Arthroscopy is a minimally invasive surgery used in the diagnosis and treatment of articular deformities and injuries. Arthroscopic surgery is considered the most effective and efficient method due to its high technology and safety. The practice of its use is widespread in the most famous and advanced clinics in the world.
Instead of the incision, the doctor makes 2 miniature holes that are used to insert surgical instruments and an arthroscope. In this regard, the joint does not open completely, respectively, and the recovery period is markedly reduced. In some cases, it is possible to leave the hospital within hours after the operation.
Igor Alexandrovich Kuznetsov before arthroscopic surgery
- History of occurrence.
- The advantages of arthroscopy over conventional surgery.
- The main types of arthroscopic interventions.
- Surgical instruments used in arthroscopy.
- Stages of arthroscopic surgery.
- Preoperative preparation.
- Rehabilitation after arthroscopy.
- You might be interested in:
- Arthroscopy of the knee
- The structure and pathology of the knee
- Performing an operation
- Meniscus damage
- What is arthroscopy of joints: medical technologies and their capabilities
- General information
- How the procedure is performed
- For what purposes is the technique used
- Shoulder joint
- Elbow joint
- How is the postoperative period
- Arthroscopy of the knee: what is it, the technique of performing the operation
- Arthroscopy of the knee
- What is being done
- Indications for conduction
- Pros and cons of the method
- In which cases the operation is contraindicated
- How is the diagnostic procedure performed?
- Remediation intervention
- Types of treatment
- Operational process
- Complications after surgery
- Common problems: swelling and pain
- Less common consequences
- Negative Prevention
- Postoperative rehabilitation
- Recovery Periods
- Hygienic seam care
- Similar articles
- How to forget about joint pain?
- General Description of the Study
- The main types of arthroscopy
- Indications for conduction
- Study Preparation
- How is the procedure?
- Possible complications after surgery
- Rehabilitation after the procedure
- Arthroscopy – indications, conduct, rehabilitation
- Study Description
- Types of arthroscopy
- Indications for the procedure
- Contraindications arthroscopy
- Preparing for an operation
- Course of operation
- Possible complications after arthroscopy
- Rehabilitation and recovery
History of occurrence.
The first mention of the arthroscopic examination method dates back to the beginning of the 1912th century. Namely, in , the famous scientist from Denmark, Severin Norrentoft, spoke at the Berlin Congress of Surgeons. It was he who first told the world about the possibility of minimally invasive treatment, detailing the results of his successful studies.
This was followed by 7 years of rigorous study of the method, which culminated in the first arthroscopic experiment in 1919. Then it was conducted by the Japanese surgeon Kenji Takagi.
In subsequent years, Eugen Bircher made a great contribution to this branch of medicine – he published many scientific papers in which he urged doctors to treat joints in this particular way. Thanks in part to his discoveries, arthroscopy is available to modern humans.
Two other scientists that cannot be ignored are Masaki Watanabe and Heshmat Shahriari. They created the instrument itself – an arthroscope – which became the prototype of the equipment used today.
The advantages of arthroscopy over conventional surgery.
There are many advantages of this technique, of which the main ones can be distinguished:
- Low invasiveness (due to the fact that the doctor does not make an extensive incision, the damage to the surrounding tissues is minimal – the holes are so small that they are not even stitched together – they heal perfectly)
- The risk of complications that open surgery is famous for, such as bleeding, infections, contractures, is minimal.
- A plaster cast sock is not required, as is the case with arthrotomy.
- The cost of the event is lower – the operation itself costs about the same, but due to the lack of the need for a long stay in the hospital, less money is needed.
- The patient does not need to use heavy painkillers, analgesics.
- Arthroscopy does not even require anesthesia, a standard local anesthesia is enough.
- Almost immediately, the patient can go home – the period of stay in the hospital does not exceed two days.
- Excellent cosmetic effect – after the intervention there are no scars, only two barely noticeable spots with a diameter of less than a centimeter on the s >
The main advantage of arthroscopic surgery is minimal surgical intervention.
The main types of arthroscopic interventions.
Depending on the location of the operation:
Shoulder. Typically, this type is carried out by people who professionally engage in sports and / or lead an active lifestyle. Sometimes not only for the purpose of treatment, but also for prevention. The reason is the unstable work of the shoulder, all kinds of dislocations, damage to the rotational cuff.
Arthroscopy of the ankle
Also, by appointment, it happens:
- Diagnostic It is prescribed to study the nature of damage and deformation of the joint. The results of the study allow you to make an accurate diagnosis and prescribe treatment. As a rule, if the diagnosis reveals the need for surgical intervention, then immediate action is taken. Thus, arthroscopy goes into the second type.
- Therapeutic. During the operation, all the planned manipulations are carried out – removing fragments, stitching, endoprosthetics, etc.
Surgical instruments used in arthroscopy.
- Arthroscope is a special device with a camera at the end, inserted inward to the joint. The image is transmitted to the monitor in real time, increasing the picture several tens of times.
- Probe – necessary for manipulations with soft tissues.
- Troakar – a tool with which punctures are made.
- Cannulas from metal – supply water and drain fluid from the internal cavity.
Stages of arthroscopic surgery.
Shishkevich Vladimir, orthopedic and traumatologist, project editor-in-chief ExpertNews.
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This is a medical history, detailed consultation with a doctor. One of the fundamental stages of preparation is the determination of patient tolerance of all components of the anesthetic drug. Also, if a person has reduced blood coagulation, he is prescribed special drugs that he takes on the eve of the event.
First of all, local anesthesia is done. The trocar makes two incisions through which an arthroscope and cannulas for washing are inserted. To better examine the affected area, use a probe. Further, the doctor, carefully studying the image displayed on the screen, determines the diagnosis and conducts treatment (meniscus resection, circumcision, and so on).
The process of arthroscopic intervention
Despite the ease of the procedure, the patient can not move around during the day. Therefore, in the event of discharge, relatives or friends should pick it up. During rehabilitation, the victim will undergo a course of physiotherapy, which will be selected by a doctor, taking into account the individual characteristics of the body.
Rehabilitation after arthroscopy.
Therapeutic gymnastics on the apparatus Arthromot
Traditionally, restoration includes:
- Electrical stimulation;
- Therapeutic massages;
- Exercise therapy (physiotherapy exercises);
- Wearing compression garments or special dressings;
- Other types of physiotherapy.
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Areas of arthroscopy. Surgical instruments used in arthroscopic surgery. History. Benefits.
Arthroscopy of the knee
9 minutes Posted by Lyubov Dobretsova 11423
Arthroscopy of the knee joint is today the gold standard in the treatment of a variety of pathologies that limit the functionality of the articular apparatus. The use of minimally invasive methods for the treatment of joint diseases was a kind of revolution in surgery and allowed not only to significantly reduce the rehabilitation period, but also to perform surgical intervention for patients who have contraindications for the use of general anesthesia. This is due to the fact that knee arthroscopy can be performed using spinal, local and conduction types of anesthesia.
The structure and pathology of the knee
Of all the joints in the human body, the joints of the lower extremities account for the largest share of the load. It is this fact that determines its more complex structure, which allows to minimize the risk of injury. The main elements that form the knee joint are:
- joint capsule and joint cavity;
- synovial bag;
Menisci are cartilaginous formations directly involved in the work of the knee joint. Their main function is to provide depreciation during the movement of the knee. There are two types of menisci – external and internal. The outer one has a rounded shape, and the inner one is a crescent shape.
Table: Pathologies of the knee joint, symptoms and causes of development
Gap PKC and ZKS (anterior and posterior cruciate ligament)
Clicking of a joint in a circular motion
The appearance of excessive knee mobility
Sagging Shin Muscles
Damage or rupture of the medial or lateral meniscus
Injury due to dislocation of the shin outward or inward, shock, sharp bending of the knee
Meniscus rupture, congenital pathology, degenerative processes in intraarticular tissues
Mobility restriction (combined with meniscus tear)
Loose bodies in the joint
The feeling of the presence of a moving fragment in the joint
Acute injury, patella displacement
Koenig’s disease (dissecting osteochondrosis)
Circulatory disorders, trauma
Pathological changes in the synovial membrane
Trauma, regular exercise, inflammation
Joint clicking when bent
To ensure convenience during arthroscopy, the operated area must be bled. For this purpose, a pneumatic turnstile is placed on the hip of the operated leg, the inflation of the cuff of which prevents the flow of blood.
Since when using a turnstile, there is a high probability of side effects (severe pain, circulatory disorders in the operated limb, thromboembolism), before applying it, the limb is maximally bled with an elastic bandage.
The duration of surgery should not be more than two hours, as in adult patients there is irreversible damage to the peripheral nerve, and in children a critical increase in body temperature.
The pain syndrome that develops when the limb is squeezed by a turnstile is called “turnstile pain”. It is characterized by a gradual increase and resistance to relief by local anesthetics. Therefore, when planning an operation, its probable duration is taken into account and appropriate anesthesia methods are used.
Table: Permissible duration of surgical intervention for various types of anesthesia
On the day of arthroscopy, it is not recommended to eat and drink.
Performing an operation
The arthroscope is a thin tube equipped with an optical element that allows, when examining the state of intraarticular elements, to display a video image on the monitor. The possibility of multiple enlargement of the picture (up to 50-60 times) enables the doctor to evaluate visible damage in detail, which is much more informative in terms of diagnosis than magnetic resonance imaging (MRI) results.
The technique of arthroscopy consists in the phased implementation of the following actions:
- Making incisions on the skin in places optimal for the introduction of surgical instruments.
- Puncture of soft tissues using a trocar or a special device fixed at the ends of surgical instruments. In the first case, the instruments are inserted after the tissue is pierced, in the second, the piercing and insertion are carried out simultaneously.
- The introduction of an arthroscope and the supply of sterile fluid into the joint cavity through cannulas. The fluid in the knee joint is under the maximum allowable pressure, which provides a better view due to the expansion of the intraarticular space and the ability to remove blood, which impairs image quality. The adjustment of the intensity of the fluid supply is carried out using the regulator located on the cannula.
- The implementation of the necessary surgical procedures for the rehabilitation of the joint (removal of free fragments, suturing of injuries, etc.).
Depending on the nature of the damage, access to the interior of the joint is carried out in the following ways:
- anterolateral (anterolateral);
- anteromedial (anteromedial);
- supralateral (superior lateral);
Since menisci are cartilage, they have a very poor blood supply, so the regeneration process in them is extremely slow. Actually, blood supply occurs only in the peripheral part of the meniscus, where the cartilage grows together with the capsule artery. In the main parts located deep in the joint, blood supply is completely absent. For this reason, with an injury to the extreme part, the meniscus is relatively quickly restored, and if the main parts are damaged, they are not restored at all.
Meniscus tears can be of the following types:
During the diagnostic and treatment procedure, using the optical system, the joint is examined and the possibility of repairing the damaged meniscus is assessed. If the gap is in the central zone or there is a complete separation of the meniscus fragment, it is removed. In order to decide on the preservation of the meniscus, the following factors are taken into account:
- patient age – young age is an argument in favor of an attempt to restore the integrity of the damaged fragment;
- prescription of the injury – the later the patient seeks medical help, the less likely he is to restore the meniscus integrity;
- the condition of the ligaments of the articular apparatus – if a meniscus injury is combined with a partial or complete rupture of the ligaments, the chances of healing a stitched meniscus are quite low;
- the shape and location of the gap – the highest chance of recovery has a fresh gap in the outer edge of the meniscus.
Despite the relative safety of the operation, there is a small risk of complications. So, the negative consequences of knee arthroscopy can be as follows:
- the development of inflammatory processes due to infection;
- multiple hemorrhages in the joint cavity;
- peripheral nerve damage;
- vein thrombosis of the lower extremities;
- pulmonary embolism;
- arthritis of an infectious origin.
It is necessary to pay attention to the doctor if the following symptoms are observed after surgery:
- increased pain in the operated knee;
- increase in edema (normal edema should decrease);
- temperature increase;
- fever and hyperemia in the operated area;
- feeling unwell, palpitations, or lack of air.
The rehabilitation process is aimed at minimizing the likelihood of complications and reducing the recovery time of the damaged joint. To reduce painful manifestations and prevent the appearance of puffiness, ice is applied immediately to the damaged joint immediately after arthroscopy. The cooling procedure is carried out strictly dosed, approximately once every 3 hours, lasting about 15 minutes.
A mandatory procedure after arthroscopy is the use of antibiotics and non-steroidal anti-inflammatory drugs (NSAIDs). The duration of admission is determined by the doctor and ranges from 2 to 5 days.
After surgery to remove the meniscus, the patient should use crutches for 5-7 days. Meniscus recovery (stitching) requires a long time to avoid stress, so the use of crutches when walking can last up to two months.
Table: Stages of rehabilitation after revision arthroscopic plastic surgery of the anterior cruciate ligament (PCL) of the knee
What is arthroscopy of joints: medical technologies and their capabilities
Monitoring of Internet requests revealed the interest of the population in the capabilities of modern diagnostic methods. The article will tell about joint arthroscopy: what is it, for what purpose is the procedure intended.
The human joint is a complex multicomponent mechanism. 180 mobile connections help us to lead a mobile lifestyle. According to statistics, 30% of people sooner or later encounter various diseases of the articular parts. Joint arthroscopy helps specialists to get complete information about the degree of pathological changes within the joint, establish an accurate diagnosis, and choose an adequate treatment method.
The founder of endoscopic research is Kenji Takagi. In 1918, a Japanese physician conducted a cystoscope examination of the articular elements of a knee in a human corpse. After 2 years, the doctor invented his own arthroscope, but the large diameter of the device did not allow its use in widespread practice. The painstaking work to improve the invention was successful in 1932. Takagi produced the first color photographs of the internal cavity of the joint.
The medical community reacted to the new product with a large share of critical distrust. Only in the 60s, a student of Takagi was able to give a powerful impetus to the development of arthroscopy. He developed a new apparatus, providing it with a light bulb, which served as a prototype of a modern endoscope.
Currently relevant devices are a metal tube equipped with an optical lens on one side, an adapter into which the light cable is connected on the other hand, and a camera that transmits the image to the monitor. Clinical experience and the modernization of technical equipment turned the method into a highly effective procedure used for the diagnosis and minimally invasive surgical reconstruction of articular parts.
How the procedure is performed
For therapeutic and diagnostic purposes, arthroscopy is performed in a hospital with the observance of asepsis rules.
To study the anatomical components, in addition to the arthroscope, use:
trocar – a tool for piercing the skin and fat; arthroscopic probe – a curved rod that facilitates surgical manipulations with intraarticular structures, thanks to the marks applied to it, it is possible to accurately determine the size of pathological formations; shaver – has similarities with a milling cutter, with its help cartilage tissues that undergo degenerative-dystrophic changes are removed; nippers – the tool is used for resection of damaged menisci, ligaments, tendons; cannulas for supplying and discharging special solutions designed to provide better visualization of articular elements by removing accumulated fluid and washing out unnecessary fragments.
Given the severity of the disease and the purpose of arthroscopy, the patient is given local or general anesthesia. Then the surgeon performs several punctures (micro incisions) into which the surgical instruments are inserted. After examining the joint cavity and the necessary surgical procedures, the doctor carefully removes medical devices, injects an anti-inflammatory or antibacterial solution into the cavity, and heals the wounds.
The time period for the diagnostic procedure is no more than half an hour, (on average 15 – 20 minutes). After 3 to 4 hours, the patient is allowed to leave the medical facility. The data obtained during the study can be stored on a video medium. The duration of the treatment depends on the degree of damage and the complexity of their elimination.
The procedure refers to minimally invasive methods, therefore, subject to sterility and technique, in most cases does not threaten complications.
For what purposes is the technique used
Arthroscopy is a multi-purpose technique. In diagnostics, the procedure is carried out at the final stage of medical screening to confirm pathological abnormalities, or to exclude diseases of a similar nature.
A universal technique allows you to examine any joint.
For surgical intervention, the method is indicated in the following cases:
complete or partial separation of the articular lip; the operation allows you to attach the torn tissue to the bone; injury to the rotational cuff of the shoulder; using the method, damaged muscle tissue is detected and sutured; infringement of tendons; surgical manipulations are aimed at eliminating compressive elements; the presence of free chondromic bodies; the procedure makes it possible to completely remove pathological formations; inflammatory tendon diseases; during surgery, a gutter is formed in the bone tissue, where tendons detached from the usual bone are placed.
Using arthroscopy, a source is established that provoked stiffness of the joint joints and the manifestation of painful sensations.
The grounds for medical intervention are:
structural changes and proliferation of the synovial membrane of the joint; elimination of the consequences of dislocations and subluxations; bursitis, arthritis, dissecting osteochondrosis; bone growths; “Tennis player’s elbow” is a pathology that developed against the background of regular monotypic movements.
Arthroscopy is justified in case of degenerative changes in bone tissue, meniscus damage, violation of the integrity of the cruciate ligaments, hyaline cartilage, and interarticular capsules. The method reveals osteoarthrosis, gonarthrosis, rheumatoid arthritis, synovitis, intraarticular fractures, aseptic tissue necrosis. For diagnostic purposes, arthroscopy of the knee joint is performed with pain of unspecified genesis and unreasonable loss of mobility. Using the procedure, biological material is taken for histological examination.
For therapeutic purposes, arthroscopy is considered as:
a method for excising damaged areas of the meniscus and articular cartilage, if their restoration is not considered possible; means for extracting bone fragments from fractures; a method for the delivery of medications for inflammatory processes associated with the penetration of pyogenic flora into the joint, the ability to remove accumulations of blood substance, or other biological fluid in the cavity of the knee joint.
Other joints may be involved in the studies, but the knee joint is the undisputed leader. The joint is included in the category of complex ones, since in its compounds there are additional inclusions in the form of internal (medial) and external (lateral) menisci. Cartilaginous layers inside the knee play the role of shock absorbers and load balancers. Injury and rupture of the meniscus can lead to blocking of the articular parts.
How is the postoperative period
Complex surgical manipulation of the knee implies the patient is in the hospital under the supervision of medical personnel. The patient is prescribed bed rest, the operated limb is fixed with a bandage and placed above the chest level. Any load on the joint is excluded, if necessary, the introduction of anti-inflammatory drugs and painkillers is prescribed. The early recovery period takes from 4 to 7 days.
After 2 to 3 days, a physiotherapeutic treatment is recommended for the patient for early rehabilitation. In addition to the use of physical means and massage, an individual gymnastic complex is selected without fail.
After discharge, the patient is shown a sparing mode of motor activity and the further development of the operated joint.
The following exercises are suitable for this purpose:
while lying on your back, slowly bend and unbend your legs at the knees; bend the healthy leg while lying down, bend at the knee, straighten the operated extremity slowly raise it, fix it for 5 sec., slowly lower it; lying on a healthy side, take the diseased limb forward, backward, upward; standing, holding on to the back of a chair, leaning on a sore leg, bend a healthy one at an angle of 90º; keep position for 10 seconds.
Gradually move on to light springy squats with a small bending amplitude. Work on your gait. Make sure that the step length is small, the rhythm of movement is measured, the walks are short-lived.
In 5 – 6 weeks after the operation, classes on a stationary bike in a gentle mode, swimming, exercises using a stable step platform are allowed.
Recovery after arthroscopy of the knee joint takes up to 4 months. Excessive physical activity and joint load are eliminated until the biomechanics of the bone joint are completely stabilized.
Arthroscopy of the knee: what is it, the technique of performing the operation
Arthroscopy is performed to examine the inside of the knee joint, and, if necessary, conduct treatment. This minimally invasive surgical procedure is used to detect gonarthrosis, all forms of arthritis, synovitis, bursitis, and their subsequent treatment. Arthroscopy is less traumatic, and after its completion a long rehabilitation is not required.
Arthroscopy of the knee
Classical arthrotomy, consisting in opening the cavity of the knee joint, is losing ground. Now, most orthopedic surgeons prefer to perform arthroscopy operations, one of the advantages of which is minimal risks for the patient.
Arthroscopy is called endoscopic examination of the knee using special arthroscopic equipment. Diagnostic manipulation allows a thorough examination of all intraarticular structures, to assess their condition. This is one of the most informative studies, the results of which often make it possible to make a final diagnosis.
What is being done
Arthroscopic manipulation can be performed for diagnostic, treatment or diagnostic purposes. Often, in the process of examining the inner surface of the knee, the doctor makes a decision on the immediate conduct of therapy – removal of foreign impurities, the use of antiseptic solutions or antibiotics, and the extraction of pathological exudate.
Indications for conduction
Arthroscopy is indicated for the detection and (or) treatment of many orthopedic pathologies. This is the “articular mouse”, deforming osteoarthritis, intraarticular fracture, rheumatoid arthritis, muscle and tendon injuries. Using an endoscopic procedure, it is possible to diagnose a rupture of the anterior cruciate ligament, damage to the menisci and immediately restore them.
Pros and cons of the method
Minimally invasive surgery is less traumatic, since the introduction of miniature instruments does not require dissection of the skin and soft tissues. Upon completion, the patient can be discharged home after 3 days. Certain complications may occur after arthroscopy, but their likelihood is significantly lower than after an abdominal operation.
In which cases the operation is contraindicated
Arthroscopy is usually not used for contractures, bone or fibrous ankylosis, low blood coagulation. It is contraindicated in the severe general condition of the patient, acute infectious process, the presence of wounds, ulcers, abrasions in the knee area. The decision to conduct surgical manipulation in patients with diabetes mellitus, arterial hypertension is made by the attending physician.
How is the diagnostic procedure performed?
The doctor makes a small puncture of the skin and soft tissues through which a fiber optic camera enters. He moves it, examining the surface of intraarticular structures. From a miniature camcorder, the image is transmitted to the monitor screen. To improve visibility, a special fluid is introduced into the cavity of the knee joint. The image is recorded on electronic media for further study.
Remediation is performed in order to remove pathologically altered tissues in the area of the knee joint. During the intervention, wound surfaces are treated with antiseptics, drug solutions with anti-inflammatory, analgesic, tissue stimulating tissue regeneration effects.
Types of treatment
Arthroscopy can be performed to remove cartilage particles moving freely in the cavity of the knee joint. The therapeutic measure is indicated for patients with torn menisci, damage to the ligament-tendon apparatus in order to restore them by stitching. Excision of bone growths (osteophytes) with subsequent plasty, cleaning of intraarticular surfaces from dead tissue, fibrin deposits, excretion of pathological exudate, as well as fresh blood and blood clots, also become arthroscopy tasks.
Before conducting minimally invasive debridement, a number of studies are prescribed to assess the overall health of the patient. These are clinical blood and urine tests, an electrocardiogram. If arthroscopy is performed in the morning, then the last meal should be the dinner of the previous day. Doctors recommend a cleansing enema, and if necessary, prescribe a mild sedative.
Even “neglected” joint problems can be cured at home! Just remember to smear it once a day.
The doctor makes several punctures of the skin and soft tissues with a trocar. An arthroscope equipped with a video camera is introduced through one of them. It transmits to the monitor screen an image of the surgical field, structures located nearby. The device is also equipped with a device, dosed supplying physiological saline. This allows you to increase the distance between the intraarticular structures to ensure the best viewing conditions.
Saline solution enters the knee cavity, and then is removed from it together with freely lying small fragments, blood clots. If necessary, the doctor uses miniature tools for manipulation during arthroscopy. Usually a special probe is used, and with the help of a shaver (a kind of milling cutter), parts of the damaged hyaline cartilage are removed. The destroyed menisci, parts of the ligaments are excised with nippers. At the end of the manipulations, 1-2 sutures are applied, and an aseptic dressing is applied over the punctures.
Complications after surgery
Since the integrity of small areas of skin and soft tissues is violated during arthroscopy, the risk of infection is rather low. In 1,5-2% of cases, after some time, complications from intraarticular structures are revealed.
Common problems: swelling and pain
These are the body’s natural responses to any surgical intervention, even minimally invasive. With a puncture, small arterial vessels – capillaries are damaged. Blood from them is poured into soft tissues, which often causes severe swelling with the subsequent formation of hematomas. Soreness after arthroscopy is also quite physiological, and its severity is gradually reduced.
Less common consequences
More rarely diagnosed complications of arthroscopy include adhesions, scars, hemorrhages in the cavity of the knee joint (hemarthrosis), case syndrome, thromboembolic processes, nerve damage.
Compliance with aseptic rules and constant monitoring of postoperative sutures allow avoiding complications. In order to avoid serious damage to the nerve or intraarticular structures, one should apply for reproductive clinics equipped with modern medical equipment for arthroscopy.
It is not enough to excise bone growths or remove pieces of cartilage from the joint cavity. It is necessary to carry out rehabilitation measures to restore all the functions of the knee, healing the tissues damaged during the operation.
A complete restoration of the amplitude of movements is observed after about 2-2,5 months. During the rehabilitation period, the patient must observe a gentle regimen – avoid stress on the operated knee, keep the leg in an elevated position, wear first rigid orthoses, and then elastic knee pads.
Hygienic seam care
For the treatment of joints, solutions of antiseptics, including alcohol-containing ones, are used. This is brilliant green, Chlorhexidine bigluconate, Furacilin, with bleeding – hydrogen peroxide. It is advisable not to soak the seams with water, and before taking a shower, you need to seal the knee with a waterproof seal. The doctor removes the remaining threads after about 10 days.
Physical therapy classes can be started only with the full restoration of torn ligaments, muscles, tendons, and relief of inflammation. An exercise therapy doctor makes a set of exercises to strengthen the knee joint individually for each patient. He is present at the first trainings, controls the execution of movements, tells how to avoid excessive loads on the knee joint.
To accelerate the healing of articular structures, the patient is assigned 5-10 sessions of magnetotherapy, UHF therapy, laser therapy, galvanic currents, ultraviolet radiation. It is also indicated balneotherapy with mud, mineral waters, massage, acupuncture.
How to forget about joint pain?
- Joint pain limits your movement and full life .
- You are worried about discomfort, crunching and systematic pain .
- Perhaps you have tried a bunch of drugs, creams and ointments .
- But judging by the fact that you are reading these lines, they did not help you much .
Arthroscopy is a modern surgical procedure that is performed to diagnose and treat several groups of joints. Arthroscopy is referred to as minimally invasive surgery, that is, operations without incisions. Risks for the patient with such treatment are minimal, and rehabilitation takes much less time compared to classical, open surgery.
General Description of the Study
The history of arthroscopy began back in 1912, when Dr. Severin Norrentoft from Denmark announced at the congress of surgeons that such an operation is quite real. In the 1920s, Eugen Bircher was actively involved in meniscus arthroscopy, but a complete carte blanche for these operations was issued to Japanese Masaki Watanabe. In collaboration with other scientists, this surgeon also invented the first full-fledged arthroscope.
Today, arthroscopy is considered a universal operation – the method allows you to assess the state of a variety of bones, remove and replace damaged tissues and restore the joint itself.
The main types of arthroscopy
- Arthroscopy of the knee joint (or meniscus). This operation is done most often. When the meniscus, PCB and ZKS (anterior and posterior cruciate ligaments) are torn, grafts from the patient’s own ligaments (for example, thighs) or artificial ones are used.
- Arthroscopy of the shoulder joint. This variety is also used quite often – both for prevention and for treatment. In athletes, a rotational cuff rupture often occurs, in ordinary people, a commonplace dislocation of the shoulder, joint instability, etc.
- Hip arthroscopy. Such manipulation is carried out much less often and requires high skills from the doctor. Used to assess the condition of the femur and other articular elements and appropriate treatment.
- Arthroscopy of the elbow joint. Recommended for patients as a diagnostic procedure for complaints of pain in the hand and any problems with flexion-extension of the limb. And also for operations with infections, arthritis, etc.
- Arthroscopy of the ankle joint. Indications for operations on the ankle are very many, they make it quickly and painlessly. Rehabilitation takes place in a gentle manner, and on average after 5 weeks the patient can already walk quietly, fully relying on the foot.
Indications for conduction
The arthroscopic procedure is universal; it is used both for surgical treatment and for diagnosis.
The diagnostic procedure is used when all non-invasive options (CT, MRI, X-ray, ultrasound) have already been tried and no clear results have been obtained. Indications for arthroscopic diagnosis are meniscus tears, PKC and ZKS for the knee, other ligaments, tendons, chronic pain. Other cases are synovitis (inflammation of the synovial membrane of the joint), fractures, arthritis, arthrosis, etc.
Indications for arthroscopic surgery represent a much more impressive group:
- damage to the meniscus and cartilage in the knee joint, meniscus cyst;
- ruptures of ligaments in the knee (PKS, ZKS or both at once);
- chronic inflammation in the bones;
- removal of foreign bodies (pieces of cartilage and bones from the joint cavity);
- flushing the joint and removing excess flu >
Regardless of whether arthroscopy of the knee joint or others is performed, there are general contraindications – absolute and relative.
Common include bone or fibrous ankylosis (the joint gap is overgrown with bone or connective tissue, respectively), purulent inflammation and wound, as well as the general serious condition of the patient.
If relative contraindications are recorded, the doctor may consent to the procedure at his discretion. These are extensive injuries when the joint tightness is broken, and hemorrhages in the joint cavity.
Preparation for such treatment is the same, be it arthroscopy of the hip joint, knee surgery or a diagnosed shoulder dislocation. Before an arthroscopic operation, a surgeon and an anesthesiologist must talk with the patient, talk about the progress of the procedure, and warn about all possible risks and complications. Then the patient must sign a consent to arthroscopy and anesthesia.
Before the procedure as prescribed by the attending physician, you need to do an ECG, pass general tests (blood, urine), conduct some other studies. 12 hours before arthroscopic manipulation, it is forbidden to eat and drink any liquid. The night before, it is also recommended to make an enema to cleanse the intestines and drink a light sleeping pill.
If arthroscopy of the knee joint is performed, crutches must be selected in advance and learned to use them. They are often brought already for surgery – crutches are needed immediately after arthroscopic intervention.
How is the procedure?
Usually, any operation of this kind – and widespread arthroscopy of the shoulder joint, and more complex arthroscopy of the hip joint, and other types – takes place under general anesthesia. Doctors use less local anesthesia – the effect may not be enough for the entire operation, and the risks of discomfort after the procedure are much higher.
For the operation, special tools are used: an arthroscope (a type of endoscope), a trocar with which the surgeon punctures tissues, metal cannulas for supplying and draining fluid from the joint cavity and an arthroscopic probe. With its help, the surgeon can push the tissues away, so that if necessary it is better to examine the affected area.
The operation itself lasts 1-3 hours and proceeds according to the following scheme.
First, the patient is placed on the operating table and provide access to the damaged bone. If this is arthroscopy of the knee joint, then the knee is bent at an angle of 90º – or they put the foot in the holder, or the shin simply hangs from the table. If the operation is carried out on the shoulder, the patient’s hand is taken up and fixed with the help of the load, if on the ankle the calf is fixed in a stand of 20 cm. There are also requirements for treating other bones.
Then – with some arthroscopic interventions – a tourniquet is applied to the patient, and then a puncture is made and an arthroscope is inserted. Then the joint is washed through another puncture, if necessary, make a few more incisions and introduce additional tools. So, in the knee area there are 8 special points through which punctures are made to treat the damaged meniscus and ligaments.
Possible complications after surgery
Joint arthroscopy is a low-traumatic operation, and the risks for the patient after such treatment are minimal. But complications after such manipulations still exist and make up from 0,6% to 1,7% of cases, depending on the region and clinic.
The main consequences of surgery on bone joints are:
- internal infection;
- intraarticular damage from broken instruments;
- accumulation of blood in the articular cavity (hemarthrosis);
- adhesions and scars;
- case syndrome (compression of muscles, tissues and nerves with fluid or gas);
- nerve damage;
- movement disorders in the operated joint, etc.
Most often, complications such as infection, damage to the bones by instruments and synovitis are recorded (synovitis can be both an indication for arthroscopy and a complication).
Synovitis after surgery on the knee usually makes itself felt within the first day. Secondary puncture of the knee with its washing will help cure synovitis. Antibiotics are used to prevent and treat post-arthroscopic infections.
Rehabilitation after the procedure
Rehabilitation after operating bone joints depends on the type of arthroscopy and the patient’s health status. The maximum stay in the hospital can drag on for 20-30 days, and after treatment, the patient’s meniscus is released home after a few hours.
Full rehabilitation takes from a couple of weeks to 3-4 months, and in order to speed up recovery, you need to follow a few simple rules.
- To prevent infections, immediately after the operation, antibiotics are administered to the patient (sometimes twice, with an interval of one day).
- The first time after surgery, the patient should be completely at rest. The operated limb (or pelvis) must be strictly fixed.
- Three to five days will have to wear compression hosiery and elastic bandages. Motor activity must be drastically reduced (so as not to provoke synovitis or other inflammation).
- For two weeks, while rehabilitation is in progress, the patient is prohibited from hot baths and hypothermia. It is also impossible to sunbathe in the sun.
Arthroscopic treatment of joints today is increasingly used instead of the traditional open surgery – arthrotomy. Its advantages are obvious – cuts on the skin are minimal (3-5 mm), the scars after healing are almost invisible, and the patients themselves tolerate this procedure very easily. And the recovery time after arthroscopy is several times less than with severe arthrotomy.
Through exercise and abstinence, most people can do without medicine.
Arthroscopy – indications, conduct, rehabilitation
In some joint diseases, invasive diagnostic procedures cannot be dispensed with. We are talking about arthroscopy – what it is, one has to learn from personal experience who have received a serious joint injury and a number of other patients. Arthroscopy often serves as an examination and therapeutic manipulation, which helps restore health to the joint.
Arthroscopy is one of the methods of treatment and diagnosis of various joint diseases. The first survey of this type was conducted in 1919 in Japan. Now the principle has remained the same, but the technology has improved significantly. The technique involves the use of an arthroscope, which is inserted into the joint cavity after performing a small incision or puncture on the skin and soft tissues. Arthroscopy is a very gentle manipulation: despite the invasiveness, there are almost no traces on the body, there are no scars.
Arthroscope is a type of endoscope – a device for examining internal organs. Before classical operations, the procedure has huge advantages:
- There is no full disclosure of the joint, the risk of infection is an order of magnitude lower;
- The process of rehabilitation and complete restoration of the joint is reduced, disability quickly returns;
- Positive outcomes are noted more often, the consequences of the operation are less serious;
- There is no cosmetic defect (cut size – up to 5 mm);
- In the hospital, the patient stays for 2-3 days.
Of course, arthroscopy can not always replace conventional surgery, but in many cases, surgeons no longer have to make large incisions and severely injure the joint.
Types of arthroscopy
Depending on the goals, arthroscopy on the joint may be as follows:
- Diagnostic (research) arthroscopy. It is carried out for statement, specification, confirmation or refutation of the diagnosis.
- Therapeutic arthroscopy. It is required to eliminate the effects of injuries, for the treatment of inflammatory, tumor, degenerative joint pathologies.
- Medical diagnostic arthroscopy. Combines both types of goals, usually assigned after an injury.
The procedure can be performed on any joint of the bones and even on the spine, depending on this, there are such zones of its execution on the joints:
- On the joints of the fingers, etc.
How much the intervention costs depends entirely on its type, goals, complexity, and vastness of treatment. Typically, the minimum price of arthroscopy is 4-5 thousand rubles, the maximum is 30 thousand rubles. on diagnostic procedures.
Indications for the procedure
Arthroscopy diagnostic surgery is indicated if other examination methods (CT, MRI, scintigraphy) are unavailable, uninformative, or not appropriate. The introduction of a micro camera with a video review into the joint allows you to determine the exact condition of all components: hyaline cartilage, articular membranes, bags, etc. During arthroscopy of the joints, you can diagnose:
- Deformation of the heads and hollows of bones;
- Abnormal bone location
- The presence of fragments, adhesions, scars;
- Presence of cysts, inflammation, fluid, blood (hemarthrosis);
- Meniscus damage;
- Detachment, bulging, cartilage roughness;
- The presence of free chondromic bodies.
During arthroscopy, the doctor, if necessary, will take a biopsy if there is a tumor process, or it is necessary to identify the causative agent of infectious inflammation. Also, an indication for diagnostic manipulation is the subsequent carrying out of a complex operation, for example, to replace a joint.
A therapeutic or diagnostic treatment procedure has other goals or combines them. Indications is treatment:
- Ligament rupture, rotational cuff of the shoulder;
- Tendon ruptures;
- Chronic capsulitis, tendonitis;
- Joint instability;
- Dislocation, including the usual dislocation of the shoulder;
- Fractures, chipping bones;
- Meniscus damage;
- Pinched sciatic nerve (on the hip joint);
- Chronic and acute synovitis, bursitis;
- Scarring, adhesions with arthrofibrosis.
Often with the help of arthroscopy, the intervertebral hernias, spinal tumors are excised, injuries and curvatures of the spinal column are treated.
Among the contraindications, there is a rather large list of diseases and conditions. The absolute prohibitions on arthroscopy of joints are as follows:
- Intolerance to anesthesia or the impossibility of its implementation;
- The complete lack of mobility of the joint of the bones (ankylosis), when the size of the cavity does not allow the introduction of an arthroscope;
- Acute infectious processes, accompanied by suppuration (this is an indication for open surgery).
There are also general contraindications – the presence of HIV, hepatitis, somatic pathologies with a severe course (for example, heart failure). Planned interventions are not done for acute infections, bleeding, during menstruation in women. With massive hemorrhage in the joint, arthroscopy can also be canceled.
Preparing for an operation
Preparations for joint treatment, first of all, include passing a series of examinations. Before arthroscopy of one or more joints is performed, you need to do:
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- Blood test for HIV, hepatitis, RW;
- General clinical tests of urine, blood;
- Ultrasound or other instrumental examination of the joint;
- In chronic diseases – consultations of narrow specialists;
- Consultation with an anesthetist.
Arthroscopy should be performed on an empty stomach, so you can’t eat on the day of the intervention, drink after 2 hours. This will help to avoid a number of complications. In the evening you need to make an enema, shave the hair on the skin in the joint area.
Course of operation
As a rule, anesthesia for this procedure is general, and under local anesthesia only quick diagnostic interventions are performed. Usually an inhaled or injectable drug is used, which is administered under the supervision of an anesthetist. When treating a knee joint during spinal arthroscopic surgery, spinal anesthesia can be used.
The main equipment for the intervention is as follows:
- Arthroscope – a tube with a light cable;
- Troakar – a device for piercing the skin, fiber, joint capsule;
- Cannula (2 pieces) – needed to supply flu >
The progress of the operation is as follows:
- The joint area is fixed with a holder.
- Anesthesia is administered.
- A tight tourniquet is applied above the joint to reduce blood flow.
- A puncture is made, an arthroscope is inserted into the joint cavity.
- After another one or two punctures, a cannula is inserted, other necessary tools for arthroscopy of the operated or examined joints.
- Inspect the joint, make the necessary manipulations.
- Withdraw instruments, treat the puncture site with an antiseptic, fix with a sterile dressing.
Possible complications after arthroscopy
Medical or diagnostic arthroscopy can cause a number of complications if the operation is performed incorrectly, but they are rare. Typically, problems are associated with a violation of the technique:
- Bleeding due to vascular damage;
- Break off small parts of tools.
Redness, joint pain, fever, swelling and hyperthermia of the skin can also become a complication. Occasionally, an operation to perform arthroscopy is complicated by suppuration of tissues, the development of arthritis, nerve damage, and thrombosis.
Rehabilitation and recovery
Rehabilitation techniques after arthroscopy are simple. A bandage is applied to the joint, the area is cooled with ice. In a hospital, a person is given painkillers for 2-3 days (usually no longer required), by the third day you can get up (if the operation covered the knee, thigh).
Recovery after arthroscopy is carried out using massage, exercise therapy from the second day. If necessary, a joint bandage is worn during rehabilitation. Antibiotics are taken in the first 5-7 days after arthroscopy. Complete restoration of joint function usually takes 2 months.