Knee & Shoulder Arthroscopy (Sports Medicine)

Arthroscopy is a surgical procedure that allows doctors to view the knee joint without making a large incision (cut) through the skin and other soft tissues. Arthroscopy is used to diagnose and treat a wide range of knee problems.

During arthroscopy, your surgeon inserts a small camera, called an arthroscope, into your knee joint. The camera displays pictures on a video monitor, and your surgeon uses these images to guide miniature surgical instruments.

Because the arthroscope and surgical instruments are thin, your surgeon can use very small incisions, rather than the larger incision needed for open surgery. This results in less pain and joint stiffness for patients, and often shortens the time it takes to recover and return to favorite activities

Your doctor may recommend knee arthroscopy if you have a painful condition that does not respond to nonsurgical treatment. Nonsurgical treatment includes rest, physical therapy, and medications or injections that can reduce inflammation.

Knee arthroscopy may relieve painful symptoms of many problems that damage the cartilage surfaces and other soft tissues surrounding the joint.

Common arthroscopic procedures for the knee include:

• Partial meniscectomy (removal of the meniscus), repair of a torn meniscus, or meniscus transplantation
• Reconstruction of a torn anterior cruciate ligament or posterior cruciate ligament
• Removal of inflamed synovial tissue
• Trimming or reconstruction of damaged articular cartilage
• Removal of loose fragments of bone or cartilage, like those caused by synovial chondromatosis
• Treatment of patella (kneecap) problems
• Treatment of knee sepsis (infection)

Once you are moved into the operating room, you will be given anesthesia. To help prevent surgical site infection, the skin on your knee will be cleaned. Your leg will be covered with surgical draping that exposes the prepared incision site.At this point, a positioning device is sometimes placed on the leg to help stabilize the knee while the arthroscopic procedure takes place.

To begin the procedure, the surgeon will make a few small incisions, called portals, in your knee. A sterile solution will be used to fill the knee joint and rinse away any cloudy fluid. This helps your orthopaedic surgeon see the structures inside your knee clearly and in great detail.

Your surgeon's first task is to properly diagnose your problem. They will insert the arthroscope and use the image projected on the screen to guide it. If surgical treatment is needed, your surgeon will insert tiny instruments through other small incisions.

Specialized instruments are used for tasks like shaving, cutting, grasping, and meniscal repair. In many cases, special devices are used to anchor stitches into bone.

While recovery from knee arthroscopy is faster than recovery from traditional open knee surgery, it is important to follow your doctor's instructions carefully after you return home.

After surgery, you will feel some pain. This is a natural part of the healing process. Your doctor and nurses will work to reduce your pain, which can help you recover from surgery faster.

Medications are often prescribed for short-term pain relief after surgery. Many types of medicines are available to help manage pain, including opioids, non-steroidal anti-inflammatory drugs (NSAIDs), and local anesthetics. Your doctor may use a combination of these medications to improve pain relief, as well as minimize the need for opioids.

Be aware that although opioids help relieve pain after surgery, they are a narcotic and can be addictive. Opioid dependency and overdose has become a critical public health issue in the U.S. It is important to use opioids only as directed by your doctor and to stop taking them as your pain begins to improve. Talk to your doctor if your pain has not begun to improve within a few days of your surgery.

In addition to medicines for pain relief, your doctor may recommend medication such as aspirin to lessen the risk of blood clots.

Keep your leg elevated as much as possible for the first few days after surgery. Apply ice as recommended by your doctor to relieve swelling and pain. Your weight-bearing status after surgery will be dictated by what is performed during the surgery.

You will leave the surgical facility with a dressing covering your knee. Keep your incisions clean and dry. Your surgeon will tell you when you can shower or bathe, and when you should change the dressing.

Your surgeon will see you in the office after surgery to check your progress, review the surgical findings, and begin your postoperative treatment program.

Most patients need crutches or other assistance after arthroscopic surgery. Your surgeon will tell you when it is safe to put weight on your foot and leg. If you have any questions about bearing weight, call your surgeon.

You should exercise your knee regularly for several weeks after surgery. This will restore motion and strengthen the muscles of your leg and knee.

Working with a physical therapist can help you achieve your best recovery.

Therapeutic exercise will play an important role in how well you recover. A formal physical therapy program may improve your final result.

Your doctor will discuss with you when you may drive. Typically, patients are able to drive from 1 to 3 weeks after surgery if the procedure was minor. More time may be needed for more extensive repairs or reconstructions.

Many people return to full, unrestricted activities after arthroscopy. Your recovery will depend on the type of damage that was present in your knee.

Unless you have had a ligament reconstruction, meniscus repair, or cartilage restoration, you should be able to return to most physical activities after 6 to 8 weeks, or sometimes much sooner. You may, however, need to avoid higher impact activities for a longer time.

If your job involves heavy work, it may be longer before you can return to your job. Discuss with your doctor when you can safely return to work.

For some people, lifestyle changes are necessary to protect the joint. An example might be changing from high impact exercise (such as running) to lower impact activities (such as swimming or cycling). These are decisions you will make with the guidance of your surgeon.

Sometimes, the damage to your knee can be significant enough that it cannot be completely reversed with arthroscopic surgery. More extensive operations may be needed in the future for these more severe conditions.

Your doctor may recommend shoulder arthroscopy if you have a painful condition that does not respond to nonsurgical treatment. Nonsurgical treatment includes rest , physical therapy, medications or injections that can reduce inflammation and allow injured tissues to heal (inflammation is one of your body's normal reactions to injury or disease; in an injured or diseased shoulder joint, inflammation causes swelling, pain, and stiffness)

Injury, overuse, and age-related wear and tear are responsible for most shoulder problems. Shoulder arthroscopy may relieve painful symptoms of many problems that damage the rotator cuff tendons, labrum, articular cartilage, and other soft tissues surrounding the joint.

Common arthroscopic procedures include:

• Rotator cuff repair
• Removal or repair of the labrum
• Repair of ligaments
• Removal of inflamed tissue or loose cartilage
• Repair for recurrent shoulder dislocation (chronic shoulder instability)

Less common procedures such as nerve release, fracture repair, and cyst excision can also be performed using an arthroscope.

Once in the operating room, you will be positioned so that your surgeon can easily adjust the arthroscope to have a clear view of the inside of your shoulder.

The two most common patient positions for arthroscopic shoulder surgery are:

• Beach chair position. This is a semi-seated position similar to sitting in a reclining chair.
• Lateral decubitus position. In this position the patient lies on their side on an operating table.

Each position has some slight advantages. Surgeons select positions based on the procedure being performed, as well as their individual training.

Once you are positioned, the surgical team will:

• Remove (shave) hair, if needed
• Spread an antiseptic solution over your shoulder to clean the skin.
• Cover your shoulder and arm with sterile drapes
• Most likely place your forearm in a holding device to ensure your arm stays still during the procedure

Your surgeon may inject fluid into the shoulder to inflate the joint. This makes it easier to see all the structures of your shoulder through the arthroscope.

Then, your surgeon will make a small puncture in your shoulder (about the size of a buttonhole) for the arthroscope. Fluid flows through the arthroscope to keep the view clear and control any bleeding. Images from the arthroscope are projected on the video screen, showing your surgeon the inside of your shoulder and any damage.

Once the problem is clearly identified, your surgeon will insert other small instruments through separate incisions to treat it. Specialized instruments are used for tasks like shaving, cutting, grasping, suture passing, and knot tying. In many cases, special devices are used to anchor stitches into bone.

Once the procedure is done, your surgeon will close your incisions with either stitches or steri-strips (small Band-Aids) and cover them with a large, soft bandage.

Although recovery from arthroscopy is often faster than recovery from open surgery, it may still take weeks to months for your shoulder joint to completely recover.

You can expect some pain and discomfort for several weeks after surgery. If you have had a more extensive surgery, however, it may take longer before your pain subsides. Ice will help relieve pain and swelling. Your doctor may prescribe pain medicine, if needed.

Treating pain with medications can help you feel more comfortable, which will help your body heal faster and recover from surgery faster.
Many types of pain medication are available to help control pain, including:

• Opioids
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Local anesthetics

Opioids can provide excellent pain relief; however, they are narcotics and can be addictive. It is important to use opioids only as directed by your doctor and to stop taking them as soon as your pain starts to improve.

Although it does not affect how your shoulder heals, lying flat may pull on your shoulder and cause discomfort. Some patients are more comfortable sleeping in a reclining chair or propped up in bed the first days after surgery.

A few days after surgery, you should be able to replace your large bandage with simple Band-Aids. You may shower once your wounds are no longer draining, but try not to soak or scrub your incisions.

You will most likely need a sling or special immobilizer to protect your shoulder. Your surgeon will discuss with you how long the sling will be needed.

Rehabilitation plays an important role in getting you back to your daily activities. Your surgeon will develop a rehabilitation plan based on the surgical procedures you required.

An exercise program will help you regain shoulder strength and motion. If you have had a more complicated surgical repair, your surgeon may recommend a physical therapist to supervise your exercise program.

For your surgery to be a success, it is important that you make a strong effort at rehabilitation.

Arthroscopic surgery has several key benefits.

An arthroscopic procedure makes very tiny incisions versus ‘open’ surgery, which may require large openings in the skin. Because less soft tissue is exposed to trauma, you have less swelling, less inflammation, and less pain than with open surgery.

You’ll have tiny wounds versus bigger ones. In some cases, within a day or two after surgery, you may be able to remove the bandages and cover the incisions with small sterilized strips with adhesive around them. On the other hand, open surgery is characterized by larger wounds that need more care and more trips to the doctor.

Before arthroscopy was developed, joint surgery required prolonged joint exposure during the procedure, which increased the risk of infection. It also increased the chance of arthrofibrosis, in which scar tissue forms as a response to the trauma of the surgery. The scar tissue restricts the range of motion, causing pain whenever you move the tissue or joint

Before the development of arthroscopic surgery, injuries involving joints often ended a professional athlete’s career. Now patients usually return to the field after time off.

Arthroscopic surgery entails a quicker recovery than open surgery. Your bandages come off sooner, your incisions heal more quickly, and you can begin physical therapy sooner if it’s needed. You’ll be able to return to work and your routine much more quickly than with open surgery

Open surgeries often took months of recovery, while the same procedure using arthroscopic surgery now takes weeks, saving time and money for hospitals, doctors, insurance companies, and patients alike. That’s why arthroscopy was one of the most important innovations in orthopedic surgery in the 20th century.