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February 9, 2010
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Arthroscopy

Medical Author: William C. Shiel Jr., MD, FACP, FACR

Doctor to Patient

Torn ACL (Anterior Cruciate Ligament) of the Knee

Medical Author: Benjamin C. Wedro, MD, FAAEM
Medical Editor: Melissa Conrad Stöppler, MD

Read about a professional athlete's rehabilitation from arthroscopic surgery for a torn ACL.Do people appreciate how amazing it is that Philip Rivers (quarterback for the San Diego Chargers) played on Sun., Jan. 20, 2008, just six days after having arthroscopic surgery? Aside from the fact that he likely had some cartilage debris cleaned out and the rehab time is measured in weeks, he still had a torn anterior cruciate ligament (ACL).

For regular people and pseudo-athletes, the days after arthroscopic knee surgery are spent reducing knee swelling and starting range-of-motion exercises. This process is hampered by a couple of physiologic barriers.

When the knee is invaded, the muscles around it tend to shut down involuntarily. The quadriceps muscle in the front of the thigh tends to get immediately weaker, and since it is one of the stabilizing muscles of the knee, it is a big deal when this muscle decides not to work. The next barrier has to do with hydraulics. The knee joint has its largest volume of fluid when it's flexed at 15 degrees. When there is even a little fluid, straightening it out combats the law of physics that says "you can't compress fluids."

Rivers gets out of surgery and presumably hops into the training room and is attacked by the physical therapists. Appreciate that for mere mortals, physical therapists can be kind and gentle, but when they want the patient to do something, they can become relentless therapists. Pushing the body to its limits is not something regular patients do. Putting it into perspective, a routine course of rehabilitation in the first week might have a patient trying to get the pedals on a stationary bicycle to go around without resistance...once.


Doctor to Patient

What is arthroscopy?

Arthroscopy is a surgical procedure by which the internal structure of a joint is examined for diagnosis and/or treatment using a tube-like viewing instrument called an arthroscope. Arthroscopy was popularized in the 1960s and is now commonplace throughout the world. Typically, it is performed by orthopedic surgeons in an outpatient setting. When performed in the outpatient setting, patients can usually return home after the procedure.

The technique of arthroscopy involves inserting the arthroscope, a small tube that contains optical fibers and lenses, through tiny incisions in the skin into the joint to be examined. The arthroscope is connected to a video camera and the interior of the joint is seen on a television monitor. The size of the arthroscope varies with the size of the joint being examined. For example, the knee is examined with an arthroscope that is approximately 5 millimeters in diameter. There are arthroscopes as small as 0.5 millimeters in diameter to examine small joints such as the wrist.

If procedures are performed in addition to examining the joint with the arthroscope, this is called arthroscopic surgery. There are a number of procedures that are done in this fashion. If a procedure can be done arthroscopically instead of by traditional surgical techniques, it usually causes less tissue trauma, results in less pain, and may promote a quicker recovery.

For what diseases or conditions is arthroscopy considered?

Arthroscopy can be helpful in the diagnosis and treatment of many noninflammatory, inflammatory, and infectious types of arthritis as well as various injuries within the joint.

Noninflammatory degenerative arthritis, or osteoarthritis, can be seen using the arthroscope as frayed and irregular cartilage. Recently, for isolated cartilage wear in younger patients, repair of crevasses in the cartilage, using a "paste" of a patient's own cartilage cells harvested and grown in the laboratory, has been performed using an arthroscope.

In inflammatory arthritis, such as rheumatoid arthritis, some patients with isolated chronic joint swelling can sometimes benefit by arthroscopic removal of the inflamed joint tissue (synovectomy). The tissue lining the joint (synovium) can be biopsied and examined under a microscope to determine the cause of the inflammation and discover infections, such as tuberculosis. Arthroscopy can provide more information in situations which cannot be diagnosed by simply aspirating (withdrawing fluid with a needle) and analyzing the joint fluid.

Common joint injuries for which arthroscopy is considered include cartilage tears (meniscus tears), ligament strains and tears, and cartilage deterioration underneath the kneecap (patella). Arthroscopy is commonly used in the evaluation of knees and shoulders but can also be used to examine and treat conditions of the wrist, ankles, and elbows.

Finally, loose tissues, such as chips of bone or cartilage, or foreign objects, such as plant thorns, that become lodged within the joint can be removed with arthroscopy.



Next: What is done in preparation for arthroscopy? »

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Arthroscopy

Introduction

The knee is a joint where the bone of the thigh (femur) meets the shinbone of the leg (tibia). The knee is the largest joint in the body. It acts like a hinge, allowing the knee to flex (bend) and extend (straighten). There are four ligaments of the joint (the medial and lateral collateral ligaments and the anterior and posterior cruciate ligaments) that provide stability and steady the knee movement.

Cartilage within the joint provides cushioning to protect the bones from the regular trauma of walking, running, and climbing. Articular cartilage lines the joint surfaces of the bones in the knee (tibia, femur, and patella, or kneecap). The medial and lateral meniscus are two thicker wedge-shaped pads of cartilage attached to the leg bone (tibia). Each meniscus is curved in a C-shape, with the front part of the cartilage called the anterior horn and the back part called the posterior horn.

If the meniscus is damaged, irritat...

Read the Torn Meniscus article »











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