I. What is arthroscopic surgery
An arthroscope is an endoscope that looks like a pencil and is only 5 – 6 mm thick in diameter. The arthroscopy is performed by making a small incision of less than 1 cm in the skin and inserting the arthroscope into the joint. A micro-camera is attached to the back of the arthroscope, which displays the situation inside the joint clearly on the fluorescent screen of a TV. The arthroscope allows for a closer look inside the joint and direct and accurate detection of the lesion.
Since 2006, our department has been using arthroscopy to examine and treat diseases of the knee, shoulder and ankle joints, and we have accumulated a lot of experience. In particular, damage to the synovial membrane, cartilage discs, ligaments and articular cartilage surfaces in the joints are often difficult to detect on X-ray, but can be seen at a glance under arthroscopy. Arthroscopy is not only used for examination of the joint, but also allows minimally invasive surgery to be performed immediately after the lesion is detected, without the need for additional large incisions in the vast majority of patients.
II. Brief description of knee arthroscopy.
1. Meniscal injury: This is the most common trauma that causes knee pain and interlocking after a sprain. Arthroscopy allows for a clear view of the meniscal injury, which can determine the choice of partial resection, subtotal resection, and total resection. For adolescent meniscus repair, disc meniscoplasty can only be performed arthroscopically.
2. Free body: The importance of arthroscopic surgery is not only to remove the free body through a small incision, but more importantly to find the cause of free body formation and to treat the identified cause to prevent the re-formation of free body.
3.Synovitis: Arthroscopic synovectomy is suitable for the early stage of synovitis, the postoperative pain is much lighter compared with the surgery to open the joint, the chance of joint adhesions is also less, and the joint activity function is recovered quickly. Even if the synovitis recurs in the future, the operation can be repeated.
4.Osteoarthrosis: It is suitable for early and mid-stage osteoarthrosis, especially for those with joint interlocking. Through arthroscopy, the damage to the cartilage surface of the joint can be clearly seen, and the cartilage surface can be repaired, the broken meniscus and cartilage can be removed, the free body can be removed, and the bone flab that prevents joint movement can be ground. This provides relief of symptoms. The damage to the articular cartilage surface is also properly evaluated.
5, synovial crease syndrome, fat pad extrusion syndrome: knee pain in not always meniscal and cartilage damage, such as synovial crease syndrome, fat pad extrusion syndrome and other conditions, these lesions with the doctor’s experience in touch examination and X-ray examination is often difficult to determine. However, dynamic examination under arthroscopy provides accurate diagnosis. And can make the corresponding treatment
6, anterior and posterior cruciate ligament injury: in sports injuries are not uncommon. And often combined with other injuries in the knee joint. Arthroscopic reconstruction of the anterior and posterior cruciate ligaments of the knee while dealing with other intra-articular lesions is an important development in arthroscopic surgery technology in the last decade.
7. Patellofemoral joint disorders: These include lateral patellar extrusion syndrome, which can be treated arthroscopically by releasing the lateral support band. For patellar subluxation or recurrent dislocation, arthroscopic release of the lateral support band, small incision reconstruction of the medial patellofemoral ligament and tibial tuberosity osteotomy can be performed.
Arthroscopic surgery of other joints is also very effective. For example; synovitis of the ankle joint, joint free body and traumatic arthritis. Synovitis, glenoid labral tear, subacromial extrusion syndrome and joint free body of shoulder joint.
Advantages of arthroscopic surgery
The main advantages of arthroscopic surgery are as follows.
①Arthroscopy is a minimally invasive surgery. The delicacy of arthroscopic surgery refers not only to the delicacy of the surgical instruments used, but also to the delicacy of the cutting operation. It can preserve the physiological function of the tissue structure intact and limit the joint trauma to the minimum;
②Arthroscopy allows dynamic observation of how the lesions in the joint produce symptoms during joint movement, as opposed to not being able to detect the cause of the lesions after the joint has been cut open. Currently, many joint diseases are only recognized by the medical community after arthroscopy is available;
③Small skin scars after surgery, which have little impact on aesthetics. The postoperative pain is also relatively mild. Bed rest and hospitalization time are short;
④More importantly, the function of the joint can be restored sooner after the surgery, and the joint can be moved to the ground earlier, so that some common complications after joint surgery can be reduced, such as joint adhesions, muscle atrophy, phlebitis and blood clots, and wound infection.
Fourth, what are the possible complications of arthroscopic surgery
Do not think that arthroscopic surgery is a minor operation, because it requires meticulous manual skills, extensive experience and good patience to avoid additional trauma. The same procedure can be performed in a much shorter time if the joint is opened. However, the patient will benefit the most from choosing the best procedure now for his or her future benefit.
Fluid and blood accumulation in the joint, and short-term swelling of the joint, are extremely common, and placement of plastic drains reduces the chance of this complication, but still cannot be completely avoided. In some cases, the fluid accumulation has to be aspirated by arthrocentesis for final resolution.
Infection is a possible complication of every surgical procedure, and to reduce the chance of infection, antimicrobials are usually used routinely for 3 days after surgery.
Phlebitis, which causes swelling in the lower leg, is thrombosed and related to many factors. For example, obesity, viscous blood, etc., as well as localized pressure bandaging of the knee joint to stop bleeding, which prevents the return of blood.