BertScopeORANGE COUNTY KNEE SPECIALIST: WHAT IS ARTHROSCOPY?

by Steve A. Mora, MD

 

Arthroscopy is a sterile procedure that allows direct visualization of the shoulder, knee, wrist, and ankle joint to diagnose and treat orthopaedic problems. It is indicated to help diagnose and correct lesions or tears of the cartilage, ligaments and tendons of the joints.

In an arthroscopic examination, an orthopaedic surgeon makes a small incision in the patient’s skin and then inserts a pencil-sized instrument that contain a small lens and lighting system to magnify and illuminate the structures inside the joint. Light is transmitted through fiber optics to the end of the arthroscope that is inserted into the joint. The television camera attached to the arthroscope displays the image of the joint on a television screen, allowing the surgeon to determine the amount or type of injury, and then repair or correct the problem, if it is necessary.


Why do arthroscopy?

Diagnosing joint injuries and disease begins with a thorough medical history, physical examination, and usually x-rays. Additional tests such as an MRI, or CT scan also may be needed. Through the arthroscope, a final diagnosis is made which may be more accurate than through “open” surgery or from radiographic studies. The un-intrusive nature of the arthroscope allows us to appreciated subtle pathologic alterations in tissue within a joint. Also, the small size of these instruments allow us to look in areas not accessible through open surgery.

What are the possible complications?

The risk of complications after arthroscopy is low. However, all surgery carries a level of risk and therefore should be taken seriously. The list below includes some common potential complications.

  • bullet bleeding
  • bullet infection
  • bullet nerve and blood vessel injuries
  • bullet cartilage damage
  • bullet anesthetic complications (including death)
  • bullet a tear in joint tissues
  • bullet loss of limb or function

What are the advantages?

Most patients have their arthroscopic surgery performed as outpatients and are home several hours after the surgery. For many people, arthroscopy provides an alternative to open joint surgery.

  • In comparison to open shoulder surgery, arthroscopy might provide:
  • bullet better cosmetic appearance of the scars
  • bullet shorter recovery time
  • bullet less pain
  • bullet less need for pain medication after surgery
  • bullet less damage to soft tissues at the incision site
  • bullet fewer complications
  • bullet greater improvement in strength and range of motion of the joint after surgery

How is Arthroscopy Performed?

The length of time of knee and shoulder arthroscopy varies, depending on what is done during the surgery. Generally, it takes one to two hours for the surgery, depending on the patient and his or her individual situation. This time estimate does not take into account the time it takes to anesthetize you.

A small incision, about half an inch in length is made to introduce the arthroscope. Attached to this is a camera and light. These, in turn are attached to a T. V. monitor to view and record the findings. A second small incision is made to allow passage of arthroscopic instruments. Pictures may be taken and saved for later reference. A third incision may be made to introduce instruments for repair and to correct injuries. For knee surgery, the usual is two incisions and for shoulder it is 3-4.

The surgeon will inspect the entire joint first. He will have an assistant to help move, rotate, and reposition the joint for visualization. Surgeons use a motorized “shaving” instrument to shave away torn cartilage, excessive growth and tissues, which may cause friction and pain. A cautery tool may be used to burn off excess tissue growth. This instrument can also smooth rough surfaces, help with repairs, shrink the capsule of the joint for better stability, and lessen bleeding.

The amount of surgery required and recovery time will depend on the complexity of your problem. Occasionally, during arthroscopy, the surgeon may discover that the injury or disease cannot be treated adequately with arthroscopy alone. The “open” surgery may be performed while you are still anesthetized, or at a later date after you have discussed the findings with your surgeon.

Upon completion of the procedure, the entire joint is irrigated until it is clear of blood and loose particles. We will inject a long acting local anesthetic into the joint to help with post-operative pain. We will close the small incisions with either stitches or apply steri-strips. The area is covered with a sterile dressing that should be kept dry until your first visit.

You will usually receive a set of pictures at your first post-op visit.

What happens immediately after surgery?

After your arthroscopy you will go to the post anesthesia care unit (recovery room). You will remain there until the effects of your anesthetic have begun to wear off. You will remain in the recovery room until you can eat, drink and urinate without difficulty. Specially trained nurses will monitor your progress and give you verbal and written discharge instructions. You will not be able to drive home after surgery on your own.

What is the recovery in the immediate post-operative period?

Ice is applied immediately after surgery and thereafter intermittently for the first 7 days. This reduces swelling and relieves pain. The small puncture wounds take several days to heal. The dressing is usually kept on until we see you in the office.

Although the puncture wounds are small, post-operative pain ranges from little or none to very significant. We will prescribe post-operative pain medication, anti-inflammatory medication and possibly an antibiotic. If you develop stomach pain or your stools turn dark or black, stop the anti-inflammatory medication.

During recovery from arthroscopy, it is normal to feel some mild soreness and a slight grinding sensation for a day or two. However, if you develop:

  • bullet pain that is severe or persistent,
  • bullet inability to move your fingers or toes
  • bullet a fever, or foul smelling drainage

Call your us right away. You may have developed a complication that requires medical attention.

You will be able to resume driving after a few days to several weeks following surgery.

During the follow-up visit, we will inspect your incisions; sutures if present will be removed after 7-10 days if present; and discuss your rehabilitation program.

Your doctor, nurse and physical therapist will instruct you on specific exercises to restore muscle function and strength. You can also print out the shoulder and knee exercises from this web site. They will also instruct you on movements you should avoid. Physical therapy will be ordered for you on an outpatient basis in most cases. Most patients are allowed to return to work within a week, depending on the nature of your job.


When can I return to normal activities ?

It is not unusual for patients to go back to work or school or resume daily activities within a few days from their surgery. Remember, though, that people who have arthroscopy can have many different diagnoses and preexisting conditions, so each patient’s arthroscopic surgery is unique to that person. Recovery time will reflect that individuality. It takes several weeks to months for the joint to maximally recover.

Following minor arthroscopic procedures, limited sports activities can usually be started by the fourth week.

In general, after major reconstruction it is never less than 3 months and rarely more than 6 months for return to full sporting activities. Professional athletes will require considerably more time than this to return to competitive form. Throwing activities are not initiated until full control and range of motion is achieved. Compliance with gradual resumption of activities is necessary for proper healing and rehabilitation. Vigorous physical activity should not be done until you are cleared.

 

About Steve A. Mora MD:

Steve Mora MD Small

Dr. Mora is a native of Orange County. He graduated from Anaheim High School in Orange County CA. He completed his training at the UC Irvine where he earned top of his class honors with his induction into the Alpha Omega Alapha Medical Society honors. He completed his Orthopedic Surgery training USC. He then completed a Sports Medicine, Cartilage, Shoulder, and Knee Fellowship at Santa Monica Orthopaedic and Sports Medical Group. He is currently practicing Orthopedic Surgery in Orange County.  Dr. Mora’s practice focus on sports related trauma, knee ligament and cartilage repair, shoulder rotator cuff and instability, hip arthroscopy and partial knee replacement and ACL reconsctruction. He sees athletes of all levels including professional soccer and UFC/MMA. He is team doctor for the Anaheim Bolts pro indoor soccer team and Foothill High School. Some of the procedures he performs include Cartilage transplantation (Genzyme), partial custom knee replacement, OATS, tibial osteotomies, meniscus transplant, knee ligament reconstruction, shoulder reconstruction, elbow arthroscopy, hip arthroscopy, platelet rich plasma and adult stem cell injections. Dr. Mora’s family heritage is Peruvian. He speaks fluent Spanish.

 

Steve A. Mora MD, Orange County ACL Surgeon.  You can request an appointment with me by calling 714 639-3750 or going to my web page www.MyOrthoDoc.com

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