Fields of treatment / Orthopedy / Arthroscopy of the knee joint

Arthroscopy is currently the method of choice in the diagnosis and treatment of injuries to the intra-articular structures of the knee joint. It is performed under gentle general anesthesia with a minimally invasive approach. Using two 15 mm incisions on the sides of the knee, an operating camera is introduced with a cable transmitting the image of the joint to a monitor, irrigation with physiological solution and special operating instruments. For a better overview of the joint, the operation is performed in the so-called bloodless state.A pneumatic cuff is placed on the thigh of the operated limb, which is filled with compressed air for the duration of the operation. This will reduce blood flow to the limb and prevent bleeding into the joint.

After the procedure, the patient is transferred to the recovery unit, where he recovers under the supervision of nurses and doctors, and in about 2 hours after the procedure, he leaves for his home environment accompanied by an adult. The patient will receive a medical report from the surgeon with a mobile contact and the date of dressing, painkillers and possibly low molecular weight heparins including instruction. Furthermore, instructions after the procedure under general anesthesia with a mobile contact to the anesthesiologist, which he studies thoroughly and strictly follows in order to avoid unnecessary health problems.

The course of treatment is mainly influenced by the type of injury and the chosen treatment. After diagnostic and simple operative arthroscopy, the operated limb must be examined for 1-2 weeks by walking on crutches with a load of up to 1/3 of the weight, and the period of incapacity for work is approximately 2-4 weeks. Depending on the type of procedure performed, the treatment period may be longer and may include immobilization in a brace (see above). Likewise, the length of recovery and rehabilitation varies depending on the severity of the injury and the chosen treatment. The long-term prognosis depends on the severity of the injury, the condition of the knee joint before the injury, and the general state of health. After treatment of a partial rupture of the meniscus and a small cartilage defect up to 1cm2, healing can be expected without permanent consequences. When a larger part or the entire meniscus is removed, greater wear of the cartilage occurs and a gradual loss of cartilage is possible, i.e. the development of arthrosis of the knee joint. Cartilage defects larger than 1cm2 heal with inferior fibrocartilage, which is manifested by chronic pain, especially after exercise, and effusions in the joint. In indicated cases, these defects are therefore covered with an autograft (see above). Rupture of the cruciate ligaments (most often the anterior cruciate ligament) is indicated for a planned replacement at a later time, depending on the degree of instability of the knee joint, the general state of health and sports activities.

The only surgical alternative to arthroscopy is the treatment of intra-articular structures openly, i.e. through an arthrotomy, which is performed from an approximately 5-10 cm incision on the front side of the knee joint with cutting of the attachments of the patella and joint capsule. The approach is significantly more invasive, does not provide a better overview than arthroscopy, increases the likelihood of early complications and is associated with longer immobilization and recovery of the knee joint. However, in some cases (intra-articular fractures, cartilage transplants, etc.) it is necessary to properly perform the procedure. Another option is a conservative approach. Refusal of the proposed arthroscopy may worsen the difficulties and permanently damage the intra-articular structures. In particular, there is increasing damage to the cartilage, the changes of which are irreversible and can lead to the development of arthrosis despite additional surgical intervention. The result is permanent pain, repeated effusions and limitation of joint function.