Knee ArthroscopyKnee Arthroscopy

University Orthopaedics & Sports University Orthopaedics & Sports MedicineMedicine

Presentation designed for patient Presentation designed for patient educationeducation

Updated 2/11

University Orthopaedics & University Orthopaedics & Sports MedicineSports Medicine

OfficesOffices

Clifton (Medical Arts Building)

Westchester www.ucortho.com 513-475-8690

University Orthopaedics & University Orthopaedics & Sports MedicineSports Medicine

Surgery

Holmes Hospital (Clifton) Outpatient Surgery Center

Mercy Fairfield Main Outpatient Surgery Center

Westchester Medical Center University Pointe Ambulatory Surgical

Hospital (ASH) University Hospital

What is Knee What is Knee Arthroscopy?Arthroscopy?

Simply looking Simply looking around the joint around the joint with a camerawith a camera

A complete A complete inventory of the inventory of the knee can be knee can be performedperformed

Many pathologic Many pathologic conditions can be conditions can be addressed.addressed.

Indications (Reasons) for Knee Indications (Reasons) for Knee ArthroscopyArthroscopy

Meniscus TearsMeniscus Tears Articular cartilage injuriesArticular cartilage injuries Ligament repairs and Ligament repairs and

reconstruction (i.e. ACL reconstruction (i.e. ACL reconstrucion)reconstrucion)

Removal of loose or foreign Removal of loose or foreign bodiesbodies

Lysis of adhesions (cutting scar Lysis of adhesions (cutting scar tissue to improve motion)tissue to improve motion)

DebridementDebridement Irrigating out infectionIrrigating out infection Lateral Release (cutting tissue to Lateral Release (cutting tissue to

improve patella pain)improve patella pain) Fixation of fractures or Fixation of fractures or

osteochondral defects osteochondral defects (bone/cartilage defects)(bone/cartilage defects)

DiagnosticDiagnostic

Meniscus Tear

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Debrided and Repaired Meniscus Tear

Arthroscopic Instruments

Camera Probe Shaver- “shaves and

debrides” loose or torn tissue

Baskets- “nibble away” damaged tissue

Scissors Cautery-coagualates

small bleeding vessels

How is surgery done? The surgery begins

with an examination of your knee while you are asleep

This allows for testing of your knee ligaments to make sure they are stable without the resistance of your muscles

“Examination Under Anesthesia”

Arthroscopic Examination

A camera is inserted into your knee thru a tiny poke hole in the front of your knee called a portal

The doctor moves the camera around your joint while looking at a monitor

A complete inventory of your knee will be performed looking at all the structures inside your joint

A second portal is created for the insertion of working instruments

Usually only two portals are necessary, but occasionally additional portals are needed to get the job done effectively

Normal Arthroscopic Anatomy

Thigh Bone

Thigh Bone

Anterior Cruciate Ligament (ACL)

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Knee Cap

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↑Shin Bone

Meniscus

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↓ ↓

Addressing PathologyAddressing Pathology

Instruments can Instruments can be used to be used to inspect the knee inspect the knee structuresstructures

Other Other instruments can instruments can be used to be used to debride or repair debride or repair structuresstructures

Probe used to evaluate torn meniscus

Shaver used to debride a bone tunnel for ACL reconstruction

Pathologic conditionsPathologic conditions

Scar tissue and adhesions

Meniscus Tear and Arthritis

Loose Bodies

Torn ACL

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↑

↑↑

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Various PathologyVarious Pathology

An infinite number An infinite number of problems can be of problems can be treated with treated with arthroscopy and we arthroscopy and we are continually are continually expanding the expanding the array of diseases array of diseases that can be that can be effectively treated effectively treated with the camerawith the camera

Tibial spine fracture with pulled off ACL

Arthroscopically assisted fracture repair and restoration of ACL anatomy

Post Operative Post Operative RehabilitationRehabilitation

Usually you can go Usually you can go home the same day home the same day

Ice and elevate your Ice and elevate your leg as much as possible leg as much as possible for the first 72 hoursfor the first 72 hours

You may or may not You may or may not have a brace have a brace depending on what depending on what surgery was donesurgery was done

Your doctor will tell Your doctor will tell you how much weight you how much weight you can put on your legyou can put on your leg

Post Operative RehabPost Operative Rehab You can usually take You can usually take

your dressings down on your dressings down on the third post op day the third post op day and showerand shower

Do not scrub or Do not scrub or submerge your woundsubmerge your wound

No soaking, swimming No soaking, swimming or hot tubsor hot tubs

Do not apply any Do not apply any ointments to your ointments to your wound—this includes wound—this includes polysporin or other polysporin or other antibiotic ointmentsantibiotic ointments

Other than bathing keep Other than bathing keep your wound clean and dryyour wound clean and dry

After your shower you can After your shower you can leave your leg open to air if leave your leg open to air if nothing is drainingnothing is draining

If your knee is draining then If your knee is draining then apply a clean dry dressing apply a clean dry dressing and notify your doctorand notify your doctor

You will be given pain You will be given pain medications and a pill for medications and a pill for nauseanausea

Please take an Aspirin 325 Please take an Aspirin 325 mg per day until your follow mg per day until your follow up appointmentup appointment

Post opPost op You will usually see your You will usually see your

doctor 5-7 days post opdoctor 5-7 days post op At that point you will get At that point you will get

into physical therapyinto physical therapy You will work on range of You will work on range of

motionmotion The thigh muscle The thigh muscle

(quadriceps) goes to sleep (quadriceps) goes to sleep after many knee injuries after many knee injuries and after surgery. Thus, and after surgery. Thus, much of your rehab will much of your rehab will be aimed at quadriceps be aimed at quadriceps strengthening exercisesstrengthening exercises

Physical TherapyPhysical Therapy The amount of The amount of

physical therapy that physical therapy that you will need depends you will need depends on what was done in on what was done in surgerysurgery

The rehab is quite The rehab is quite different for different different for different arthroscopic knee arthroscopic knee surgeriessurgeries

Please make sure you Please make sure you understand the understand the expected rehab goalsexpected rehab goals

Physical therapy is Physical therapy is very important in very important in optimizing your optimizing your outcomeoutcome

It is critical to do It is critical to do exercises at home on exercises at home on your own as wellyour own as well

Your therapist will Your therapist will give you a home give you a home exercise program that exercise program that should be done every should be done every dayday

Return To Work or SportReturn To Work or Sport Desk job—3-5 daysDesk job—3-5 days Prolonged standing or Prolonged standing or

heavy lifting—usually heavy lifting—usually about a monthabout a month

This is highly variable This is highly variable depending on surgery depending on surgery and rehab and most and rehab and most importantly what kind importantly what kind of work you do or of work you do or what sport you playwhat sport you play

This is also very much This is also very much dependant on your dependant on your rehab progressrehab progress

It is best to anticipate It is best to anticipate the expected length of the expected length of recovery before surgery recovery before surgery

Sometimes the Sometimes the recovery is shorter or recovery is shorter or longer than expected longer than expected but often can be but often can be estimated before estimated before surgery surgery

When Can I Drive?

Must be off all narcotics Should be able to hold a straight leg

raise for 10 seconds Ask you doctor before you drive? Practice in a parking lot first

Conclusions Knee arthroscopy is a very useful tool of the

orthopaedic surgeon We are constantly getting better and better

to expand the types of procedures that can be done

The recovery is variable, but you should be able to get a ballpark estimate based on the anticipated procedure

Your doctor or therapist can be a useful resource for any and all questions. Do not hesitate to ask questions at your appointment or call the office when questions arise

513-475-8690

Thank You