaments, leading to increased difficulty in post-operative rehabilitation.
Therefore, the pain of the knee joint must not be avoided, but must be seen by a specialist early to rule out the possibility of meniscal injury to avoid more serious sequelae.
(ii) Anterior Cruciate Ligament Injury
Injuries to the anterior cruciate ligament of the knee can lead to degenerative knee osteoarthritis due to abnormal dynamic changes in the joint. Some studies have shown that knees with chronic ACL defects have a fairly high chance of meniscal rupture and cartilage damage, and inevitably degeneration of the knee joint will occur.
ACL injuries are not a new disorder in the field of orthopedic sports medicine, but it is the development of sports medicine that has led to the development and advancement of ACL injury therapeutics. It is no exaggeration to say that the advances in the technical approach to surgical treatment of ACL injuries over the past two decades have distilled the essence of recent developments in sports medicine and related disciplines.
Due to the increasing emphasis on the mechanical function of the ACL and the functional instability caused by the injury, the impact on the structure and function of the knee joint is gradually being recognized. Those with “functional instability” of the knee joint that is not adequate for life and sports after ACL injury should be treated surgically.
Surgery after ACL injury can be traced back to a long time ago, with “ligamentous end sutures”, “extra-articular dynamic reconstruction”, “extra-articular static reconstruction”, “intra-articular reconstruction”, etc. “Intra-articular reconstruction” and so on.
Modern scientific research proves that due to the poor blood supply of the ACL, it is difficult to ensure the healing of the ligament by suturing the ligament severed ends, and the poor mechanical properties of the scar-repaired ligament cannot meet the function of stabilizing the knee joint. And the normal tension of the ACL is difficult to be achieved by open surgical sutures. Therefore, the method of suturing the severed end after ACL injury has now been abandoned, whether it is open surgery or arthroscopic surgery.
In addition, extra-articular power reconstruction or static reconstruction, which are complicated surgical operations, do not conform to the original ACL biomechanical properties, and the results are mostly unsatisfactory.
At present, in the field of orthopedic sports medicine, intra-articular anatomical reconstruction after ACL injury has basically become a consensus. Moreover, the vast majority of doctors emphasize and advocate arthroscopic reconstruction in order to restore the injured person’s athletic ability and competitive level as much as possible with minimal surgical trauma by means of minimally invasive surgery.
(iii) Patellar dislocation
Habitual patellar dislocation refers to the dislocation of the patella from the femoral trochlea during activity and often occurs in adolescents. Although habitual patellar dislocation is not very common in sports injuries, it is easy to be misdiagnosed or missed in the clinical diagnosis because the patella can reset itself after dislocation.
In the past, treatment of acute patellar dislocation was limited to 3-4 weeks of immobilization in a long-legged cast brace, but simple conservative treatment prevented good healing of the torn medial stabilizing structures of the patellofemoral joint, resulting in later relaxation of the medial stabilizing structures and easily causing habitual patellar dislocation. Therefore, surgical treatment immediately after acute dislocation to repair the torn medial stabilizing structures of the patellofemoral joint in situ, along with the management of concomitant other injuries, such as free bodies formed by cartilage injury and knee hematomas, has been increasingly accepted by sports medicine physicians. Several clinical studies have demonstrated that compared with conservative treatment, surgical treatment can substantially improve patients’ postoperative quality of life and subjective satisfaction, reduce the possibility of postoperative patellar re-dislocation, and minimize the impact of acute patellar dislocation on the knee joint.