A meniscus injury is one of the most common knee injuries. Most often it occurs in athletes and able-bodied people aged 18-40 years. Arthroscopy is the best treatment for knee injuries. This is a minimally invasive surgical procedure that is characterized by low trauma. The surgeon performs all manipulations through small incisions, under visual control (for this, an arthroscope with a camera is inserted into the joint cavity).
Indications for meniscus arthroscopy
Arthroscopic intervention is indicated for serious injuries of the knee joint when doctors suspect or have already detected damage to the intra-articular structures. Arthroscopy can be performed for both diagnostic and therapeutic purposes. In the first case, it allows you to identify tears and tears of the menisci, damage to the cruciate ligaments, synovium, articular cartilage, etc. In the second, it makes it possible to restore the integrity of the structures of the knee joint without opening the articular cavity and minimally injuring soft tissues.
Arthroscopy is used for significant damage to the menisci when conservative treatment is ineffective. Whenever possible, doctors try to perform partial resection of the meniscus, its plastic, or suture. A total of meniscectomy (complete removal) is used only in extreme cases. After all, the complete removal of the meniscus leads to an increase in the load on the articular cartilage and the further development of arthrosis. At the same time, plastic surgery and resection preserve the function of the knee and avoid cartilage degeneration after surgery.
Preparation and anesthesia
Even at the stage of planning a surgical intervention, the patient undergoes a series of tests and undergoes a full examination. In the absence of contraindications, the doctor appoints the date of the operation and tells how to properly prepare for it. During preparation, the patient should carefully follow all the recommendations of a specialist. The patient should stop eating, drinking, and smoking at least 12 hours before the arthroscopy (since the anesthetic drugs must be administered on an empty stomach). The patient is premedicated 30-40 minutes before the administration of painkillers. Its essence lies in the administration of tranquilizers and Hyposensitization drugs. Premedication reduces patient anxiety and enhances the effect of anesthetic drugs.
Meniscus arthroscopic interventions are usually performed under spinal or regional anesthesia. In the first case, pain relievers are injected into the spine and thereby block the nerve roots that are responsible for the innervation of the lower limb. In the second case, the femoral and sciatic nerves are blocked, infiltrating the nearby soft tissues with anesthetics.
In rare cases, for special indications, the operation is performed under general anesthesia. In this case, anesthetics are administered intravenously, and the patient is on spontaneous breathing or breathes through a laryngeal mask. Local anesthesia for arthroscopy is rarely used due to its weak analgesic effect and short duration.
Description of operation
The operation begins with anesthesia and treatment of the operating field. The skin in the area of the knee joint is carefully shaved, after which it is treated several times with antiseptics. This is necessary in order to prevent the introduction of infection into the synovial cavity, where manipulations are carried out.
All arthroscopic procedures are performed under visual control. To visualize intra-articular structures, an arthroscope is introduced into the articular cavity, which is a tube and an eyepiece head rigidly connected to each other. The image from the arthroscope is displayed in the operating room, which allows the surgeon to control his actions, and the patient to observe the progress of the surgical intervention.
First, the patient’s leg is bent and a cannula is inserted through a small incision. Then the arthroscope is unbent and the arthroscope is inserted through the cannula. Instruments for arthroscopic manipulations are inserted through small incisions 4-5 mm long. After the operation, the arthroscope and all instruments are removed, and the postoperative wounds are sutured and sealed with adhesive tape.
Types of meniscus restoration
For meniscus damage, several types of arthroscopic techniques are used:
- suture application;
- plastic meniscus;
- partial resection of unstable meniscus fragments;
- a total meniscectomy (complete removal).
Arthroscopic meniscus repair is now preferred by doctors because it provides better clinical and radiographic results than partial and complete meniscectomy. The integrity of the meniscus is restored by suture or plastic. Such an operation allows stabilizing movements in the joint and achieving a uniform distribution of the axial load on the articular surfaces of the thigh and lower leg. And this, in turn, reduces the risk of subsequent development of osteoarthritis.
On the other hand, with severe injuries, it is far from always possible to restore the integrity of the meniscus. Therefore, doctors often have to perform partial resection or remove it completely. This gives less favorable results.
Duration of surgery
The duration of surgery usually depends on the degree of damage to the meniscus. On average, arthroscopy takes 60 minutes. In difficult cases, it can last 1.5-2 hours. On the MRI on the right – a rupture of the posterior meniscus horn, on the left – a healthy meniscus.
How is the restoration of the meniscus
Arthroscopic interventions are performed without opening the articular cavity, which significantly reduces postoperative rehabilitation. With arthroscopy, the tissue is damaged much less than with other operations. And the scars remain almost invisible due to the small size of the incisions.
The first few days after the operation, the person is in the hospital, and the attending physician closely monitors his condition. At this time, the patient takes the prescribed medications and, under the supervision of the medical staff, performs special exercises. His postoperative wound is carefully looked after. After discharge from the hospital, the patient continues to study and take care of the wound, but on his own. At the same time, he fulfills all the recommendations given by the doctor.
The duration of rehabilitation is usually 8-12 weeks. After this period, the patient is allowed to return to his usual way of life and even to sports. He can return to work in the office even earlier – in 2-3 weeks. And to physical labor – in 4-6 weeks.
Early healing stage (first 7-10 days)
After arthroscopy, the patient is allowed to get up immediately after the anesthesia ends. At first, doctors recommend using crutches or a cane. At the stage of early healing, a person is allowed to walk carefully within the apartment, avoiding painful sensations in the knee.
During this period, it is also recommended:
- Apply an ice pack wrapped in a towel to the knee 4-5 times a day. It should be kept for at least 15-20 minutes. This will help ease knee pain and speed up rehabilitation.
- Wear compression garments or bandage the limb with an elastic bandage from the foot to the middle third of the thigh. Such a precautionary measure is necessary for the prevention of thromboembolic complications in the postoperative period.
- Give an elevated position to the lower leg and knee joint. In bed, the operated limb should lie on a pillow above the level of the heart.
- Perform special exercises at least 2-3 times a day. Each workout should last 20-30 minutes. Daily exercises are needed to train muscles and normal recovery of limb functions.
If swelling and redness of the skin appear in the area of the knee joint, it is necessary to reduce the load on the limb or temporarily stop doing exercises. And if the swelling persists for more than two to three days, you need to see your doctor.
Late healing stage (days 10-14)
At this stage of rehabilitation, exercise therapy is supplemented by exercise on a stationary bike with a load, cycling, and exercise with resistance. However, the patient still has to use crutches when walking.
Third stage (starting from the third week)
During this time, a person can do various exercises, but sports are still prohibited. In the absence of contraindications, a month after the operation, the patient is allowed to walk in an orthosis with full load on the operated leg. During the second month, a person performs functional exercises that allow him to restore muscle strength, train endurance, and completely restore the range of motion of the limb.
At the end of the second month, the patient can return to a free motor regime, including playing sports.Pain and complications of knee arthroscopy: causes, symptoms and treatment
Possible complications after surgery
Arthroscopy is one of the safest surgical procedures for the knee joint. However, even after it, complications can occur, both early and delayed.
- Complications caused by anesthesia. They can arise as a result of individual intolerance to drugs, the patient’s serious condition or errors of the anesthesiologist.
- Hemarthrosis is a massive hemorrhage in the articular cavity. It occurs extremely rarely, after arthroscopy it practically does not occur.
- Thromboembolic complications. With adequate prophylaxis and wearing compression garments, they are rare. In exceptional cases, patients have venous thrombosis of the lower extremities or pulmonary embolism (BODY).
- Joint fluid leakage. With an excessively rapid resumption of physical activity, synovial fluid can flow out of the articular cavity and enter the periarticular tissues. To avoid this, early loading on the limb should be avoided.
- Nerve damage. Damage to the nerve branches during surgery can cause paresthesias in the knee joint. In this case, the patient may feel “creeping” after arthroscopy.
- Internal lateral ligament sprain. It rarely occurs when the surgeon performs enhanced manipulations by increasing the distance between the femur and tibia for better access to the menisci.
- Deforming osteoarthritis. It develops late after arthroscopy, as a result of progressive damage to the articular cartilage. It is difficult to treat and, over time, can lead to impaired knee function and mobility.
The risk of complications largely depends on the experience and skill of the operating surgeon, as well as the level of the institution where the operation takes place. If you want to protect yourself, try to treat in the best clinics, and choose the best specialist as your doctor.
Contraindications for conducting
Arthroscopy is prohibited in the presence of such contraindications:
- severe general condition of the patient;
- individual intolerance to anesthetics (allergies);
- the presence of adhesions in the synovial cavity that can interfere with the movement of the arthroscope;
- Knee contracture caused by ligamentous sclerosis or muscle spasm;
- active inflammation in the knee area.