Dr. Vinay Tantuway
M.S. (Orthopaedics)
Orthopaedics Surgeon Dr. Vinay Tantuway at Indore
What is knee arthroscopy?
The arthroscope is a small fiber optic instrument that is put into the knee joint through a small incision. A camera is used to view the inside of the knee on a TV monitor, and pictures can be taken. The arthroscope allows a complete evaluation the entire knee joint, including the kneecap (patella), the cartilage surfaces, the meniscus, the ligaments (ACL & PCL), and the joint lining. Small instruments ranging from 3-5 millimeters in size are inserted through an additional incision so any injury can be diagnosed, and any damaged tissue can be repaired, reconstructed, or removed. Before the development of arthroscopy, large incisions had to be made over the knee joint to treat or diagnose injuries. Today's arthroscopic techniques allow more complete evaluations of the knee joint while accelerating the rehabilitation process.
What kinds of procedures can be performed with the arthroscope?
Arthroscopy allows the surgeon to view the inside of the knee joint and perform a variety of surgeries. These surgeries include:
1. Complete evaluation of the joint (diagnostic arthroscopy)
2. Removal of damaged or torn cartilage (partial meniscectomy)
3. Repair of torn cartilage (meniscus repair)
4. Smoothing of damage to the cartilage surface in arthritis(chondroplasty)
5. Assist in replacement of damaged ligaments (ACL or PCL reconstruction)
6. Realignment of patella in patellar mal-tracking (lateral release)
7. Removal of joint lining (synovectomy)
8. Replacement or repair of articular cartilage (cartilage transplant)
What are some of the possible complications of surgery?
Possible complications of arthroscopy include stiffness of the knee after surgery or continued pain. The use of arthroscopic techniques attempts to limit these complications. Other complications include an infection, bleeding, nerve or artery damage, blood clots, or problems with the anesthesia. The risk of a complication from surgery are very small.
What kind of anesthesia is used?
Knee arthroscopy can be performed with general anesthesia (going to sleep), regional anesthesia (spinal or epidural block) or local anesthesia with sedation. The type of anesthesia will depend on your choice, as well as the type of procedure you are having
What do I need to do to prepare for surgery?
Our staff will help to set up the surgery through your
insurance company and will instruct you on any paperwork
that may be necessary.
Prior to your surgery, you may be asked to get several
medical tests, done on an outpatient basis. Most patients need
some minor blood tests and a urinalysis. If you are over age
50, you may require an EKG and chest x-ray. Some patients
need to see an internist or their family doctor to obtain clearance
for surgery.
The night before the surgery, a member of our staff will
contact you about what time to arrive for surgery. You may
not eat or drink anything after midnight the night before your
surgery.
Can I continue to take my medications?
You should STOP taking any aspirin or anti-inflammatory medication (Motrin, Advil, Relafen, Naprosyn, etc.) at least seven days prior to your surgery. However, you may CONTINUE to take Celebrex or Bextra if you are on these medications. You may also take Tylenol as needed. Continue to take any other prescribed medications, such as blood pressure pills, up until the day of surgery. You may also take these medications the morning of surgery with a sip of water.
How long will I be in the hospital?
Almost all patients are able to have surgery and go home the same day. Occasionally, patients will be admitted for an overnight stay.
What happens the day of surgery?
The day before surgery you will be told what time to report
to the hospital. You will be admitted and taken to a preoperative
holding are where you are prepared for surgery.
You will be asked several times which knee is being
operated on, and the surgical site will be initialed. Please note
that you are asked several times which is the correct side for
surgery on purpose.
After the operation, you will be taken to the recovery room
to be monitored. Once the effects of anesthesia have worn off
and your pain is under good control, you will be taken to
another area where you can see your family and finish
recovering. You will be given all of your post-operative
instructions and pain medication before leaving.
Please be aware that the process of getting checked in,
prepared for surgery, undergoing the operation, and recovering
from anesthesia takes the majority of the day. I would
recommend that you and your family members bring along
some reading material to make the process easier for all.
How should I care for my knee after surgery?
Prior to your discharge, you will be given specific instructions on how to care for your knee. In general, you can expect the following:
Diet:
Resume your regular diet as soon as tolerated. It is best to start with clear liquids before advancing to solid food.
Medication:
You will be given a prescription for pain medication.
Bandage:
You will have a thick dressing on the knee. You will be instructed on when it can be removed, usually in 3 days. After your dressing is removed, you should cover your sutures with a Band-Aid to protect the area from irritation.
Showering:
You may shower after your dressing is removed, after 2 -3 days. You cannot take a bath until the wounds are completely sealed, usually 2 -3 weeks after surgery.
Crutches:
You will have crutches after surgery, and will be instructed on how to use them. How long you use crutches will depend on the type of surgery performed, and can vary from one to two days to 6 weeks.
Brace:
Depending on your surgery, you may receive a brace for your knee. You will be instructed on the amount of motion allowed in the brace, and how long it is needed.
Ice:
You may receive an ice machine that continually surrounds your knee with cold water. If not, you may apply ice over the dressings for 30 minutes every hour for several days. Do not use heat.
Suture removal:
Your stitches will be removed at your office visit 7-10 days after surgery. Occasionally, sutures are used which absorb and do not need to be removed.
Follow-up office visit:
You will be instructed on when to follow-up in the office. This is usually 7-10 days after surgery.
Exercise:
You will be instructed on exercises you can do immediately after surgery. You will start physical therapy within 1 to 2 weeks after surgery.
Return to work or school:
You can return to school or work within 3 -5 days using the crutches. If your job involves more extended walking or heavy activity, you may be out of work or school for a longer period of time.
What will rehabilitation involve?
The rehabilitation is based on several goals: 1) allowing the tissue to heal; 2) regaining motion; 3) regaining strength; and 4) return to sports. The specific rehabilitation protocol for the physical therapist will depend on the procedure performed, and will be reviewed after surgery.
When can I return to sports?
Your return to sports will depend on the extent of damage and the procedure performed on your knee. In general, you will be allowed to return to sports in one to two months after surgery. You must have good motion, strength, and control of your knee. How quickly you return to sports depends on several factors, including: 1) your own rate of healing; 2) the damage found at surgery; 3) if you have any complications; 4) how well you follow the post-operative instructions; 5) how hard you work in rehabilitation.
What Is an ACL Injury?
The anterior cruciate ligament (ACL) is one of four ligaments that provide stability to the knee joint. These fibrous bands attach bone to bone and help control excessive motion of the knee joint and keeps the lower leg from sliding too far forward. Of the four major ligaments of the knee, the ACL injury is the one most commonly injured. The majority of ACL repairs that occur each year are done on young athletes (under age 25) and female athletes.
What Causes an ACL Injury?
ACL injuries are common in sports that involve sudden changes of direction, such as football, and soccer.
Most are non-contact injuries that occur during sudden twisting motion (for example, when the feet are planted one way and the knees are turned another way) or when landing from a jump
Are Women At Higher Risk of ACL Injury?
The causes of ACL injury have recently been the focus of research. Factors contributing to ACL injuries include ground hardness, grass type and cleat type. But one of the other major findings is that women are nearly three times more likely to have ACL injuries than men. And some statistics says that a female soccer player is eight times more likely to injury her ACL than a male soccer player. Researchers believe this may be due to differences in hormone levels on ligament strength and stiffness, neuromuscular control, lower limb biomechanics, ligament strength and fatigue. Findings have show a difference in neuromuscular control in women when landing jumps (women appear to have less hip and knee flexion than men).