What is knee arthroscopy?
Arthroscopy is a procedure for diagnosing and treating joint problems.
We insert a narrow tube attached to a fiber-optic video camera (arthroscope) through a small incision — about the size of a buttonhole. The view inside your joint is transmitted to a high-definition video monitor.
Arthroscopy allows us to see inside your joint without making a large incision. We can even repair various types of joint damage during arthroscopy, with pencil-thin surgical instruments inserted through these small incisions.
What is the meniscus?
There are 2 menisci in the knee (one medial and one lateral). The medial meniscus is on the inner side of the knee and the lateral meniscus is on the outer side of the knee. These cartilage structures are "C"-shaped disks that function as shock-absorbers.
The menisci protect the articular cartilage on the surfaces of the thighbone (femur) and the shinbone (tibia). Articular cartilage is the smooth, slippery material that covers the ends of the bones that make up the knee joint. The articular cartilage allows the joint surfaces to slide against one another without damage to either surface.
What is the goal of the arthroscopy? Knee arthroscopy is used in performing a wide range of different types of surgical procedures on the knee joint including confirming a diagnosis, removing loose bodies, removing or repairing a torn meniscus, reconstructing torn ligaments, repairing articular cartilage and fixing fractures of the joint surface.
Our goal with your surgery is to fix and repair your torn meniscus. This restores the normal contact forces, pressure, and mechanics of your knee. The results of this depend on the type of tear, the duration of symptoms, the tissue quality, what can be done inside your knee to fix the tear, and your effort at rehabilitation after the surgery.
What happens during the surgery?
Before surgery you will be placed under either general anesthesia. The skin around the knee is prepped with a sterile solution. Sterile drapes are placed to create a sterile environment for the surgeon to work. There is a great deal of equipment that surrounds the operating table including the TV screens, cameras, light sources and surgical instruments.
We begin the operation by making two small openings into the knee, called portals. These portals are where the arthroscope and surgical instruments are placed inside the knee. Care is taken to protect the nearby nerves and blood vessels. We then insert the arthroscope into the knee joint and fill the joint with sterile fluid.
We then take a “tour” (diagnostic arthroscopy) to look at all aspects of the knee joint. We then address any areas of damage or injury with specialized arthroscopic instruments.
Next, we identify and evaluate the meniscus tear, and ensure the tear configuration and tissue quality is appropriate for a repair. We use special surgical implants designed for meniscus repair to place sutures across the tear. We also prepare the surrounding tissue to promote healing of the meniscus repair.
Once the surgical procedure is complete, the arthroscopic portals and surgical incisions will be closed with absorbable sutures (no sutures have to be removed). A large bandage will be applied with a compressive wrap to reduce swelling and prevent blood clots in the leg. Once the bandage has been placed, you will be taken to the recovery room.
What about stem cell treatments?
Stem cells are used in regenerative medicine to repair diseased or damaged tissues. While stem cell or PRP injections may not heal the tear on their own, there is emerging evidence that it can be used to augment and strengthen your surgical repair.
These treatments can be done during your surgery. Unfortunately, they are currently not covered by insurance. Please contact us if you would like more information or would like to include this with your surgery.
What is the anesthesia like?
The surgery is almost always performed under general anesthesia. During the surgery, numbing medication is injected in and around the knee to help with pain control after the surgery.
How much time do I spend in the hospital?
You will enter the hospital in the morning, have the surgery and go home the same day. This is called outpatient surgery.
What are the risks of surgery?
The risks are similar to the risks of any surgical procedure. There is a less than 1% risk of infection. We minimize this risk by giving you antibiotics prior to the start of surgery. There is a less than 1% risk of bleeding or nerve injury. We are very familiar with the anatomy of the nerves and blood vessels around the knee. There is a very low risk of blood clots in the leg (called deep vein thromboses and pulmonary embolus if goes to lung). To further reduce this risk, we recommend you take an aspirin following surgery. There is a risk of arthrofibrosis (stiff knee). This occurs when there is too much scar tissue that forms in your knee. Most often this can be treated with physical therapy, but there are cases when you would need a second arthroscopic surgery to remove scar tissue.
There is a risk that your knee pain can persist. This mostly depends on how healthy or worn the cartilage is inside the knee. Early or advanced cartilage wear may lead to continued pain and swelling around the knee that does not improve after the arthroscopy.
My purpose in listing the types of complications that could possibly occur is to inform, not frighten you. While it would be preferable if we could perform surgery without any risk, this is not the case. The complications are rare (less than 1%) but regrettably, despite our best efforts, they do occur. I feel it is your right to know.
Will I be in a brace after surgery?
You will be in a brace for 6 weeks following surgery. This brace protects the repair by preventing increased force on the meniscus, and supports the leg until your muscles are strong enough.
Is ice or heat helpful after surgery?
Ice is recommended instead of heat. An ice pack should be applied to the knee (not directly on the skin) for at least 20 minutes, three times a day.
The use of a cold therapy device (e.g. PolarCare) device helps decrease pain and swelling after surgery. This may or may not be covered by your insurance plan. You should check with your insurance company. cold-therapy device can also be purchased for you to own. Please contact us if you have questions about this.
How long will I be on crutches after surgery?
Crutches are recommended for your comfort. However you can put your full weight on the surgical leg. Most people stop using crutches 2-3 days after the surgery.
How long will it be until I can shower after surgery?
Incisions should stay dry until the first follow-up visit. You may shower 48-72 hours after surgery, but you must cover the incisions with plastic so that it does not get wet. If it does get wet, then use a clean towel and pat-dry the wet areas. Do not submerge or soak your knee in water until 3 weeks after surgery.
When is my follow-up visit?
At 7-10 days after surgery, you will return to the office. We will go over your surgery further, assess your motion, and examine the incisions. The sutures I use are buried under the skin, and do not need to be removed. We will then schedule additional post-op appointments.
When do I start physical therapy (PT)?
We will give you a prescription for physical therapy to begin the same week as your surgery. In addition, we will give you a sheet of exercises that you can do easily on your own before beginning PT.
What if I have more questions?
We encourage you to return to the office for a further discussion at any time. We will do our best to answer any questions by phone as well. We have a lot of information on our website, www.gomberamd.com There are surgical animations on the website as well.
How do I schedule surgery?
Please contact Chantel by phone at (713) 794-3457 or email at email@example.com