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Knee Arthroscopy

Structure of the Knee

Ligament

A ligament is a very strong band of tissue that attaches 2 bones together. This prevents the 2 bones from moving apart in a certain direction and hence provides stability in that direction.

Four Main Ligaments in the Knee

There are four major ligaments in the knee. Ligaments are elastic bands of tissue that connect bones to each other and provide stability and strength to the joint. The four main ligaments in the knee connect the femur (thigh bone) to the tibia (shin bone) and include the following: 

      1. Anterior Cruciate Ligament (ACL)

The ligament, located in the center of the knee, that controls rotation and forward movement of the tibia (shin bone).

       2. Posterior Cruciate Ligament (PCL)

The ligament, located in the back of the knee, that controls backward movement of the tibia (shin bone). 

      3. Medial Collateral Ligament (MCL)

The ligament that gives stability to the inner knee. 

      4. Lateral Collateral Ligament (LCL)

The ligament that gives stability to the outer knee.

Tendon

Tendons connect the knee bones to the leg muscles that move the knee joint. Ligaments join the knee bones and provide stability to the knee: 

  • The anterior cruciate ligament prevents the femur from sliding backward on the tibia (or the tibia sliding forward on the femur). 
  • The posterior cruciate ligament prevents the femur from sliding forward on the tibia (or the tibia from sliding backward on the femur). 
  • The medial and lateral collateral ligaments prevent the femur from sliding side to side. 

Cartilage

Two C-shaped pieces of cartilage called the medial and lateral meniscus act as shock absorbers between the thigh bone (femur) and lower leg bone (tibia). The meniscus may be damaged by twisting movements that force the knee beyond its normal range of movement.

Symptoms of Knee Injury

Knee injuries are generally caused by twisting or bending force applied to the knee or a direct blow such as from sports, falls or accidents. You may hear a “popping” sound when the injury occurs, followed by leg buckling when trying to stand on it, pain and limitation of movement.

Does the torn ligaments can heal by itself?

While a torn ligament can heal on its own over time, it is best to seek out medical attention to ensure that the affected area heals correctly without a lot of excessive scarring. 

Ligaments heal through a distinct sequence of cellular events that occur through three consecutive phases: the acute inflammatory phase, the proliferative or regenerative phase, and the tissue remodeling phase. Ligament healing is often slow and incomplete.

Treatments for Knee Injury

Specific treatments for a knee ligament injury will be determined by the surgeon based on: 

  • Your age 
  • Your overall health and medical history 
  • How bad your injury is 
  • How well you can tolerate specific medications, procedures, and therapies 
  • How long it may take for your injury to heal 
  • Your opinion or preference 

Treatments may include: 

  • The involvement of RICE therapy such as Rest, Ice, Compression and Elevation
  • Physiotherapy 
  • Muscle-strengthening exercises
  • Protective knee brace (for use during exercise) 
  • Surgery

Diagnosis Procedure

Knee injuries are diagnosed by a patient history and physical examinations. Other tests maybe be conducted as follows:-

  • X-ray and CT scans are used to determine for bony injuries (fractures) 
  • MRI of the knee to evaluate soft tissue damage (ligaments and cartilage)
  • Arthroscopy to enable the surgeon to view your knee joint through small incisions made in the knee. If the meniscus is torn, it can either be repaired or removed if it is damaged beyond repair.

What is Knee Arthroscopy?

The word arthroscopy comes from two Greek words, “Arthro” defines as a “Joint” and “Scopy” defines “to look”. The term “arthroscopy” refers to looking within the joint. 

Knee Arthroscopy is a surgical technique that can diagnose and treat problems in the knee joint. During the procedure, the surgeon will make a very small incision and insert a tiny camera, which is called an arthroscope into your knee. This allows them to view the inside of the joint on a screen. Therefore, the surgeon is able to investigate a problem with the knee and if necessary, correct the issue using small instruments within the arthroscope. 

This procedure is conducted under anaesthesia. It is a relatively safe procedure and a majority of the patient’s discharge from the hospital on the same day of surgery.

What happens during the knee arthroscopy?

The surgeon will give you an anesthetic before knee arthroscopy starts. Options for anesthesia include:

Local Anesthetic Regional Anesthetic General Anesthetic
It applies where the knee joint is numbed but you can be awake It applies where the lower extremities are numbed from the area near your spine. You can remain awake in the procedure, or choose to be sedated you will be asleep during surgery when general anaesthesia is administered

Benefits of Knee Arthroscopy

Arthroscopy is much less traumatic to the muscle, ligaments and tissues than the traditional method of performing “open” surgery with long incisions (arthrotomy). 

The benefits of arthroscopy:

– smaller incisions

– faster healing 

– more rapid recovery

– less scarring

Common Knee Surgeries

The common surgeries performed on the knee include: 

  • Removal of the damaged part of a meniscus (partial menisectomy) 
  • Repair of the meniscus 
  • Reconstruction of the ligaments 
  • Lateral release of the patella if it is tilted or tight 
  • To clean out the joint of debris and inflamed tissue in arthritic joints

Knee Injury Admission Procedure at Spire Orthopaedic Clinic

Our doctor will need to know about your medical history and explain to you the nature of your surgery, as well as, its complications.

Our doctor will advise you to have blood test done to check for overall health and fitness for the surgery.

For the patients who aged 40 years and above, he/she will have to undergo additional tests such as Electrocardiogram (ECG) and Chest X-ray to assess the health their hearts and lungs.

Our  staff will provide you with pre-surgery instructionss as follows: 

  1. the estimated days of hospitalization
  2. estimate of the surgical bills 
  3. the fasting requirement (ie. fasting 6 hours prior to surgery)
  4. medications that will be dispensed and has to be taken upon discharge from hospital 
  5. to stop anti-coagulant medication one week before surgery 
  6. to stop smoking and no alcohol intake two weeks before surgery 
  7. in the event you feel any unwell 2 days before the scheduled surgery, please call our hotlines at 65-80314388

On the Day of Admission

  1. You have to settle the registration for hospital admission 2 hours of prior to the scheduled surgery
  2. The surgeon will go through with the patient again for the nature of surgery and its complications. After that, we will need to get the consent from you for surgery
  3. The anaesthetist will  assess your fitness for surgery
  4. The hospital nurse will explain what is to be anticipated when in the operating theatre as well as when you are are awake from surgery.

On the Day of Surgery

During Surgery

The surgery is performed in the operating theatre either under general, regional or local anaesthesia.

The surgeon will insert the arthroscope into the joint through a tiny cut at approximately 1cm in size. The arthroscope carries fibreoptic lights and is attached to a video camera. The image is viewed on a screen. Through 1 or 2 of similar 1cm incisions, the surgeon will pass other instruments into the joint. The surgeon will confirm the diagnosis and the damaged portion of the joint is corrected or repaired as required.

At the end of the surgery, a bulky dressing is placed around the joint. This is usually removed about 24-48 hours after the procedure a new bandage is applied.

After Surgery

After the surgery, you will be closely observed in the ward.

You may experience some pain or discomfort. If any symptom of nausea or vomitting occurs, please inform the nurse immediately.

A tube or drain may be inserted near your operated site to drain any excess blood or body fluids from the joint area.

You have to stay in bed for minimum of 6 hours after the surgery for the anaesthesia to wear off. You may to sit up or walk slowly around the bed if you are feeling well.

You will be given food and drink after surgery.

Physiotherapist will be assigned to you for leg exercises and walking with crutches in order for you to regain for your muscle strength and stabilize the affected joint

Day of Discharge

Our Surgeon will

  1. examine your wounds
  2. advise if you can be discharged
  3. provide instructions on medication intake post discharge
  4. medications will be dispensed at the clinic or hospital on discharge

The nurse will provide a discharge letter, medical certificate and post-operative follow up appointment date before leaving hospital.

Rehabilitation after Knee Surgery

What should you do at home after your surgery?

1) You should take medications that being prescribed in the clinic. Medications will help you to minimize the swelling and pain over operated knees. The pain will be subsided gradually each day 

2) You are required to walk around your home using a front-wheel walker, crutches or a cane (assistive walking device) that the physiotherapist instructed to use 

3) To do daily knee exercise that being advised from physiotherapist in order to regain the muscle strength and improve the range of movements for the operated knees 

4) Keep the wound clean and dry at all the time to prevent from any infection 

5) To cover the operated knee with waterproof protector during shower 

6) To come back for post-op review appointment given from the clinic so that the surgeon can review the wounds

Knee Rehabilitation Exercises

There are 2 types of exercises that helps to strengthening for leg muscles namely thigh squeezes (Quadriceps setting) and straight leg raising.

Thigh Squeezes (Quadriceps Setting) 

  • Lie on your back with your knees straight, legs flat and arms by your side 
  • Tighten the muscles on the top of the thigh (quadriceps) by pushing the back of your knee down into the bed
  • Hold for 5 seconds and relax. 
  • Repeat this exercise for 6 times 
  • Perform the quadriceps setting at least 4 times a day

Straight Leg Raising 

  • Bend your non-surgical leg with your foot flat on the bed 
  • Tighten the muscles on the top of your thigh, stiffening your knee
  • Raise your surgical leg up (about 12 inches), keeping your knee straight 
  • Work up to holding for 5 seconds 
  • Slowly lower your leg down and relax
  • Repeat this exercise for 6 times 
  • Perform the straight leg raising at least 4 times a day

Conclusion

Knee arthroscopy is a simple procedure that is proven helpful to knee injury patients. If you have any other questions regarding knee injury and knee arthroscopy, feel free to contact us at Spire Orthopaedic Clinic.

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