Arthroscopy Of The Knee

Arthroscopy of the Knee: How Is The Procedure Done?

Arthroscopic surgery is generally done on an outpatient basis, allowing you to go home a few hours after surgery. However, following ACL reconstruction, you may stay in the hospital an extra day.

Preparing for arthroscopy

The operation

Preparing For Arthroscopy

Depending on your age, certain preoperative tests will be arranged, such as blood tests, urine tests, chest x-ray, and EKG.

  • For an ACL reconstruction, leg measurements may be taken to order a knee brace. Your rehabilitation program will be discussed in detail with you.
  • You may meet the anesthesiologist, who may offer you a choice of anesthesia:
    • If you choose a general anesthetic, you will be asleep during the procedure.
    • If you choose an epidural, an injection is given into the back that numbs the lower half of the body. This wears off a couple of hours after surgery.
    • If you chose a local anesthetic, you will receive injections of a local painkiller in the knee and surrounding areas.

    If you have an epidural or local anesthesia, you can often watch the whole operation on the television monitor as seen through the arthroscope.

Need To Know:

  • If you take aspirin, anti-inflammatory drugs, or blood thinners, you should stop taking them one week before surgery to minimize bleeding. Discuss this with your doctor. Also, beware of certain homeopathic supplements that may interact with anesthetic agents.
  • You should not eat or drink anything (even water) for eight hours before surgery. This usually means not eating or drinking anything after midnight the night before surgery.
  • If you would normally be taking medication during the hours before surgery, talk to your doctor.

Need To Know:

What to tell your doctor

Be sure to tell your doctor:

  • If you are allergic to iodine, penicillin, or any other drugs
  • What medications you take
  • About your past medical history
  • If you have ever had deep vein thrombosis or other blood clotting abnormalities

    For more information about deep vein thrombosis, go to Deep Vein Thrombosis.

Also tell your doctor if you develop any of these symptoms prior to surgery:

  • Fever or chills
  • Irritation of the eyes, ears, throat or gums
  • Sniffling or sore throat
  • Boils or inflamed skin abrasions and cuts

The Operation

After the chosen anesthetic has been administered, the leg is thoroughly cleaned, usually with an iodine-based solution. A tourniquet may be placed around the thigh.

A tiny incision is made on the outer side of the knee about level with the lower end of the knee cap. The arthroscope is then gently introduced into the knee, so the surgeon can see the inside of the knee on the TV monitor.

Another small incision is then made on the inner side of the knee to allow the surgeon to insert specialized instruments.

  • If the meniscus is torn: the torn flap or segment is carefully trimmed away, leaving a smooth edge. However, if the tear is on the outer side of the meniscus, where the blood supply is better, it is possible to repair the tear using specialized sutures.
  • If the anterior cruciate ligament is completely torn: an additional two-inch incision will be required to remove either the patella tendon or hamstring tendon to create a new cruciate ligament. Tunnels are drilled in the tibia and femur through which the new ligament is passed. The ligament is then anchored firmly to the bone, usually with screws at either end.

    For more information about ACL tears, go to ACL Tears.

  • If a loose body is found, treatment may vary. If it is truly loose and floating around the joint, it can be easily removed. If it is still partially attached, it can be gently pushed back into place and held with a specialized screw.
  • If the problem is arthritis or chondromalacia, the roughened surface may be smoothed with power instruments. The surgeon will also remove any bits of bone or cartilage floating in the joint.

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