Arthroscopy of the knee joint is a procedure that is very popular. It allows you to identify the pathology in time and quickly defeat the disease. In the past, traumatic surgeries were used to eliminate knee problems. However, with the development of technologies, the approach to the treatment of such pathologies has radically changed.
What is arthroscopy of the knee joint?
This procedure is a minimally invasive surgical procedure. It is carried out using a special device - an arthroscope. This unit is equipped with a thin needle with a fiber optic camera. The entire image is displayed. To understand what arthroscopy is, the doctor will help, who will tell the patient all the features of such manipulation. There are several varieties of this procedure:
- diagnostic;
- curative.
To date, this procedure is considered a "gold standard" in the fight against pathology of the musculoskeletal system. This technique has no analogues. It has many advantages:
- Minimally invasive - the procedure is performed with minimal intrusion into the cavity of the joint bag;
- all manipulations are performed with incredible accuracy;
- the intra-articular cavity does not contact the non-sterile external environment;
- During the procedure, liquid drainage can be performed simultaneously;
- because the operation is done without incisions, the time of its conduct is reduced to an hour, and the subsequent stay in the hospital - up to 2-3 days;
- there is no need to immobilize the foot for a long time.
There are drawbacks to this method:
- the procedure is not cheap, because it is performed on expensive equipment;
- the doctor doing this operation should be a high-class specialist, since the interference of an inexperienced doctor can lead to the development of complications.
Arthroscopy of the knee joint - indications
The referral to this procedure is given by a traumatologist, rheumatologist or orthopedist. Operation of arthroscopy of the knee joint is recommended in such cases:
- with a dislocation ;
- when the sanation of the knee is necessary in case of accumulation of purulent masses;
- if necessary, tissue biopsy;
- in the case where replacement of the damaged joint is required;
- with rheumatoid arthritis ;
- when the integrity of the meniscus is broken;
- in the presence of a foreign body in the cavity of the knee joint;
- in the case of chronic hyperplasia of the fat body.
Diagnostic arthroscopy of the knee joint
This procedure is considered informative. Thanks to her, the condition of the knee joint is examined from the inside. All information is displayed on the monitor in real time. Knee arthroscopy helps to obtain such information:
- determine the area of localization of pathology;
- to predict the rate of its spread;
- correctly diagnose.
Therapeutic arthroscopy
This method is recommended when conservative drug therapy is ineffective. For example, surgical arthroscopy of the knee joint is prescribed, resection of the meniscus in this case takes place with minimal complications. Such a treatment procedure is considered to be less traumatic: after it a small seam remains. In addition, rehabilitation is not delayed for a long time. As practice shows, patients quickly return to their lifestyle.
Arthroscopy - contraindications
Although this procedure has many advantages, in some cases it will have to be abandoned. The final verdict is whether the arthroscopy of the knee joint is made by the doctor after a thorough examination of the patient. All contraindications to the implementation of this procedure can be conditionally divided into two groups: absolute and relative. The first include the following:
- inflammation accompanied by the formation of pus;
- fibrous or bone ankylosis;
- severe condition of the patient.
Relative contraindications include:
- fractures of condyles;
- violation of the integrity of the tissues, located next to the joint bag;
- hemarthrosis .
How is knee arthroscopy performed?
Before going through such a procedure, the patient should prepare for it. Arthroscopy of the knee joint provides that the following manipulations will be performed in advance:
- ECG was performed;
- blood pressure was measured;
- the clotting factor was determined;
- X-ray of the chest;
- MRI of the knee joint was performed;
- blood and urine tests were submitted.
In the evening on the eve of the day when arthroscopy of the knee joint meniscus is performed, the patient is cleansed with an enema. Before going to bed, they give him sleeping pills of light action. Also in the evening you can not eat or drink anything. In the morning immediately before the operation shave your hair in the knee area. The procedure itself takes not more than an hour.
Arthroscopy of the knee joint is performed as follows:
- The patient lies on the operating table (on the back). The knee on which the operation will be performed should be bent at an angle of 90 ° and fixed with special devices.
- The skin is decontaminated.
- To reduce the flow of blood to the knee joint, a tourniquet is placed on the thigh.
- Introduced anesthesia.
- The surgeon makes 3 notches 3-6 mm long.
- An arthroscope is inserted through the hole. The doctor carefully examines the affected area. If necessary, it pumps out the exudate, rinses the cavity and conducts all the required manipulations.
- Through the notch, the inserted tool is extracted.
- On the treated area, sterile pressing bandages are applied.
Arthroscopy of the knee joint - anesthesia
Based on the results of the tests submitted before the operation and taking into account the duration of the forthcoming operation, the anesthetist decides on which method of anesthesia to give preference. Anesthesia with arthroscopy of the knee joint can be as follows:
- Local - provides a subcutaneous injection of an anesthetic drug (Lidocaine, Novocaine or Ultrakain) near future incisions. The drawback of this method is its short duration. Local anesthesia is done if arthroscopy of the knee joint is diagnostic.
- Spinal (it is also called epidural) - the drug is injected through the catheter into the area of the spinal column. The main advantage of this method of anesthesia is that during the operation the doctor constantly keeps in touch with the patient. If there is a need for an extension of anesthesia, this is done through a medical catheter.
- Common - it is used only in the treatment of the most serious pathologies.
Arthroscopy of the knee joint
Three surgical incisions are made during surgery. These manipulations are represented by arthroscopy - the technique is as follows:
- The first puncture - through this hole into the joint cavity, an optical camera is inserted. This device is connected to the monitor where the image is being sent.
- The second incision is through which a drug is injected into the joint cavity (eg, Adrenaline, sodium chloride). These drugs are used to reduce the risk of bleeding during surgery and to expand the examination channel.
- Third incision - through it into the cavity is introduced the main working tool.
Arthroscopy of the knee joint - after surgery
At the end of the procedure, the doctor will give the patient recommendations on how to behave during the recovery period. Follow them need to be scrupulous. These recommendations are just as important as properly performed arthroscopy, preparation for surgery. In most cases, they are discharged the day after the surgery. Very rarely the patient is left under the doctor's supervision for another couple of days.
Arthroscopy - complications
Although such a surgical intervention is considered a safe procedure, there is a risk that there may be negative consequences after it. More often note such complications:
- The knee after arthroscopy swells;
- the body temperature rises;
- there is discomfort in the chest (the patient is hard to breathe);
- because of wound infection, arthritis develops;
- problems in the vascular system are noted;
- the mobility of the joint is impaired;
- there are clicks while driving;
- the knee is very sore;
- there is hyperemia of the skin;
- very rare hemarthrosis.
Pain after arthroscopy of the knee joint
Such uncomfortable sensations after the operation are quite normal. In most cases, they are stopped with anesthetic drugs. For this reason, the patient should not worry and worry that something went wrong. If, after the arthroscopy of the meniscus, the knee hurts very much, and the painkillers prescribed by the doctor do not help, medical help should be sought immediately. Most likely, a serious postoperative consequence arose. More often intolerable pain is accompanied by the following complications:
- clotting of blood vessels with blood clots (occurs in patients with obesity);
- arthritis ;
- articulation of the joint fluid, provoked by too intense load on the knee;
- hemarthrosis;
- algodystrophic syndrome;
- inflammation of the tissues of the rumen.
Clicks in the knee after arthroscopy
A crunch during the postoperative period is considered a physiological norm. Its reasons are as follows:
- In the articular cavity gas bubbles accumulate;
- the patient has a moderate deposition of salts;
- there was overgrowing of the articular ligaments.
If the knee crunches after arthroscopy after 4-5 months, this indicates the development of arthrosis. With this disease, the articular cartilage is thinned and the amortization of movement is disturbed. The knee becomes inflamed, resulting in a local increase in temperature. The skin in this area becomes hot and acquires a reddish color. All this is accompanied by severe pain.
The knee does not bend after arthroscopy
In the first post-operation days in this phenomenon there is nothing terrible. However, if knee arthroscopy does not bend the knee after a week, this is already a warning signal. The reasons for the limited movement may be:
- hemarthrosis;
- inflammation of the postoperative cicatrix;
- articulation of the joint fluid;
- algodystrophic syndrome.
Rehabilitation after arthroscopy of the knee joint
Restorative process begins in the first hours after surgery. It can last from 3 to 8 weeks. Then the patient returns to a full life. Restoration after arthroscopy of the knee joint is reduced to the following recommendations:
- To prevent the onset of the inflammatory process, the patient should take antibiotics prescribed by the doctor.
- Keep the operated leg in a raised position. The ice should be applied to the knee. Such manipulations will reduce pain and swelling.
- It is necessary to do dressings every 2-3 days.
- To ease the patient's condition, taking pain medication is mandatory.
- It is necessary to exclude the load on the operated knee joint. You can get up on the 3rd day after the operation. In this case, you can only move using crutches.
- In the next 2-3 weeks after the operation, driving is prohibited!
- Arthroscopy of the knee joint recovery after surgery will speed up exercise therapy.
- The first couple of weeks after surgery, hot baths are not allowed. It is inadmissible and hypothermia.
- To restore cartilage tissue, chondroprotectors should be taken.
LFK after arthroscopy of the knee joint
The therapeutic gymnastics helps to strengthen the muscles and speed up the recovery process. Before you develop a knee after arthroscopy, you need to consult a specialist. Incorrect rehabilitation can cause great harm. After the arthroscopy of the affected knee joint was performed, the restoration is recommended to begin with a small load, gradually increasing it. Exercises can be:
- tension of the thigh muscles;
- lifting of the foot;
- keeping it on weight;
- swimming;
- walking and so on.