Arthroscopy of the knee diagnostic and operative
Human life is impossible without movement, which is provided by our musculoskeletal system. Musculoskeletal system, in turn, consists of many elements, most important of which are motor mechanisms — joints. It should be noted that one of the specific methods of diagnostics of joint injuries and diseases is knee arthroscopy, which has the greatest practical value in the diagnosis of pathologies and injuries of the knee.
The joints provide the movement of our body, performing various exercises, holding of sports and simply moving in space, the physical work. Malfunction of a joint immediately affect the quality of our lives, work duties and activities in a favourite sport. For example, knee pain is deprived of the joy of movement and forced to consult a doctor in order to determine the cause, correct diagnosis and selection of optimal method of treatment that will eliminate pain and return the taste of life.
Considering arthroscopic diagnosis of the knee, not to say a few words about the structure of the knee joint.
The structure of the knee joint
The knee joint is a movable connection of the patella, the upper articular surfaces of the tibia and the medial femoral and lateral femoral condyles. The knee joint has surround the joint capsule and its synovial sheath forms folds with adipose tissue, inversions and synovial Bursa. It performs the following set of movements: extension, slight rotations of the tibia inwards and outwards in a bent position, bending.
Various injuries and diseases of the knee diagnosed by appropriate research methods, including radiography, ultrasonography and arthroscopy.
Therefore, it should be noted that arthroscopy (endoscopy or joints) have found wide application in traumatology and orthopedics.
What is arthroscopy
Arthroscopy (from the Greek word «joint» + «to explore, observe», synonyms endoscopy, entrancecode) of the knee joint as a method of endoscopic examinations and as an aid in holding a number of surgical interventions is a visual examination of the cavity of the knee joint through optical instrument — arthroscope (endoscope).
Procedure knee arthroscopy is performed by a doctor, podiatrist by introducing the optical element of the arthroscope with a lens system, fiber optic cable and camera into the cavity of the knee joint through a special surgical instrument (trocar) through a small incision. Visual image is analyzed visually through the arthroscope by the specialist conducting the arthroscopy, or transferred to a monitor and enables, in particular, to carry out keyhole surgery. It should be noted that the greatest distribution in the world and in domestic medical practice became arthroscopy with angle 30° and 70° and a tube diameter of 4-5,5 mm.
During the knee arthroscopy orthopedic surgeon visually through the arthroscope or through the monitor examines in detail the internal structure of the knee joint, examines the state of the cavities and other components in joints and identifying diseases and injuries. Modern arthroscopic (endoscopic) technique also provides an opportunity to get a photo of the internal structure and to conduct endoscopic operation without opening the cavity of the knee joint. Therefore, in addition to diagnostic tasks using modern minimally invasive arthroscopic possible to carry out surgical interventions and rehabilitation of joints.
Therefore, knee arthroscopy is of two types:
For a diagnostic knee arthroscopy local anaesthesia is used with short duration of action, and for carrying out operative arthroscopy is used epidural anesthesia. In severe cases, General anesthesia is used, in particular for surgical intervention and treatment for severe joint injuries or diseases.
Arthroscopy in the diagnosis
A variety of diagnostic knee arthroscopy is used in conducting examinations of the knee in these injuries and diseases of the knee joints like:
- tearing of the meniscus;
- arthritis of the knees;
- statutory mouse;
It should be noted that when an injury or dislocation often occurs massive hemorrhage (hemarthrosis) in the joint. This diagnosis is made primarily through ultrasonography (ultrasound), arthroscopy and radiography, allowing to exclude other injuries to the joint.
Quite heavy and dangerous knee injury is a meniscus tear, which manifests itself after a certain time after the injury. The main symptoms are periodic ankylosis (immobilization) of the joint and sharp pain. This diagnosis is refined by carrying out arthroscopy and ultrasonography (ultrasound high frequency).
When the disease of arthritis or arthritis recommended arthroscopy in combination with biopsy, allowing an accurate diagnosis based on the data of the inspection and the results of the study of biomaterial.
Except in cases of arthrosis of the diagnostic arthroscopy is used during the examination of the joint with suspected articular mouse. This pathology of the functioning of the joint is a separated piece of cartilage located in the cavity of the knee joint and occasionally leading to contracture (reduction of normal range of joint movements). The diagnosis of articular mouse is placed with the help of arthroscopy, ultrasound and radiographs.
As mentioned above, during the diagnostic arthroscopy is used, local or epidural anesthesia. Special preparation of this examination is not required.
The procedure is a diagnostic arthroscopy is carried out not only through the arthroscope, but with the use of auxiliary tools: pliers of various kinds, clamps, drainage tubes, etc.
In addition to diagnostic arthroscopy in recent years an increasing use has operational or endoscopic arthroscopy. When performing this kind of transaction is frequently used in General anesthesia. This operation is carried out in case of diagnosis:
- gap brestoblresursy ligaments (often the case in athletes);
- tear of meniscus and clear indications for meniscectomy (removal of meniscus);
- the presence of intra-articular bodies;
- the presence of abnormal folds of the joint capsule.
Arthroscopic (endoscopic) surgery is one of the leading minimally invasive therapies, therefore, allows to avoid the traumatic abdominal intervention and thus greatly accelerate recovery and restore normal functioning of the joint.
It should be noted that such operation is carried out using video images obtained through the arthroscope and transmitted to the monitor. Thus, without opening the joint, the surgeon is able to conduct operations such as meniscectomy, resection of abnormal folds of the joint capsule of the knee, to remove intra-articular bodies (such as the articular mouse), to restore injured ligaments etc Maloinvazivnogo this method allows patients to quickly cure the knee and return to the sport or to normal life and work. Therefore, this type of surgical therapy has a positive feedback of the patient and favorable forecasts and feedback from practicing medical professionals.
Arthroscopic surgery on the knee joint is basically the same set of surgical instruments, and diagnostic arthroscopy. However, in this case, can not do without removing for better awareness about the state of the knee joint video. In addition, the mandatory General anesthesia or epidural anesthesia. It should be noted that the entire operation is recorded by means of videotape for further analysis and training of the operating surgeon and visual AIDS for beginners to experts.
Video recording allows you to make a detailed description of surgery and to obtain the necessary photo.
After the arthroscopic surgery requires a small rehabilitation period, including the conduct of a number of physiotherapy (electrical myostimulation, massage, etc.), then it needs a further exercise therapeutic areas and the influence of the dosed physical loads to restore the functions of the joint.
Rehabilitation after operative arthroscopy is performed on an outpatient basis.
During diagnostic arthroscopy for osteoarthritis or arthritis is often a podiatrist shall appoint an arthroscopic debridement of the knee joint. In this case, arthroscopic debridement involves lavage of the cavity of the knee joint with saline to remove fragments of articular cartilage after cleaning the articular surfaces with special tools from the cartilage and salt growths.
Arthroscopic debridement are shown in order to restore the functioning of the joint and return to normal physiological volume of joint movements. Of course, this type of surgical intervention is not decisive in the treatment of joint diseases, as it requires an integrated therapy aimed primarily at removing the causes of disease. However, arthroscopic debridement allows for at least the time to restore the necessary range of motion of the joint and relieve pain.