Scenario of sudden onset knee pain

Sometimes you may have a twisting injury or fallen directly on your knee. You suddenly experience an excruciating knee pain. Sometimes you may just be walking and felt excruciating pain in your knee. The knee seems to have stuck in flexed position, after a minute or two you can limp along home, but just barely.

This is an ideal scenario of doing a knee arthroscopy and relief of symptoms may be immediately within a day or two following trimming or repair of the torn meniscus.

What is arthroscopy?

This is also referred as key hole surgery for the joints. Arthroscopy allows an Orthopedic surgeon to insert a thin hollow metallic instrument into a joint with a small incision about the size of the hole on a button. The instrument contains a light and a camera, which sends a magnified view of the joint examined to a computer screen, so that the Surgeon can see the damage and make an accurate diagnosis. He may do corrective procedure and treatment through arthroscopy as and when indicated e.g. torn meniscus.

A Knee arthroscopy is one of the most common procedures done in the world today. Many people have both a torn meniscus and osteoarthritis (the age-related, wear-and-tear type of arthritis). The combination is common, not only because these conditions become more common with age, but also because a meniscal tear is a risk factor for developing osteoarthritis.

Recent scientific evidence suggest that (published in Arthritis and Rheumatology journal) people age 45 and older who had

• knee pain for at least a month with symptoms that seemed related to a meniscal tear (such as intermittent, sudden pain or catching)
• little or no improvement despite taking medications, limiting activity, and/or physical therapy
• osteoarthritis (confirmed by x-rays or MRI scan) and a meniscal tear demonstrated by MRI scan.

These patients do well after arthroscopic treatment for a short period of time.

What are the other indications for arthroscopy of knee?

Other than torn meniscus repair or trimming the following knee conditions can be treated with arthroscopy

1. Removal of bone or cartilage fragments
   With the help of arthroscopy the surgeon can clear a joint of bone, cartilage and tissue fragments that accumulate as a result of injuries, inflammation and tissue tears. Debris left floating free in the joint area can result in pain, swelling and locking.
2. Swollen or inflamed synovium
   The synovium is a membrane that functions to lubricate and nourish knee and shoulder joints. It creates synovial fluid, but the membrane itself is distinguished by irregular folds and it can become painfully inflamed. When this happens, the surgeon can insert an arthroscope to facilitate removal of the tissue that is causing the pain and swelling.
3. Torn Anterior Cruciate Ligament (ACL) or Posterior Cruciate Ligament (PCL)
   The damaged portion of ligament is removed and replaced with tendon from another part of the patient’s knee. ACL injury is commonly a result of repeated injury due to participation in sports that require fast starts, stops and changes of direction, such as basketball or downhill slalom racing. Although less severe ACL injuries can sometimes be improved with physical therapy, arthroscopic surgery is the primary choice for athletes and extremely active patients. The surgery itself is typically an outpatient procedure, and recovery is relatively swift.PCL injury is a result of high energy injury to the knee during a road traffic accident or motor bike accidents. PCL injury or tear can be treated with reconstruction through arthroscopic technique.
4. Popliteal Cyst
   Sometimes known as a Baker’s cyst, this condition is characterized by fluid-filled lumps that appear at the back of the knee. These cysts can disappear with treatment of the underlying cause, which might include arthritis, injury to surrounding cartilage or other inflammation.
5. Treating Knee infections
6. Removing Loose bodies (joint mice)
7. Treat cartilage defects with Mesenchymal Stem cells
8. Treatment of specific articular fractures of knee

Benefits of Arthroscopy of Knee

Some of the benefits of knee arthroscopic surgery when compared to traditional knee surgery include:

• Shorter recovery period
• Fewer risks and complications
• Smaller incisions and minimal scarring
• Less post-operative pain
• Less rehabilitation time

How it is performed?

During the procedure, the patient will receive local or regional (sometimes even general) anesthesia so he or she is comfortable and don’t feel pain. The surgeon will inject saline into the joint to inflate the surgical area, keep the view clear, and control bleeding.

Once the surgeon inspects the joint on the monitor and diagnoses your problem, he/she has the option of also performing arthroscopic surgery to fix the problem. The surgeon will make other small incisions to insert surgical tools, using the image on the screen to guide the surgery.

What to expect after operation?

One usually will return home the same day. It will take several days or a week for your incision to heal and you’ll likely experience some pain and discomfort for at least a week. Your doctor may recommend stabilizing the joint as it heals and post-operative rehabilitation to regain your strength and mobility in the joint. For rehabilitation time for a torn meniscus trimming takes a week and two weeks to get back to normal active life. Someone who had ACL reconstruction it takes at least 3months of specific rehabilitation to return back to normal active life. If someone had Mesenchymal stem cell therapy for osteochondral defect or early osteoarthritic cartilage defect one may expect to be off weight bearing on their operated limb for 6weeks to allow the cartilage to heal in real time.

If you have a knee problem that is not responding to alternative medical treatment, such as medications or physical therapy, you can request Dr U K Debnath for an appointment  for an arthroscopy of knee joint.