Shoulder & Knee Arthroscopy

Arthroscopy is a minimally invasive diagnostic and surgical procedure performed for joint problems. Shoulder arthroscopy is performed using a pencil-sized instrument called an Arthroscope. The arthroscope consists of a light system and camera to project images to a computer screen for your surgeon to view the surgical site. Arthroscopy is used to treat disease conditions and injuries involving the bones, cartilage, tendons, ligaments, and muscles of the shoulder joint.

Disease Overview

The shoulder joint is made up of a ball and socket joint, where the head of the humerus (upper arm bone) articulates with the socket of the scapula (shoulder blade) called the glenoid. The two articulating surfaces of the bones are covered with cartilage, which prevents friction between the moving bones enabling smooth movement. Tendons and ligaments around the shoulder joint provide strength and stability to the joint. Injury and disease to the bones or soft tissues of the shoulder joint can make it instable, and lead to pain, inflammation and reduced mobility.

Indications

Shoulder arthroscopy is indicated to treat the following shoulder conditions when conservative treatment such as medication and therapy fails to relieve pain and disability:

• Shoulder Impingement: this occurs when the shoulder blade applies pressure on the underlying soft tissues when the arm is lifted
• Rotator cuff tear
• Frozen shoulder or stiffness of the shoulder joint
• Shoulder Instability this occurs when the head of the upper arm bone slips out of the socket of the shoulder blade’s glenoid cavity either due to injury or overuse
• Biceps rupture occurs when the tendons attaching the bicep muscle to the shoulder or elbow tears
• Damaged cartilage or ligaments
• Bone spurs or bony projections
• Arthritis of the collarbone

Procedure

Your surgeon performs shoulder arthroscopy under general or regional anesthesia. You may be positioned lying down on your side with your arm propped up or sitting in a semi-seated position. Sterile fluid is injected into the shoulder joint to expand the surgical area so your surgeon has a clear view of the damage and room to work. A button-sized hole is made in the shoulder and the arthroscope is inserted. Your surgeon can view images captured by the camera in the arthroscope on a large monitor. Surgical instruments are introduced into the joint through separate small holes to remove and repair the damage to the joint. After surgery, the instruments are removed and the incisions are closed with stitches or small sterile bandage strips.

Post-operative Care

After the surgery, the small surgical wounds take a few days to heal and the surgical dressing is replaced by simple Band-Aids. The recovery time depends on the type and extent of problem for which the procedure was performed. Pain medications are prescribed to keep you comfortable. The arm of the affected shoulder is placed in a sling for a short period as recommended by your doctor. Physical therapy is advised to improve shoulder mobility and strength after the surgery.

Advantages

The advantages of arthroscopy compared to open surgery with a large incision include

• Less pain
• Fewer complications
• Shorter hospital stay
• Faster recovery

Risks and Complications

Complications of shoulder arthroscopy include infection, bleeding, damage to nearby nerves or blood vessels, or delayed healing after the surgery. In certain cases, stiffness of the shoulder joint may occur after the surgery. It is important to participate actively in your physical therapy to prevent this from occurring.

Knee Arthroscopy is a common surgical procedure performed using an arthroscope, a viewing instrument, to consider the knee joint to diagnose or treat a knee problem. It is a relatively safe procedure and most the patient’s discharge from the hospital on the same day of surgery.

Knee Anatomy

The knee joint is one of the most complex joints of the body. The lower end of the thighbone (femur) meets the upper end of the shinbone (tibia) at the knee joint. A small bone called the patella (kneecap) rests on a groove on the front side of the femoral end. A bone of the lower leg (fibula) forms a joint with the shinbone.

To allow smooth and painless motion of the knee joint, articular surfaces of these bones are covered with a shiny white slippery articular cartilage. Two C-shaped cartilaginous menisci are present in between the femoral end and the tibial end.

Menisci act as shock absorbers providing cushion to the joints. Menisci also play an important role in providing stability and load bearing to the knee joint.

Bands of tissue, including the cruciate and collateral ligaments, keep the different bones of the knee joint together and provide stabilization to the joint. Surrounding muscles are connected to the knee bones by tendons. The bones work together with the muscles and tendons to provide mobility to the knee joint. The whole knee joint is covered by a ligamentous capsule, which further stabilizes the joint. This ligamentous capsule is also lined with a synovial membrane that secretes synovial fluid for lubrication.

Indications for Knee Arthroscopy

The knee joint is vulnerable to a variety of injuries. The most common knee problems where knee arthroscopy may be recommended for diagnosis and treatment are:

• Torn meniscus
• Torn or damaged cruciate ligament
• Torn pieces of articular cartilage
• Inflamed synovial tissue
• Misalignment of patella
• Baker’s cyst: a fluid filled cyst that develops at the back of the knee due to the accumulation of synovial fluid. It commonly occurs with knee conditions such as meniscal tear, knee arthritis and rheumatoid arthritis.
• Certain fractures of the knee bones

Procedure

Knee arthroscopy is performed under local, spinal, or general anesthesia. Your anesthesiologist will decide the best method for you depending on your age and health condition.

• The surgeon makes two or three small incisions around the knee.
• Next, a sterile saline solution is injected into the knee to push apart the various internal structures. This provides a clear view and more room for the surgeon to work.
• An arthroscope, a narrow tube with a tiny video camera on the end, is inserted through one of the incisions to view the knee joint. The structures inside the knee are visible to the surgeon on a video monitor in the operating room.
• The surgeon first examines the structures inside the knee joint to assess the cause of the problem.
• Once a diagnosis is made, surgical instruments such as scissors, motorized shavers, or lasers are inserted through another small incision, and the repair is performed based on the diagnosis.

The repair procedure may include any of the following:

• Removal or repair of a torn meniscus
• Reconstruction or repair of a torn cruciate ligament
• Removal of small torn pieces of articular cartilage
• Removal of loose fragments of bones
• Removal of inflamed synovial tissue
• Removal of baker’s cyst
• Realignment of the patella
• Making small holes or microfractures near the damaged cartilage to stimulate cartilage growth
• After the repair, the knee joint is carefully examined for bleeding or any other damage.
• The saline is then drained from the knee joint.
• Finally, the incisions are closed with sutures or steri-strips, and the knee is covered with a sterile dressing.

After the Surgery

Most patients are discharged the same day after knee arthroscopy. Recovery after the surgery depends on the type of repair procedure performed. Recovery from simple procedures is often fast. However, recovery from complicated procedures takes a little longer. Recovery from knee arthroscopy is much faster than that from an open knee surgery.

Pain medicines are prescribed to manage pain. Crutches or a knee brace may be recommended for several weeks. A rehabilitation program may also be advised for a successful recovery. Therapeutic exercises aim to restore motion and strengthen the muscles of the leg and knee.

Risks and Complications

Knee arthroscopy is a safe procedure and complications are very rare. Complications specific to knee arthroscopy include bleeding into the knee joint, infection, knee stiffness, blood clots or continuing knee problems.