Knee Arthroscopy
Arthroscopy is a procedure in which the inside of a joint is visualised using advance camera and lighting equipment. Technology has allowed both the camera and the light source to be incorporated in a thin tube. This tube can be introduced inside the joint through a very small incision or cut. The name key-hole surgery has been coined for arthroscopy as it is minimally invasive. Knee arthroscopy has many advantages. The interior of the joint can be completely visualised by this procedure. As it doesn't require a lot of skin and tissue cutting, it can be used as a diagnostic tool. Because the arthroscope tube is thin, we can visualise areas at the back of the knee which are difficult to see in open surgery. As the surgery is done through small holes, postoperative pain is minimal and recovery is very quick.
Knee arthroscopy has revolutionised treatment of certain problems. A classic example is synovitis or thickening of the lining of the knee. Synovitis can happen due to various reasons. Sometimes it is necessary to remove a part of the synovium (or lining) as a biopsy. In other cases it is required to remove the entire lining as treatment. Formal open synovectomy (or removal of lining) was a major surgery that led to postoperative pain and knee stiffness. Besides some synovium would remain behind at the back of the knee due to difficult access. With arthroscopy, total synovectomy can be achieved with minimal pain and stiffness.
Another area where arthroscopy has made tremendous progress is in the field of ligament and meniscal injury. The commonest ligament which gets injured during a sport or road traffic accident is called the anterior cruciate ligament (ACL). Once this ligament is injured, it leads to instability. The patients knee buckles every now and then and he/she loses balance and may fall. The patients describe the problem as a 'wobbly knee' and get a typical 'giving way' sensation in the knee. These repeated instability episodes eventually wear out the knee and patients end up with knee arthritis in a few years. In earlier times there was no good solution for this problem. Open ligament reconstruction procedures were fought with failure. All this changed with the advent of arthroscopy. Nowadays arthroscopic ligament reconstruction has become an extremely successful procedure. The patients own hamstring muscle tendon is harvested and a new ligament is made by folding the tendon on itself. This new ligament is then fixed into pre-drilled tunnels in the patients thigh and leg bone to become the new ACL ligament. This eliminates instability so efficiently that patients can start playing contact sports like football after the procedure. The patients knee is restored to its original state and any further wear and tear is arrested. It has now been proved beyond doubt, in multiple studies done internationally that results of ACL reconstruction are much better than non surgical treatment.
The meniscus is a thick structure found inside the knee joint which acts like a shock absorber. Just like the ligaments, the meniscus can also tear due to injury. A meniscal tear classically causes pain and locking of the knee. The locking occurs because the torn meniscal fragment gets stuck between the two bones. Repeated locking episodes lead to pain and swelling. Before the advent of arthroscopy, it was very difficult to treat meniscal tears. Surgeons ended up removing the entire meniscus which was not only unnecessary but also harmful as it lead to early degeneration of the knee. With arthroscopy it is now possible to tackle only the torn fragment. Either the torn part is removed and the rest of the meniscus is left behind or the torn fragment is repaired. Again arthroscopy allows the knee to be restored to its original state.
Arthroscopy is a major advance in orthopaedics and it is now being successfully utilised in solving problems of other joints as well like the shoulder. Patients should be aware of the benefits of arthroscopy and must take advantage of this science when required.
