Reviewed by Michael Fuller, M.D.
Knee arthroscopy has become a valuable tool in diagnosing and treating problems of the knee. “Arthro” means joint and “scope”, to see or visualize. It literally means to see inside the joint. The indications (reasons for performing an arthroscope) are varied. They include cartilage, meniscal, and ligamentous damage.
Sometimes, the arthroscope is used to determine the cause of knee pain. Occasionally, x-rays, physical exams, MRI scans and various other techniques cannot determine the cause of knee pain. Arthroscopy, since it “sees” inside the knee, can help determine what may be the problem. This is called a “diagnostic arthroscopy” because it helps to diagnose the problem. The arthroscope can also be used to aid in the treatment of various fractures and assist in surgeries such as ACL reconstruction, as well as to repair minor cartilaginous abnormalities.
Two to four small incisions are strategically placed about the knee. Instruments are inserted through one and the camera through another. Sometimes other small incisions (called portals) are used to facilitate fluid drainage of the knee or to allow additional instruments to be introduced into the knee. During an arthroscopy, sterile fluid is pumped into the knee to keep the joint large enough so the camera and instruments can fit in the knee joint space. It also helps to keep the camera lens clean and free of debris.
As techniques become more advanced and surgeons become more experienced with arthroscopic procedures of the knee, more and more procedures that previously required large incisions can be done with the arthroscope. In the case of meniscal injury, the meniscus can be seen and evaluated with the arthroscope. Repairable damage can be addressed and non-repairable damage can be removed. The decision between repair and removal can be difficult.
The meniscus is thought to play a much larger role in keeping the knee healthy and stable than previously thought. Preservation of the most amount of the meniscus is desired.
Meniscal repairs, when possible, can be done through the arthroscope but rarely may still require a larger, formal incision. Arthroscopic sewing techniques and instrumentation used for meniscal repair are being improved. When the meniscus requires removal, the minimum amount can be removed through the arthroscope. Previously, a total meniscectomy (meniscus removal) was thought to alleviate the problems the meniscus injury caused. Now, removal is as limited as possible (called a partial meniscectomy). Long term results of total meniscal removal caused early arthritis, which is minimized with partial meniscectomies. This is facilitated through the arthroscope.
The arthroscope can also help minimize incision requirements for other surgeries, too. Because of the less invasive manner of the arthroscope, healing occurs quicker and recovery is shortened considerably. Knee arthroscopy, as well as arthroscopy of other joints, has revolutionized orthopaedic surgical patient care.
Last updated: 01-May-07