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The arthroscope is essentially a small camera that uses fibre-optic cables to relay a picture to a screen in the operating theatre. Whereas in the past open surgery would have meant a stay in hospital, most arthroscopic procedures are carried out as outpatient cases, where the patient doesn’t have to stay in hospital overnight. There is no need for a big scar, so the overall rehabilitation period is significantly shorter.
Arthroscopic surgery is now commonly used in the treatment of knee conditions which, in the past, would have required conventional open surgery. Conditions such as ruptured anterior cruciate ligament, torn cartilage (meniscus) and loose bodies within the knee are all now routinely operated on with the orthopaedic surgeon using an arthroscope.
The
procedure takes place under anaesthetic. This may be a conventional
general anaesthetic, or an epidural anaesthetic which numbs the
patient from the waist down. The epidural may be used in patients
who have respiratory problems, because a general anaesthetic can
impair respiratory function. Once the patient is anaesthetized the
surgeon makes a small incision so that the arthroscope can be inserted
into the joint. The arthroscope, commonly used for knee procedures,
is 5mm in diameter which means the incision, or ‘portal’,
is very small. Usually the surgeon uses three portals: one for the
arthroscope, one for fluid to be pumped into the joint and one for
fluid to be pumped out of the joint. This fluid is clear and distends
the joint, enabling the surgeon to see structures within the knee
joint. The pictures on the screen can be seen by the theatre staff
and anaesthetist, as well as the surgeon.
Once the procedure has been completed the portals are sutured and the wounds dressed. As with any surgical procedure there is a risk of infection so the wounds must be kept scrupulously clean. The post operative advice of the surgeon must be adhered to. In some procedures, such as removal of a loose body, the patient may be allowed to walk, but following more complex procedures, such as reconstruction of the anterior cruciate ligament, the patient will be told to wear a knee brace and instructed by the surgeon to use crutches for a period.
