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Knee arthroscopy

Knee-joint

Introduction

Arthroscopy of the knee joint is the most commonly performed and most sophisticated arthroscopic joint operation. This is a mini-invasive endoscopic technique that allows us to fully visualize the knee joint while also allowing us to surgically treat possible damage. This mini-invasive technique allows us to reduce post-operative pain and thus accelerate post-operative rehabilitation, which means a quicker return of a patient to normal daytime activities

Anesthesia

In arthroscopy of the knee joint, we use general anesthesia or spinal anesthesia (the lower limbs are anesthetized by application of anesthetics to the spinal canal), possibly in combination with regional anesthesia. Overall anesthesia is patient friendly and allows for good muscle relaxation. To reduce perioperative bleeding, we use a pneumatic turnstile that weighs roughly halfway through the thigh. Regional anesthesia is most often used to relieve postoperative pain. It is a blockage of the femoral nerve, especially in cross-linkage operations. These blocks disappear within 24-48 hours after the operation and greatly reduce our consumption of opiates.

 

Location and approaches

In arthroscopy of the knee joint we use a position on the back where the operating limb is suspended over the edge of the table so that we can manipulate it during surgery.


Operational approaches

Basic

  • AL - anterolateral: Placed about 1.5 cm outside the leagues. Patellae and 1.5 cm below the edge of the patella. We use it as a port for optics.
  • AM - anteromedial: Placed about 1.5 cm medially from leagues. Patellae and 1.5 cm below the edge of the patella. We use it as a working port for operating tools.

Other

  • SL - overlapping lateral
  • SM - overlapping media
  • M - Medium Medium Patellar
  • L - lateral central patelar
  • C – central

Hardware

In arthroscopic operations, we use a relatively complex set of optical and surgical instruments that are placed in the so-called arthroscopic tower. Its part is usually:

 

  • The camera - (analog, digital), when attached to the eyepiece of the arthroscope, allows you to transfer the image to the monitor
  • Light source - xenon lamp with optical cable
  • ASK pump - keeps the pressure and flow of solution through the joint
  • Shaver - rotary, motor-driven cutter
  • Vulcan - for the treatment of soft tissues on the principle of high-frequency thermocoagulation
  • Documentation device - printer, smart card, video, DVD, HD

We also use:

  • Troakar - a cannula whose mandrel is replaced by an arthroscope after insertion into the joint
  • Arthroscope - rigid or flexible sapphire lens tube allowing 30 or 70 degrees lateral view
  • Tools - panch, scissors, knives, pliers, extractors, rasps, hooks
  • Specialized instrumentaria - reconstruction of ligaments, mosaicoplasty, shoulder stabilization

Indication

  • Meniscus injury
  • Frontal junction injury (PZV)
  • Cartilage injuries
  • Patella hyperpression
  • Free articulated bodies
  • Arthrofibrosis, synovialitis
  • Intra-articular fracture

Performance parameters

Duration of surgery: 60 minutes (depending on procedure)
Duration of anesthesia: 80 minutes
Length of hospital stay: 1 days

 

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