Knee arthroscopy is an endoscopic research method that allows you to assess the condition of various structures of this anatomical formation. It can be diagnostic and therapeutic. It allows to identify inflammatory and degenerative-degenerative changes, traumatic injuries, pathologies of rheumatological origin, at the same time to carry out some surgical manipulations. It refers to minimally invasive operations, does not involve the administration of medications (with the exception of therapeutic knee arthroscopy), requires compliance with certain rules on the part of the patient during preparation.
Arthroscopy makes it possible to visualize all the structures of the articular cavity using special equipment and optical installations. If changes are detected, the doctor can immediately begin performing therapeutic manipulations. The history of the study began in 1961, when the Japanese scientist Professor Tagaki invented a device equipped with tubes with a diameter of 4 mm to take synovial fluid from the cavity of the knee joint.
Nowadays knee arthroscopy is considered one of the most informative methods of diagnosis and treatment of diseases of this anatomical area, because it allows you to audit 95% of the articular cavity and assess the condition of even small structures. In comparison with radiography, this technique is much more informative. This is explained by the complete visualization of the menisci, ligamentous apparatus, intra-articular cartilage and the cavity as a whole, which is impossible when studying a conventional radiograph. Arthroscopy is widely used in orthopedics, traumatology, and is used in sports medicine, as athletes are prone to traumatic injuries due to significant loads on the musculoskeletal system.
Arthroscopic examination is used with insufficient information content of radiography, CT and MRI. The diagnostic procedure is indicated for suspected osteoarthritis with deformity of bone tissue, meniscus injury, tendon damage, ligamentous apparatus. The study reveals rheumatoid arthritis, inflammatory processes and neoplasms. With its help, it is possible to detect an intra-articular fracture, avascular tissue necrosis. Diagnostic manipulation is also performed if the patient has complaints of constant joint pain, limited mobility of unclear etiology. This method is also used when taking material for histological examination.
Therapeutic arthroscopy is indicated if it is necessary to excise individual sections of the meniscus or articular cartilage if it is impossible to restore them. With the help of the procedure, foreign bodies and fragments of fractures are removed from the joint cavity. The indication for manipulation is the need for joint rehabilitation, which occurs during purulent processes, accumulation of effusion and hemarthrosis (in cases when the fluid cannot be removed by puncture). During the procedure, it is possible to administer medications to stop the inflammatory process.
Intervention to restore lost functions is used for rheumatoid arthritis, patellar dislocation, degenerative processes (gonarthrosis), ligament damage. Arthroscopy is contraindicated in the presence of joint contracture (volume of movements less than 60 degrees) and extensive adhesions. The operation cannot be performed in acute infectious and inflammatory processes of the articular cavity. The procedure is not carried out if the patient is allergic to the anesthetics used.
Preparation for arthroscopy
The procedure is performed only by appointment of a traumatologist, surgeon or orthopedist. Before endoscopic manipulation, the patient must undergo a number of studies. It is necessary to pass a general analysis of urine, blood, coagulogram, it is shown to conduct a biochemical blood test, fluorography of the OGC and ECG. Consultation of an anesthesiologist is required. In the presence of chronic diseases, the patient should be examined by a therapist and narrow-profile specialists, depending on the existing pathologies. It is necessary to inform the doctor about the prescribed medications, in agreement with a specialist, temporarily refuse to take disaggregants, anticoagulants. A few hours before knee arthroscopy, it is recommended not to eat or drink.
Methodology of conducting
The study is conducted on an outpatient basis. The patient must change clothes for clean underwear or a special disposable medical suit and place himself on the operating table. The intervention is performed using local, regional or general anesthesia. A tourniquet is applied to the thigh, after which the skin is treated with an antiseptic solution, 3 punctures are made in the knee joint area. An arthroscope equipped with a video camera and various tools (forceps, scissors, special hooks, grinding devices) are introduced through them. During the procedure, the specialist consistently examines the articular cavity for the presence of pathological changes, paying attention to the condition of the articular surfaces, menisci and ligamentous apparatus, if necessary, conducts therapeutic interventions. Upon completion of arthroscopy, single stitches are applied to the puncture sites, the wounds are closed with a sterile bandage.
The duration of the diagnostic procedure is 15-20 minutes, the duration of therapeutic arthroscopy varies depending on the activities carried out, can reach 1 hour or more. After 3-4 hours, the patient can go home. If pronounced pathological changes are detected or complex therapeutic manipulations are performed, the patient is recommended to stay in the hospital. For a speedy recovery, physical therapy, massage, physiotherapy are prescribed. It is important to exclude intensive loads on the lower extremities, a bandage should be put on the knee joint, and during rest – place the leg above chest level.
The data obtained are recorded in the medical report. The information can also be stored on video media. Depending on the detected changes, patients are prescribed appropriate therapy. Usually knee arthroscopy is well tolerated and is not accompanied by complications. Negative consequences may occur if the manipulation technique is violated, if the sterility conditions are not observed. In such cases, endoscopic examination can lead to infection with the subsequent development of bursitis, arthritis, hemarthrosis. If the integrity of the vessels is violated, bleeding and venous thrombosis may occur. Sometimes there is hyperthermia, pain, swelling of tissues. Contractures and adhesions in the long-term period are very rare.