Arthroscopic knee surgery is a technique where we utilize a minimally invasive surgical procedure to perform an examination and to treat damage to the inside of the knee. We perform the surgery using an arthroscope (fiber optic camera with a lens) that is inserted into the joint through small incisions called portals. This allows us the ability to perform many procedures in addition to others that include the trimming and smoothing of torn menisci (cartilage), repair torn menisci, remove loose cartilage from bone ends, micro fracture early areas of cartilage loss to improve healing, replace areas of cartilage loss with donor cartilage from non-weight bearing areas within the knee, repair torn ligaments, reconstruct torn ligaments, balance the tracking of the patella, and remove abnormal synovial growths or non-malignant tumor conditions.
There are many advantages of arthroscopic knee surgery over open knee surgery. Oddly enough one of the most important advantages is that you can make a more accurate diagnosis and perform the surgery much easier due to your ability to see in small spaces. Since you do not have to open the joint with an incision you greatly reduce the pain since less tissue is damaged, which speeds up recovery time and reduces the risk of infection. It is especially useful for professional athletes who frequently injure knee joints and need a fast healing time so they can return to their sport quickly. It is equally important to the rest of us who want an expert job done with a quick recovery so that we too can return to work and our family obligations quickly.
Within the knee joint there are 2 fibrocartiaginous structures called menisci. They act as primary stabilizers of the knee joint (along with ligaments), assist in cartilage nutrition, and are primary structures for the proper load distribution which occurs across the knee joint. As a result, certain activities associated with pivoting, squatting, and other vigorous twisting activities put the menisci at risk for tearing. When a meniscus tears it can occur in both a vertical and also a horizontal direction. The proper diagnosis of a torn meniscus is achieved through a history, physical exam, and sometimes an MRI. There are times however that even the MRI will not see significant tears of the cartilage. However, when there is a significant tear of the cartilage, patients most often will have symptoms associated with weight bearing and twisting and those symptoms can even occur at sleep time. Not all meniscus tears are symptomatic, and not all meniscus tears require treatment. Conservative treatment can consist of anti-inflammatory medication, cortisone injection, physical therapy, and some will even try platelet rich plasma. However, certain meniscus tears will not improve with conservative management and arthroscopic surgery would be indicated.
The goal of arthroscopic surgery for meniscus tears involves creating a stable construct. Loose pieces of meniscus which are torn will cause secondary damage to the articular cartilage overlying that area. This is due to the fact that knee motion over the uneven meniscus occurs more than 1 million times per year. If secondary damage to the articular cartilage occurs in the face of a torn meniscus the risk of developing arthritis is greatly increased. As mentioned above, the goal of arthroscopic surgery for meniscus tears is to remove the torn or unstable portion so as to provide a smooth surface for the articular cartilage which is gliding over the meniscus. Sometimes a tear will extend back to the periphery of the meniscus where there is a better blood supply and we are able to do an actual meniscus repair by sewing the meniscus back to its attachment. When that occurs (less than 10% of the time) newer inside out systems allow us to repair the meniscus with multiple sutures which we then protect with crutches and non-weight bearing for a period of 6 weeks. Most often however, the torn segment of the meniscus can be trimmed and the patient can return to normal activities quickly. It is not uncommon for patients to return back to work within a few days avoiding deep knee bending, heavy lifting, and squatting. Depending upon the size of the meniscus tear, secondary changes to the articular cartilage will hopefully be delayed. The larger the tear, then the more interference with load sharing and the higher likelihood of development of articular cartilage issues over time. One of the worst types of tears is the posterior horn avulsion injury which completely destabilizes the meniscus and greatly reduces its ability to load share due to loss of loop stresses. This particular injury has a very high rate of development of articular cartilage lesions and ultimately arthritis over time. Unfortunately this particular type of injury is oftentimes missed on an MRI study.