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    Knee

Knee Arthroscopy

If you have persistent pain, clicking, catching, locking or swelling in your knee, a procedure known as arthroscopy may help relieve these problems. .

Arthroscopy allows an orthopaedic surgeon to diagnose and treat knee disorders by providing a clear view of the inside of the knee with small incisions, using a pencil-sized instrument called an arthroscope. The scope allows transmission of an image of your knee through a small camera to a television monitor. The image allows the surgeon to thoroughly examine the interior of the knee and determine the source of the problem. During the procedure, the surgeon also can insert surgical instruments through other small incisions in your knee to remove or repair damaged tissues.

With improvements of arthroscopes and higher resolution cameras, the procedure has become highly effective for both the accurate diagnosis and proper treatment of knee problems.

Anatomy

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Normal knee

The knee is the largest joint in the body, and one of the most easily injured. It is made up of the lower end of the thigh bone (femur), the upper end of the shin bone (tibia), and the knee cap (patella), which slides in a groove on the end of the femur. Four bands of tissue-the anterior and posterior cruciate ligaments and the medial and lateral collateral ligaments-connect the femur and the tibia and provide joint stability. Strong thigh muscles give the knee strength and mobility.

The surfaces where the femur, tibia, and patella touch are covered with soft articular cartilage. Articular cartilage is a smooth substance that cushions the bones and enables them to glide freely. Semicircular rings of tough fibrous cartilage tissue, called the lateral and medial menisci, act as shock absorbers and stabilizers.

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The articular cartilage cushions the knee joint.

The bones of the knee are surrounded by a thin, smooth tissue capsule lined by a thin synovial membrane. The synovium releases a special fluid that lubricates the knee, reducing friction to nearly zero in a healthy knee.

Knee Problems

Normally, all parts of the knee work together in harmony. Sports, work injuries, arthritis, or weakening of the tissues with age can cause wear and inflammation, resulting in pain and diminished knee function.

Arthroscopy can be used to diagnose and treat many of these problems:

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Problems in the knee joint that usually can be seen with an arthroscope.

  • Torn meniscal cartilage.

  • Loose fragments of bone or cartilage.

  • Damaged joint surfaces or softening of the articular cartilage, known as chondromalacia.

  • Inflammation of the synovial membrane, such as rheumatoid or gouty (crystalline arthropathy) arthritis.

  • Abnormal alignment or instability of the kneecap.

  • Torn ligaments, including the anterior and posterior cruciate ligaments.

By providing a clear picture of the knee, arthroscopy can also help the orthopaedic surgeon decide whether other types of reconstructive surgery would be beneficial.

Do you need Arthroscopy?

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Signs that you may be a candidate for this procedure include swelling, persistent pain, catching, giving way, and loss of confidence in your knee. When other treatments, such as the regular use of medications, knee supports, and physical therapy, have provided minimal or no improvement, you may benefit from arthroscopy.

Most arthroscopies are performed on patients between 20 and 60 years of age. Patients younger than 10 years of age and older than 80 years of age have benefited from the procedure as well.

The orthopaedic knee evaluation usually consists of a medical history, a physical examination, and X-rays and other special tests (MRI)

During the medical history, Orthopaedic surgeon at A+OSM Center will gather information about your general health and will ask you about your symptoms.

A physical examination will be done to assess the motion and stability and muscle strength of the knee as well as the overall alignment of the leg.

X-rays will be done to evaluate the bones of the knee. orthopaedic surgeon. At A+OSM Center may also arrange for you to undergo magnetic resonance imaging (MRI) to provide more information about the soft tissues of your knee. An MRI uses magnetic sound waves to create images. They are not X-rays and are very safe. Blood tests may be obtained to determine if you have arthritis.

Orthopaedic surgeon will review the results of your evaluation with you and discuss the best methods to further diagnose your knee problem. Other diagnostic tests may be indicated, such as magnetic resonance imaging (MRI).

Treatment options include medications or surgical procedures, such as arthroscopy.

Orthopaedic surgeon at A+OSM Center will explain the potential risks and complications of knee arthroscopy, including those related to the surgery itself and those that can occur after your surgery.

Preparation for Surgery

If arthroscopy is indicated, you may be asked to have a complete physical examination with your family physician before surgery. This will assess your health and rule out any conditions that could interfere with your surgery.

Before surgery, tell orthopaedic surgeon at A+OSM Center about any medications or supplements that you are taking. You will be informed which medications you should stop taking before surgery.

Tests, such as blood samples or a cardiogram, may be ordered by orthopaedic surgeon to help plan your procedure and a routine check-up with anaesthetist is also undertaken.

Arthroscopic Surgery of the Knee

Almost all arthroscopic knee surgery is done on an outpatient basis for healthy patients. Usually, you will be asked to arrive at the hospital an hour or two prior to your surgery. Do not eat or drink anything after midnight the night before your surgery.

After arrival, you will be evaluated by a member of the anesthesia team. Arthroscopy can be performed under local, regional, or general anesthesia. Local anesthesia numbs your knee, regional anesthesia numbs you below your waist, and general anesthesia puts you to sleep. The anesthesiologist will help you determine which would be the best for you.

If you have local or regional anesthesia, you may be able to watch the procedure on a monitor, if you wish.

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The orthopaedic surgeon will make a few small incisions in your knee. A sterile solution will be used to fill the knee joint and rinse away any cloudy fluid, providing a clear view of your knee.

The surgeon will then insert the arthroscope to properly diagnose your problem, using the image projected on a monitor to guide the arthroscope. If surgical treatment is needed, the surgeon can use a variety of small surgical instruments (e.g., scissors, clamps, motorized shavers, or lasers) through another small incision.

This part of the procedure usually lasts 45 minutes to 1 1/2 hours.

Common treatments with knee arthroscopy include:

  • Removal or repair of torn meniscal cartilage.

  • Reconstruction of a torn cruciate ligament.

  • Trimming of torn pieces of articular cartilage.

  • Removal of loose fragments of bone or cartilage.

  • Removal of inflamed synovial tissue.

At the conclusion of your surgery, the surgeon may close your incisions with a suture or paper tape and cover them with a bandage.

You will be moved to the recovery room. Usually, you will be ready to go by evening or next day morning. You should have someone with you to drive you home.

Your Recovery at Home

Recovery from knee arthroscopy is much faster than recovery from traditional open knee surgery. Still, it is important to follow orthopaedic surgeon's instructions carefully after you return home. You should ask someone to check on you that evening.

Swelling

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Keep your leg elevated as much as possible for the first few days after surgery. Apply ice as recommended by Orthopaedic surgeon to relieve swelling and pain.

Dressing Care

You will leave the hospital with a dressing covering your knee. This will be changed after 48 hours and a small banded is left. You may remove the dressing the day after surgery. You may shower, but should avoid directing water at the incisions. Do not soak in a tub. Keep your incisions clean and dry.

Orthopaedic surgeon will see you in the office a few days after surgery to check your progress, review the surgical findings, and begin your postoperative treatment program.

Bearing Weight

After most arthroscopic surgeries, you can walk unassisted. Orthopaedic surgeon may advise you to use crutches, a cane, or a walker for a period of time after surgery. You can gradually put more weight on your leg as your discomfort subsides and you regain strength in your knee. Your surgeon may allow you to drive after a week.

Exercises to Strengthen Your Knee

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You should exercise your knee regularly for several weeks following surgery to strengthen the muscles of your leg and knee. A physical therapist may help you with your exercise program if orthopaedic surgeon recommends specific exercises.

Medications

Orthopaedic surgeon may prescribe antibiotics to help prevent an infection and pain medication to help relieve discomfort following your surgery.

Complications

Potential postoperative problems with knee arthroscopy include infection, blood clots, and an accumulation of blood in the knee. These occur infrequently and are minor and treatable.

Warning Signs

Call orthopaedic surgeon immediately if you experience any of the following:

  • Fever

  • Chills

  • Persistent warmth or redness around the knee

  • Persistent or increased pain

  • Significant swelling in your knee

  • Increasing pain in your calf muscle

What to expect  after Arthroscopic Surgery?

Although arthroscopy can be used to treat many problems, you may have some activity limitations even after recovery. The outcome of your surgery will often be determined by the degree of injury or damage found in your knee. For example, if you damage your knee from jogging and the smooth articular cushion of the weight bearing portion of the knee has worn away completely, then full recovery may not be possible. You may be advised to find a low-impact alternative form of exercise.

An intercollegiate or professional athlete often sustains the same injury as a weekend recreational athlete, but the potential for recovery may be improved by the over-development of knee muscles.

Physical exercise and rehabilitation will play an important role in your final outcome. A formal physical therapy program also may add something to your final result.

A return to intense physical activity should only be done under the direction of your surgeon.

It is reasonable to expect that by six to eight weeks you should be able to engage in most of your former physical activities as long as they do not involve significant weightbearing impact. Twisting maneuvers may have to be avoided for a longer time.

If your job involves heavy work, such as a construction laborer, you may require more time to return to your job than if you have a sedentary job.

Knee Arthroscopy Exercise Guide

Importance of Exercise

Before You Start

Initial Exercise Program

Intermediate Exercise Program

Advanced Exercise Program

Importance of Exercisee

Regular exercise to restore your knee mobility and strength is necessary. For the most part, this can be carried out at home.

Orthopaedic surgeon may recommend that you exercise approximately 20 to 30 minutes two or three times a day. You also may be advised to engage in a walking program.

Before You Start

Orthopaedic surgeon may suggest some of the following exercises. The following guide can help you better understand your exercise or activity program that may be supervised by a therapist at the direction of Orthopaedic surgeon.

As you increase the intensity of your exercise program, you may experience temporary set backs. If your knee swells or hurts after a particular exercise activity, you should lessen or stop the activity until you feel better.

You should Rest, Ice, Compress (with an elastic bandage), and Elevate your knee (R.I.C.E.). Contact Orthopaedic surgeon if the symptoms persist.

Initial Exercise Program

Hamstring Contraction

Repeat 10 times.

No movement should occur in this exercise. Lie or sit with your knees bent to about 10 degrees. Pull your heel into the floor, tightening the muscles on the back of your thigh. Hold 5 seconds, then relax.

Quadriceps Contraction

Repeat 10 times. 

Lie on stomach with a towel roll under the ankle of your operated knee. Push ankle down into the towel roll. Your leg should straighten as much as possible. Hold for 5 seconds. Relax.

Straight Leg Raises

Repeat 10 times. 

Lie on your back, with uninvolved knee bent, straighten your involved knee. Slowly lift about 6 inches and hold for 5 seconds. Continue lifting in 6-inch increments, hold each time. Reverse the procedure, and return to the starting position.

Advanced: Before starting, add weights to your ankle, starting with 1 pound of weight and building up to a maximum of 5 pounds of weight over 4 weeks.  

Buttock Tucks

Repeat 10 times.

While lying down on your back, tighten your buttock muscles. Hold tightly for 5 seconds.

Straight Leg Raises, Standing

Repeat 10 times.

Support yourself, if necessary, and slowly lift your leg forward keeping your knee straight. Return to the starting position.

Advanced: Before starting, add weights to your ankle, starting with 1 pound of weight and building up to a maximum of 5 pounds of weight over 4 weeks.

Intermediate Exercise Program

Terminal Knee Extension, Supine

Repeat 10 times.

Lie on your back with a towel roll under your knee. Straighten your knee (still supported by the roll) and hold 5 seconds. Slowly return to the starting position.

Advanced: Before starting, add weights to your ankle, starting with 1 pound of weight and building up to a maximum of 5 pounds of weight over 4 weeks.  

Straight Leg Raises

Perform 5 sets of 10 repetitions.

Lie on your back, with your uninvolved knee bent. Straighten your other knee with a quadriceps muscle contraction. Now, slowly raise your leg until your foot is about 12 inches from the floor. Slowly lower it to the floor and relax.

Advanced: Before starting, add weights to your ankle, starting with 1 pound of weight and building up to a maximum of 5 pounds of weight over 4 weeks.

 Partial Squat, with Chair

Repeat 10 times.

Hold onto a sturdy chair or counter with your feet 6-12 inches from the chair or counter. Do not bend all the way down. DO NOT go any lower than 90 degrees. Keep back straight. Hold for 5-10 seconds. Slowly come back up. Relax.

Quadriceps Stretch, Standing

Repeat 10 times.

Standing with the involved knee bent, gently pull heel toward buttocks, feeling a stretch in the front of the leg. Hold for 5 seconds.

Advanced Exercise Program

Knee Bend, Partial, Single Leg

Repeat 10 times.

Stand supporting yourself with the back of a chair. Bend your uninvolved leg with your toe touching for balance as necessary. Slowly lower yourself, keeping your foot flat. Do not overdo this exercise. Straighten up to the starting position. Relax.

Step-ups, Forward

Repeat 10 times.

Step forward up onto a 6-inch high stool, leading with your involved leg. Step down, returning to the starting position. Increase the height of the platform as strength increases.

Step-ups, Lateral

Repeat 10 times.

Step up onto a 6-inch high stool, leading with your involved leg. Step down, returning to the starting position. Increase the height of the platform as strength increases.

Terminal Knee Extension, Sitting

Repeat 10 times.

While sitting in a chair, support your involved heel on a stool. Now straighten your knee, hold 5 seconds, and slowly return to the starting position.

Hamstring Stretch, Supine

Repeat 10 times.

Lie on your back. Bend your hip, grasping your thigh just above the knee. Slowly straighten your knee until you feel the tightness behind your knee. Hold for 5 seconds. Relax.

Repeat with the other leg.

If you do not feel this stretch, bend your hip a little more, and repeat.

No bouncing! Maintain a steady, prolonged stretch for the maximum benefit.

Hamstring Stretch, Supine at Wall

Repeat 10 times.

Lie next to a doorway with one leg extended. Place your heel against the wall. The closer you are to the wall, the more intense the stretch. With your knee bent, move your hips toward the wall. Now begin to straighten your knee. When you feel the tightness behind your knee, hold for 5 seconds. Relax.

Repeat with the other leg.

Exercise Bike

Start pedaling for 10 minutes a day.

If you have access to an exercise bike, set the seat high so your foot can barely reach the pedal and complete a full revolution. Set the resistance to "light" and progress to "heavy."

Increase the duration by one minute a day until you are pedaling 20 minutes a day.

Walking

An excellent physical exercise activity in the middle stages of your recovery from surgery (after 2 weeks).

Running

Running should be avoided until 6 to 8 weeks because of the impact and shock forces transmitted to your knee. Both walking and running activities should be gradually phased into your exercise program.

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