1.The history of arthroscopy
In 1918, Tagaki in Japan was the first to use a cystoscope to deafen a cadaveric knee joint, thus pioneering the use of an endoscope to examine structures in the body through an unnatural orifice and through the surgical population, and thus Tagaki is recognized as the first person to pioneer the history of arthroscopy. Thus, arthroscopy itself has its roots in endoscopy, just as gastroscopy and colonoscopy are now commonly referred to. As arthroscopic techniques became more widespread in the 1970s, improvements to the arthroscope and its operating system continued to be made, leading to an expansion of the field of application of arthroscopy. With the accumulation of experience and increased awareness, arthroscopic techniques have evolved. Today, arthroscopy is no longer just an adjunct to joint examination, but an essential component in the diagnosis and treatment of joint diseases.
2. What can knee arthroscopy do?
(1) Diagnostic examination of the knee joint, including examination of knee disorders with unclear clinical diagnosis, sampling of diseased intra-articular tissue, and preoperative evaluation of intra-articular knee surgery.
(2) Excision, repair or suturing of meniscal injuries and ruptures, and discoid meniscoplasty.
(3) synovial tissue sampling and synovectomy for various types of synovitis, including rheumatoid arthritis, etc.
(4) joint cleaning and irrigation and drainage for septic arthritis.
(5) Focal debridement for knee tuberculosis.
(6) Treatment of synovial and fat pad lesions.
(7) Removal of intra-articular free bodies and foreign bodies.
(8) joint irrigation and cleaning for osteoarthritis (degenerative joint lesions), as well as articular cartilage repair and trimming
(9) Resetting and internal fixation of intra-articular fractures.
(10) Reconstruction of cruciate ligament injuries.
(11) treatment of lateral patellar dislocation
(12) Removal of gout crystals from the knee joint.
3.What are the characteristics of knee arthroscopy?
Small wound, generally under 0.5 cm; less interference and lighter reaction in the joint; higher diagnosis rate and more delicate and reasonable treatment; less complications and sequelae and faster recovery of knee function.
4. How much scarring will be left by knee arthroscopy and does it affect the aesthetics?
For most lesions in the knee joint, knee arthroscopy only requires 2-3 standard incisions. These are usually 2 incisions on either side of the patellar ligament below the patella, known professionally as the anterolateral approach and the anteromedial approach, and are about the size of the head of a chopstick. Through these 2 incisions, lenses and instruments are inserted into the joint cavity for diagnosis and surgery, and after surgery, the wound only requires 1 stitch or intradermal suture, leaving only a very small scar after healing, sometimes smaller than the skin of a fall, which basically does not affect the aesthetics.
5.Will the meniscus injury or rupture affect the function of the knee joint after surgery?
The need for surgery after a meniscus injury or rupture is a matter of weighing the pros and cons and evaluating the degree of maintenance and improvement of knee function. If the meniscus rupture is large, the knee joint has significant pain and/or frequently the ruptured meniscus is embedded in the joint causing interlocking, due to the structural characteristics of the meniscus itself the possibility of self-healing is very low, most of them will tear more and more heavily, resulting in the reduction of the residual part of the meniscus, at the same time the embedded meniscus fragments will destroy the articular cartilage in the joint like a bead caught in a bearing, causing early or accelerated knee joint degenerative changes; in this case, meniscus surgery is required. If the meniscal rupture is small or only mildly worn, removal of part of the meniscus will increase the stress on the articular cartilage at the site of removal, which in turn will aggravate the degenerative changes in the knee. There is blood supply around the edge of the meniscus, and a rupture here has the potential to heal with surgical suturing, which is more conducive to protecting the function of the knee joint.
6. How is arthroscopic surgery of the knee done for meniscal injury or rupture?
Given the important function of the meniscus in the knee joint and the significant impact of meniscectomy on the progression of degenerative joint changes, the principle of surgery for meniscal rupture is to preserve as much normal, stable meniscal tissue as possible. The type of rupture is an important factor in considering whether to revise or repair. Barrel stem-like ruptures and vertical longitudinal ruptures have a tendency to self-replace and stabilize and may be considered for repair; horizontal, radial, lamellar, complex and degenerative ruptures are difficult to heal and partial excision is the most common treatment. For disc meniscus, meniscus revision is performed directly.
7.How to rehabilitate after meniscus arthroscopy?
The rehabilitation exercises after meniscal arthroscopy vary from person to person and from disease to disease. Younger people and those with milder lesions will recover faster; those with combined cartilage degeneration should slow down their rehabilitation exercises. The following rehabilitation program may be different in time, but the sequence and contents are the same.
(1) Post meniscectomy knee rehabilitation program
1-2 days postoperatively Move the patella with the thumb and index finger, do up and down extension and flexion of the ankle, do leg lifts and ice the knee.
3-14 days after surgery Continue the above exercises, do knee extension and flexion exercises to promote muscle strength recovery.
2-3 weeks after surgery Gradual weight-bearing of the affected limb and gradual return to daily life
Six months after surgery, gradually resume sports.
(2) Knee rehabilitation program after meniscus suture surgery
Within 3 weeks after surgery Knee brace immobilization, use thumb and index finger to move patella, ankle up and down extension and flexion activities, leg lifting activities, knee icing.
After 3 weeks of surgery, knee flexion and extension activities, no more than 90 degrees of flexion for 4 weeks, avoid weight-bearing activities for 6 weeks.
Six months after surgery, resume sports
8.How do I see a doctor if I have a meniscus injury and need surgery?
(1) The patient should bring the records of previous visits and various tests; remember, if X-rays and MRIs have been done, make sure to bring the films (each doctor’s reading will be different); the doctor can make a comprehensive assessment.
(2) Adults and children are different, usually with a cut-off at 18 years of age; pediatric patients should go to a specialized orthopedic department of a children’s hospital.
(3) If surgery is required, an inpatient appointment is usually required at a tertiary care hospital.
(4) The hospital stay for surgery is usually 3-5 days; for younger patients with simple meniscal rupture and no degenerative knee pathology, the hospital stay can be shortened; while for older patients with other knee pathologies, the hospital stay may be longer.