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Like the clinical examination, the arthroscopic examination should follow a specific pattern. Only compliance with the rules of systematic examination will guarantee that no pathological changes in any part of the joint will be missed (Table 1).
Table 1
Sequence of arthroscopic diagnosis of the knee joint
1. Articular surface of the patella 2. Superior patellar inversion:
3. Lateral inversion (flank):
4. Femoral-patellar joint 5. Medial inversion (flank):
6. Medial section:
7. Posteromedial section (it may be necessary to replace the optics with a 30° viewing direction by 70°, as well as a separate posteromedial diagnostic approach):
8. Intercondylar fossa:
9 Lateral section:
10. Posterolateral section (it may be necessary to replace the optics with a 30° viewing direction by 70°, as well as a separate posterolateral diagnostic approach):
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In addition, it is necessary to know the basic positions of the joint in space, in which its various parts are most accessible to inspection, and to learn how to maintain these positions during manipulation of the arthroscope and instruments.
After inserting the arthroscope into the joint, its end is in the superior inversion. By placing the light guide from below, and slowly moving the arthroscope back (pushing it out of the joint), the surgeon should see the articular surface of the patella, which will be on top if observation is carried out directly through the eyepiece.
When using a video camera, it is necessary to orient it in relation to the arthroscope so that the shiny white surface of the patella occupies the top position on the monitor screen. From this point, the arthroscopic examination begins, with the knee joint fully extended and the patient's foot resting on the surgeon's abdomen (Fig.
1) or supported by an assistant (first position).
Rice. 1. First position of the knee joint to examine the patella and superior inversion: full extension (Kohn D., 1991)
From this position, the surgeon, with careful movements, pushing back and forward the arthroscope, rotating it around its axis to increase the viewing area, examines the articular surface of the patella and the patella surface of the thigh (photo 1).
The surgeon can examine the entire surface of the patella by moving it with his free hand in relation to the arthroscope. Normal hyaline articular cartilage appears smooth, white, and shiny.
Its surface layer is smooth and, when felt with a hook, quite hard and elastic.
Photo 1. Articular surface of the patella
It is well known that pathological changes in cartilage are very difficult to diagnose clinically and radiologically, especially in the early stages. In these cases, arthroscopy may be helpful in assessing the size and location of cartilaginous lesions. The most widely recognized is the 4-degree classification of chondromalacia (Outerbridge RE, 1961).
I degree - softening, swelling or loosening of the surface layer of cartilage. When pressed with a hook, a hole is formed on the surface (photo 2).
- II degree - fiberization of the cartilage with cracks, flaps, erosions that do not reach the deep layers and subchondral bone (photo 3).
- III degree - fiberization of the cartilage with deep cracks, flaps, erosions reaching the deep layers and subchondral bone (photo 4).
- Grade IV - erosions and cartilage defects with exposure of the subchondral bone (photo 5).
Photo 2. Chondromalacia of the patella I degree: softening of the cartilage surface
Photo 3. Chondramation of the patella II degree: superficial fiber disintegration, uneven surface of the cartilage
Photo 4. Chondramation of the medial facet of the patella of the III degree: deep fiber separation, cracks, cartilage flaps
Photo 5. Chondromalacia of the medial femoral condyle, grade III (coarse deep fibering and surface erosion) and tibial condyle, grade IV (subchondral bone plate exposed)
Pathological changes in cartilage are most often observed on the medial facet and in the region of the apex of the patella. Chondromalacia of the patella is often found even in patients who have no complaints of pain behind the patella.
Almost all people over 50 years of age can have changes in the patellar cartilage of varying degrees.
Therefore, in order to make a judgment about the pathological significance of chondromalacia of the patella detected during arthroscopy, it is necessary to correlate the obtained morphological data with the patient’s complaints (the presence of the so-called patellofemoral pain syndrome).
Next, the surgeon moves the arthroscope slightly forward and examines the structures of the superior patellar inversion .
Before entering the superior suprapatellar bursa, the surgeon usually encounters remnants of the suprapatellar septum , which are either a synovial membrane with a fairly large window in the center, or a vertical synovial fold of a crescent shape with the base localized on the medial capsule ( medial suprapatellar fold ). Intra-articular bodies may be hidden behind the fold.
The lateral portion of the membrane may be separated from the capsule and appear as the lateral vertical suprapatellar chord . Sometimes the suprapatellar septum is represented by a complete synovial fibrous membrane (solid or with a narrow slit-like opening) and separates the suprapatellar bursa from the main cavity of the joint (photo 6).
To ensure that the arthroscope is actually inserted into the bursa, the surgeon must find on the anterior wall of the superior patellar inversion the longitudinal fibers of the quadriceps tendon and the articular muscle of the knee, which is attached to the superior vault of the capsule, visible through the synovium (Figure 7).
If the muscles are not visible, then it is most likely that the end of the arthroscope is in front of the continuous suprapatellar septum.
Photo 6. Suprapatellar septum with a large window (entrance) into the suprapatellar bursa (a); medial suprapatellar fold (b); vertical lateral suprapatellar chord (c). Complete suprapatellar membrane: an irrigation cannula inserted into the bursa is visible through the septum (d)
Photo 7. Longitudinal strands of fibers of the quadriceps femoris tendon under the synovial membrane of the anterior wall and the articular muscle of the knee at the apex of the suprapatellar bursa
The complete suprapatellar septum is a rudiment of the embryonic membrane and in some cases can be the cause of patellofemoral pain syndrome.
It impedes the circulation of synovial fluid between the joint cavity and the suprapatellar bursa, contributing to a chronic increase in pressure in the bursa and the development (after acute or chronic injury) of isolated synovitis or bursitis.
With forced movements in the joint, a dense fibrous membrane can be pinched between the extensor apparatus and the patellar surface of the femur, causing mechanical local synovitis and chondromalacia of the contact zone of the patella. In such cases, arthroscopic membrane resection is an effective treatment method.
In the superior patellar volvulus, the subject of study is the synovial membrane , which is here most pronounced and more often subject to pathological changes. When examining, pay attention to the color, swelling, vascular pattern and pathological inclusions on the surface and in its layers, to the number, shape, size and structure of synovial villi.
The normal synovial membrane is usually pink, smooth and transparent, with a distinct, faint pattern of fine vasculature (Figure 8). On the lower wall of the inversion (the anterior surface of the femur) you can find small thin transparent thread-like villi containing central blood vessels.
Some villi may normally have a yellowish tint due to their high fat content.
Photo 8. Normal synovium of the superior inversion
In the acute period of injury to the knee joint, the synovium looks swollen, hyperemic, with an expanded bright vascular network (photo 9).
In acute reactive synovitis, there is pronounced swelling, bright or stagnant hyperemia of the synovial membrane, proliferation and hypertrophy of its filamentous villi (photo 10). Chronic synovitis is characterized by congestive hyperemia, hyperplasia, sclerosis and loss of transparency of the synovial tissue.
Overgrown villi acquire a club-shaped shape and an uneven reddish-violet matte color; their vascular pattern cannot be traced (photo 11).
Photo 9. Acute post-traumatic synovitis: hyperemia, edema and increased vascular pattern of synovial villi
Photo 10. Acute reactive synovitis: intense congestive hyperemia and swelling of the synovium, hypertrophied club-shaped villi with dilated vessels
Photo 11. Chronic synovitis: opaque hyperplastic and sclerotic club-shaped villi without a vascular pattern
In some patients with a clinical picture of synovitis of the knee joint, deposits of whitish crystals are detected, the nature of which (gout, pseudogout) can be clarified by histological examination of biopsy specimens (photo 12).
Photo 12. Pyrophosphate arthropathy (pseudogout): deposits of calcium pyrophosphate crystals and reactive changes in the synovium (a, b), cartilage (c), meniscus (d)
In the rare hereditary disease alkaptonuria (ochronosis), characteristic multiple deposits of greenish-black or dark brown ochronotic pigment are observed in the synovium, menisci and articular surfaces (Figure 13).
The essence of the disease is that, as a result of a congenital defect of the homogentisinase enzyme, homogentisic acid products accumulate in the body and affect cartilage and connective tissue, causing chronic reactive inflammatory and degenerative processes in large joints.
Photo 13. Deposits of needle-shaped crystals of the ochronotic pigment homogentisic acid in the synovial membrane (a), greenish-black pigmentation of the cartilage tissue of the knee joint (b) with alkaptonuria (ochronosis)
Trachuk A.P., Shapovalov V.M., Tikhilov R.M. Basics of diagnostic knee arthroscopy
Published by Konstantin Mokanov
Source: https://medbe.ru/materials/artroskopiya-kolennogo-sustava/posledovatelnost-artroskopicheskoy-diagnostiki-chast-1/?PAGEN_2=2
Knee arthroscopy: what is it, complications, contraindications and reviews
Knee arthroscopy is an endoscopic operation used for the purpose of comprehensive diagnosis and surgical treatment of various joint injuries.
A highly informative visual technique allows for high-quality examination and treatment of the joint in a closed manner, using puncture portals, which significantly reduces the degree of surgical trauma, minimizes pain and significantly shortens the recovery period.
A visual diagram of the operation.
It began to be used as an operation at the dawn of the 20th century. But until now, the procedure has gone through many stages of improvement. And now it has become a truly indispensable area in orthopedics, thanks to minimal trauma, one hundred percent diagnostic accuracy and high efficiency.
Concept and advantages of the procedure
The surgery is performed using specialized, state-of-the-art fiber optics integrated into an innovative device called an arthroscope. Thanks to the unique device, the procedure got its name. The process involves an internal study of bone and cartilage tissue, menisci, tendons, muscles, ligaments, connective tissue elements, and synovial fluid.
Image of the joint cavity.
For the purpose of highly informative diagnostics, a specialist, through a microportal, inserts the working tube of the device into the joint, into which a system of ultra-strong lenses, a powerful light source and digital video recording equipment are mounted.
All structures that the arthroscope “sees” are visualized on the screen in a “live” form, and the image is received in a many times enlarged format.
The doctor can find the exact location of the injury or degenerative changes, determine the nature of the pathology, the severity and take action.
Arthroscopy has been proven to be superior to any existing diagnostic methods. It clearly shows from the inside all the structural units of the bone connection in the smallest detail, allowing you to identify even small hidden damage that cannot be detected using standard fluoroscopy or arthrography, ultrasound, MRI, CT and other popular imaging methods.
The method is used not only as a diagnostic tool, but also as a therapeutic and restorative tactic. Having discovered certain violations of the cartilage surface, the doctor can immediately eliminate them. He will perform surgical manipulations through an additional incision (about 6 mm in size) using microsurgical instruments, and he will perform the entire process while looking at the monitor.
Indications and contraindications
Let us immediately note that treatment extremely rarely leads to negative consequences. However, this cannot be ruled out if it was done despite contraindications. But first we will cover the recommendations, and then the restrictions.
Partial tear of the lateral ligament of the knee joint.
The procedure may be prescribed for:
- an unclear cause of pathological symptoms, when other methods are powerless to establish it;
- ligament ruptures, damaged tendons;
- suspected dislocation of the calyx (patella);
- the presence of free bodies in the cavity;
- inflammation of the synovial membrane of unknown origin;
- aseptic necrosis of the head of the articular bone;
- injuries, degenerative-dystrophic diseases of the meniscus;
- arthritic disease and gonarthrosis;
- intra-articular fractures, etc.
It is contraindicated in the presence of such ailments as:
- hypertension;
- diabetes mellitus in the stage of decompensation;
- disturbed balance of blood clotting;
- severe dysfunction of the pulmonary or cardiac systems;
- local skin inflammation.
Therapeutic and diagnostic arthroscopy is performed with caution; the consequences can be unpredictable if you are allergic to local/general anesthetic. Therefore, be sure to tell your specialist if you are prone to allergic reactions to any medications.
Preparing the patient for surgery
Preparation consists of a thorough examination of the patient, collecting anamnesis, and conducting basic instrumental and laboratory tests.
Until the doctor is convinced that this is a safe operation and weighs the pros and cons, the operation is impossible.
Therefore, at first, a round of some specialists of a narrow profile is always prescribed, for example, in addition to an orthopedist or traumatologist, depending on the situation, also a cardiologist, endocrinologist, pulmonologist, allergist, etc.
It is extremely important to take into account absolutely all the results of the preliminary diagnosis. They will influence the choice of anesthesia; a special role is given to the selection of the optimal type of anesthetic that will not cause harm to the body.
In addition to medical rounds, the patient is given directions for an ECG and fluorography, and for laboratory tests of blood and urine.
Having made sure that it is advisable to undertake this operation, they conduct a consultation on preparation.
During the consultation, you are warned that you will need to stop eating 12 hours before the procedure, and stop taking anticoagulants (aspirin, heparin and medications based on them) a couple of weeks before the procedure.
Patients who left reviews report cautionary recommendations from doctors regarding smoking and drinking alcohol.
You will have to give up bad habits 10-14 days before the intervention and, of course, try not to return to them afterward or at least minimize the dose.
If you intend to resort only to diagnosis, preoperative preparation is carried out according to similar rules.
Description of the microsurgical process
In reviews, patients tell how quickly and painlessly they underwent the procedure, without general anesthesia.
This is quite likely, but do not forget that clinical cases are not the same for everyone, and the physiological status of each patient is different. Therefore, it would be more correct to say that pain, thanks to strong local anesthesia, is almost impossible.
However, post-operative discomfort in the area of the operated area will most likely bother you a little for some time.
Disintegration of ligaments when they rupture.
The video allows you to understand all the intricacies of the process. There are plenty of them on the Internet. But due to the fact that not everyone will be able to watch specific stories to the end, we suggest that you simply and calmly read about the important points.
Positioning of the patient on the operating table.
Based on the etiology and degree of pathological changes, the patient’s condition and concomitant diseases, the anesthetic agent is selected individually.
Most often, local anesthesia is used, that is, regional anesthesia (epidural or conduction). The regional anesthetic contains lidocaine, ropivacaine or bupivacaine.
To enhance the anesthetic effect, a medicine from the opiate category can be added to the main solution in a mini-dose. In some situations, however, general intravenous anesthesia is appropriate.
First, regardless of the surgeon's plans, a diagnostic arthroscopy will be performed. It involves inserting an endoscopic probe in the form of a rod into the cavity of the bone joint. When anesthesia takes effect, then diagnostic surgery begins.
To do this, the limb, half bent at the knee, closer to the thigh, is twisted to reduce blood flow, after which a puncture (6 mm) is made, through which a contrast agent is injected to enhance the visibility of the articular and periarticular structures. Next, a tube is inserted through this operating port.
The specialist thoroughly examines every millimeter of the problem organ.
The surgical field, you can see a glow inside.
The video is broadcast in real time on the screen and reveals any existing defects in the diseased joint.
If the doctor considers it necessary to perform regeneration of pathological elements, he will create an additional incision (6-8 mm), through which he will eliminate the detected defect using the necessary instrument from the microsurgical set.
He can perform partial resection of osteochondral tissues, plastic surgery of ligaments and tendons, suturing or removal (partial, complete) of the meniscus, expropriate chondromic bodies, extract effusion and pus, administer anti-inflammatory drugs, take a fragment of tissue or synovium to study their composition, etc.
At the end of the surgery, the surgical field is washed and all instruments are removed. The doctor treats the wound with disinfectant compounds, installs drainage and makes a small suture, which he closes with a sterile adhesive plaster. On the operated knee, in order to give it maximum immobility, a tight fixing bandage is applied from the foot to the middle of the thigh.
The entire session takes an average of 1 hour, in some cases up to 3 hours. Restorative measures are simple, but they must be strictly followed so as not to provoke dangerous complications. Negative phenomena that can develop will be discussed further.
Complications after knee arthroscopy
Like any surgical method, this method, even with all its minimal invasiveness, can have an unfavorable outcome. Complications result from non-compliance with rehabilitation standards, violation of the principles of asepsis and antisepsis, and medical errors. An unfavorable picture occurs infrequently, so there is no need to panic. You must initially take full responsibility when choosing a clinic.
ACL reconstruction.
Feedback from patients after knee arthroscopy, together with official statistics, allowed us to create a list of the most common excesses. It includes the following negative phenomena that occur in the early or late postoperative period:
- increase in general body temperature;
- pronounced permanent or periodic pain in the joint area, often radiating to the lower leg or hip segment;
- local hyperemia, swelling, hyperthermia;
- local infections, abscesses;
- vascular thromboembolism;
- intra-articular hemorrhage;
- arthritis due to inflammation, bursitis;
- bleeding from the wound;
- pain and numbness due to damage to nerve formations;
- violation of the integrity of the ligaments as a result of incorrect manipulations by the surgeon.
Recovery Features
To prevent swelling of the soft tissues covering the knee, apply cold to the wound. Dry ice packs are applied every 60-90 minutes during the initial stages of rehabilitation. The person must remain in the hospital under the supervision of specialists for at least two days.
He is prescribed good painkillers, as well as a series of antibiotics to prevent infectious pathogenesis. It is allowed to get up already on the 3rd day, but walking is allowed only with a walker or crutches.
It is necessary to protect the leg from full load for at least one week.
The success of arthroscopic knee surgery depends entirely on the quality of postoperative care. Full recovery occurs in approximately 1-1.5 months; all this time, all points of the rehabilitation program, individually drawn up by a highly competent rehabilitologist, must be followed in strict order.
Massage, a complex of exercise therapy, physiotherapy, hard work and patience help to recover at an intensive rate.
After approximately 7-10 days, it is possible to cancel the supporting means for movement, the person is allowed to move as nature requires, namely, without support on two legs with an equal load, the movements are smooth and slow, the step is small. Therapeutic exercises and walking for a certain period of time are carried out in a special functional orthosis, worn on the problematic leg.
Scars.
Exercise therapy in the early stages is gentle. In the first week, they usually practice in a lying position.
The basis of the complex is tension/contraction of the hip muscles, raising the straight limb by 45 degrees with a 5-second hold, and warming up the ankle. Lymphatic drainage massage is used to relieve postoperative swelling.
It is performed manually or using a microcurrent machine by a professionally trained massage therapist. In the later period, cycling, swimming, walking and running in water are prescribed.
Conclusion
Identifying the cause of joint dysfunction is often problematic using conventional diagnostic techniques, such as computed tomography or magnetic resonance imaging, x-rays, and ultrasound. In this case, a visual “researcher” of the articular cavity comes to the rescue - an arthroscope, used in orthopedic practice to obtain complete and reliable information about the state of the joint.
The procedure is very highly valued by specialists, because in addition to such a highly informative examination, it allows you to simultaneously correct the detected deficiencies, and to do this in a high-tech manner, without traumatic dissection of the supra-articular soft tissues and without exposing the bone joint.
It would be preferable to have your knee examined and, if necessary, operated on in one of the highly specialized clinics in Europe. They master this technique at the highest level.
Wonderful orthopedic surgeons in this area work in the Czech Republic, this is mentioned in European scientific and medical sources.
And, as reviews show, arthroscopy of the ankle and knee joint in the Czech Republic, patients are attracted by the price.
Source: https://msk-artusmed.ru/artroskopiya/kolena/
Arthroscopy of the knee joint as a method of treatment and diagnosis
Originating at the dawn of the 20th century in Japan, arthroscopy to this day remains the most reliable and least traumatic invasive method for examining large joints.
Concept of the term
Arthroscopy is a highly informative visual method of diagnosis and treatment with minimal damage to the skin, tissue, ligaments and internal structures of the joint.
Without making a large incision, you can examine its entire internal part, identifying all damage that is inaccessible to other research methods (fluoroscopy, ultrasound, arthrography, arthrotomy, MRI). Surgery is performed using a fiber-optic device - an arthroscope.
Indications
Arthroscopy is indicated for various lesions of the knee joint, such as:
- deforming osteoarthritis;
- meniscus damage;
- damage to the knee ligaments;
- rheumatoid and deforming arthritis;
- damage to the synovial membrane;
- bursitis;
- intra-articular fractures;
- the presence of small foreign bodies;
- diagnosis of tumors with biopsy.
As a therapeutic procedure, arthroscopy is often used for ligament ruptures and meniscal injuries. Recent publications cast doubt on the need for its use in osteoarthritis.
Contraindications
The main contraindications to arthroscopy are the patient’s health condition and the presence of the following diseases:
- hypertonic disease;
- low blood clotting;
- diabetes;
- lung disease.
The patient's history of allergic reactions must be taken into account. You should be especially wary of allergies to certain medications.
Advantages
Using the arthroscopy method, it is possible to identify joint pathologies at the earliest stages and prevent further development of the disease. Attract:
- high reliability of diagnostic arthroscopy;
- minimal risks of complications;
- short rehabilitation period;
- low blood loss;
- minimum contraindications;
- minor cosmetic defect.
Arthroscopy Instruments
The method allows you to monitor the course of the disease over time and carry out joint rehabilitation. Remove small foreign fragments of bones and cartilage after fractures, “rice bodies” with bursitis. Makes it possible to do biopsies for tumors and other pathologies.
How is it carried out?
Arthroscopy is still an operation, and it is performed with mandatory anesthesia. It takes from 30 minutes to one hour. Taking into account the complexity of the disease, the patient’s condition, the presence of allergies to drugs and other nuances, the doctor chooses the method of anesthesia. It could be:
Carrying out arthroscopy
The surgical field is treated with one of the antiseptics. The orthopedic surgeon makes a small tissue incision ranging in size from 3 to 6 mm. There may be several such cuts.
Through the first incision with an arthroscope, a miniature fiber-optic camera is delivered to the examination site. It is connected to the computer. Through the lens system, a clear, clear image of the desired object is obtained, which is displayed on the monitor screen.
Through the second incision, a special solution consisting of sodium chloride, lidocaine, and adrenaline is injected into the joint area using a cannula. With its help, the research channel is expanded and the risk of bleeding is reduced.
The necessary medical manipulations are carried out through the third incision. The progress of the examination or operation is recorded and captured in the form of photographs.
Upon completion of the operation, the previously injected fluid is pumped out of the joint cavity. To prevent infection, antiseptic and antibacterial agents are administered. An antiseptic pressure bandage is applied to the joint area.
Preparing the patient
Before arthroscopy, as before any operation, a standard examination is performed. The patient is examined by a doctor and undergoes a general blood and urine test. A cardiogram is taken and a fluoroscopy of the lungs is performed. To avoid complications during examination and treatment, it is necessary to inform the doctor about the presence of all concomitant diseases.
The operating field is ready
On the day of the examination, it is not advisable to smoke or eat. If local anesthesia is chosen, the patient is prescribed sedatives to relieve emotional stress.
Outcome of the operation
The outcome of diagnosis and treatment is largely determined by the qualifications of the surgeon. The reactivity of the patient's body is of considerable importance. Consequences of knee arthroscopy in the form of complications are rare. Usually, intervention in the knee joint ends successfully.
There is nothing special about the presence of pain immediately after surgery and the first days after it. Swelling is a classic reaction of knee joint tissues to surgery. These symptoms disappear quickly. Joint mobility may be limited for one to two weeks. After exercise therapy, his functions are completely restored.
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But sometimes during surgery and in the postoperative period some complications arise:
- bleeding when one of the vessels ruptures;
- infection leading to the development of arthritis;
- damage to some joint structures - fascia, ligaments;
- formation of postoperative blood clots;
- inflammation of the scar surface.
If hopes for the operation are not justified, it has to be done again or in a different way.
A complication such as hemorrhage into the joint cavity is eliminated by repeated puncture and lavage. The same procedures are carried out for infectious arthritis, and antibiotics are also prescribed. Inflammation of scars is treated by applying antiseptic dressings and antibiotic-based ointments.
The most dangerous complication of arthroscopy is the development of thrombophlebitis, which is an inflammation of the inner lining of the veins with the formation of a blood clot. Initially, one vessel is affected. Then the inflammation spreads to the surrounding tissues, deep veins. When the limb is loaded, the pain intensifies; the floating (moving) part of the thrombus can break off and clog the pulmonary artery.
Recovery
Rehabilitation after treatment with arthroscopy takes significantly less time compared to open joint surgery. Simple manipulations are carried out successfully on an outpatient basis. Hospital stay is usually limited to one to two days.
Knee bandage
Immediately after the operation, the leg is placed in the most optimal elevated position. This reduces the risk of hematoma formation and swelling of the knee tissue. Joint development and simple physical exercises begin on the second day. If there are no contraindications, physiotherapy, massage, and exercise therapy are prescribed for a faster and more complete recovery. The joint can be fully loaded within a week.
The price of arthroscopy is quite affordable (about 20,000 rubles). Depends on whether only examination or diagnosis will be carried out simultaneously with treatment. The cost is determined by the type, severity of the disease, and length of stay in the hospital. There are medical institutions with the appropriate license that issue sick leave.
Deciding to undergo arthroscopy, leaving everything as is, or using other methods of examination and treatment is the patient’s choice.
Source: https://dialogpress.ru/lechenie/artroskopiya-kolennogo-sustava-kak-metod-lecheniya-diagnostiki
Arthroscopy: an endoscopic method for examining joints
Arthroscopy is a diagnostic procedure that refers to minimally invasive surgery. It is used to examine and treat large joints using an endoscopic device - an arthroscope. This method is less traumatic for the patient than the standard operation of opening the joint.
What is endoscopic examination of joints?
Arthroscope device (photo: medicalexpo.ru)
In order to examine the cavity of large joints (ankle, hip, knee, etc.), as well as their outer part, without extensive surgical intervention, the method of arthroscopy (joint endoscopy) is used.
Diagnosis is carried out using an arthroscope, which is equipped with a video camera capable of recording the areas under study in high-precision quality and displaying their image on a special screen.
Arthroscopy makes it possible to solve problems such as:
- Taking a piece of tissue for examination (biopsy).
- Assisting the doctor in choosing the method of surgical intervention.
- Understanding of the feasibility of the operation.
- Determination of the exact location of the pathological process.
- Differentiation of diagnosis.
- Finding out the causes of the disease.
The capabilities of the arthroscope are widely used for the treatment of joint pathologies of various types (arthrosis, trauma, bursitis).
Types of arthroscopy
Arthroscopy is performed only on large joints, for example, such as:
- Ankle joint. The most common disease for which this procedure is performed. This is post-traumatic arthrosis.
- Knee-joint. Used for pathologies such as meniscal tears, damage to knee ligaments, etc.
- Elbow joint. Arthroscopy is used to diagnose and treat bursitis, with limited joint mobility of unknown etiology, detection of loose cartilage and bone growths.
- Shoulder joint. Five joints provide high mobility of the shoulder. It is they who are exposed to stress during sports activities. Arthroscopy is used to diagnose and treat primary and repeated shoulder dislocations, arthrosis, chondromatosis, etc.
- Hip joint. It is carried out to diagnose early arthritis, injuries, joint locking, etc.
Indications for joint endoscopy
It is advisable to perform arthroscopy for the following pathologies:
- Meniscus tear.
- Rheumatoid arthritis (initial stage of the disease).
- Osteoarthritis.
- Rupture of articular cartilage.
- Restoring joint mobility using reconstruction of its ligaments.
- Introduction of necessary medications into the joint cavity.
- Removal of inflammatory effusion.
- Joint instability.
- Examination before a full-fledged surgical intervention to open the joint cavity.
- Intra-articular cyst.
- Sprain, rupture of tendons, ligaments.
Contraindications to arthroscopy
Joint endoscopy cannot be performed for the following pathologies:
- Allergy to anesthetics.
- An infectious, purulent process in the joint area of an acute or chronic nature.
- Complete immobility of the joint (ankylosis).
- Severe reduction or complete disappearance of the joint space (arthrosis of the 3rd and 4th degree).
- If an X-ray examination of the joint with a contrast agent was performed, arthroscopy should be postponed for 10-12 days.
- Acute viral infections.
- High or low-grade (37°C) body temperature.
- High blood pressure.
- Mental instability of the patient.
- Pregnancy.
- Thrombosis.
- The presence of a large amount of blood in the joint cavity.
- Skin lesions in the area of the joint being examined are purulent in nature.
- Blood clotting disorders.
- History of severe joint injuries.
- Tuberculosis of bones.
- Women have a pathological menopause, menstrual period.
How to Prepare for an Arthroscopy Study
The procedure is prescribed by an orthopedist or traumatologist. Before arthroscopy, the patient must first come for a consultation with an anesthesiologist if general or epidural anesthesia is intended.
Important! You must tell your doctor about all medications you are taking. For example, drugs such as Aspirin or Warfarin can cause severe bleeding during surgery.
Doctors usually prescribe tests such as:
- General detailed blood test.
- Immunogram.
- Clinical urine analysis.
- Coagulogram (blood clotting test).
- Biochemical blood test.
- Screening for HIV infection, syphilis and viral hepatitis (B, C).
- Rheumatoid tests.
- Before endoscopy of the joint, you need to do an electrocardiogram and fluorography.
- On the eve of the procedure, have a light dinner; on the day of the examination, eating is prohibited.
- If arthroscopy is planned on the lower extremities, you should check with your doctor in advance about the possible need for a cane or crutches.
- It is advisable to take an accompanying person with you, in particular if the trip is planned by personal transport.
How is endoscopic examination of joints performed?
Arthroscopy of the knee joint (photo: sustav.pro)
This examination method makes it possible to fully assess the condition of large joints and their cavities with minimal damage. Arthroscopy allows for the restoration of both the joint itself and the replacement of its damaged parts.
Joint endoscopy can be performed under spinal, general anesthesia or local anesthesia. The procedure requires the following tools:
- Special metal rod with graduation (arthroscopic probe). With its help, the joint is expanded.
- The arthroscope device is equipped with a rigid tube and a video camera.
- Instrument for piercing tissue (trocar).
- A cannula whose function is determined by the supply and removal of fluid.
- Needle for puncture.
The doctor places the patient in the most comfortable position, most often the person lies on his back or on his healthy side. The sore arm or leg is fixed with special blocks.
Next, the surgeon performs the following manipulations:
- Processes the surgical field and marks it.
- A needle for puncturing the joint makes a puncture directed into the joint cavity itself.
- After the synovial fluid has leaked into the joint cavity, before introducing the arthroscope, it is necessary to inject a 0.9% sodium chloride solution - 50-60 ml, which will facilitate the procedure itself.
- An incision is made. For different types of arthroscopy, the size of the incision can vary from 0.5 mm to 5 cm. If the operation is performed for therapeutic purposes, the doctor can make several minimal incisions to insert special instruments.
- An arthroscope tube with a video camera is inserted using a trocar.
- A cannula is inserted at the puncture site, which serves as drainage to drain joint fluid. It also delivers necessary medications.
- After the examination or treatment is completed, all instruments and the arthroscope are removed from the joint.
- Wash out the residual blood with a 0.9% sodium chloride solution, which is then pumped out.
- To relieve pain and prevent infection, corticosteroids, painkillers, and antibiotics are injected into the joint.
- The incisions are covered with sutures, an aseptic bandage and support.
- If sutures were placed with a material that does not dissolve, they must be removed 6-12 days after the procedure.
Advantages of arthroscopy over other instrumental examination methods
Arthroscopy is the most informative method of examination compared to diagnostic methods such as MRI, CT, ultrasound, and x-ray.
It allows, without X-rays, not only to see all the pathological changes inside the joint, to assess the integrity of ligaments, cartilage and synovial tissue, but also to remove abnormal ones, and relieve patients from various acquired and congenital diseases.
Using an arthroscope, you can inject drugs directly into the joint itself, which can significantly reduce the pain of patients, restore joint mobility, and speed up their healing. Also, increase the time of remission in chronic intra-articular pathologies, determine the nature and localization of the pathological focus, and prescribe timely treatment.
Arthroscopy is not an emergency way to help patients. It is carried out as planned.
It is especially important to carry out endoscopic diagnosis at the initial stage of the disease, when other research methods are not able to cope with this task fully, due to a small, insignificant abnormal process.
Arthroscopy has significant advantages over open joint surgery. For example, such as:
- Fast recovery.
- It does not require a long stay in the hospital, a maximum of 4 days, and the patient is often allowed to go home 15 hours after the procedure.
- Does not require long-term rehabilitation.
Possible complications after arthroscopic examination
Complications following joint endoscopy are uncommon. They can manifest themselves according to the following signs:
- Pain and stiffness may persist for several days after surgery.
- In rare cases, vein injury occurs.
- Nerve damage.
- Joint injury.
- Intra-articular bleeding.
- Blood clot formation.
- Swelling, redness, hematoma in the joint area.
Very rarely, arthroscopy can provoke compartment syndrome. This is an extremely serious condition, accompanied by high subfascial pressure, causing necrosis (death) of tissue.
How to behave correctly after arthroscopy
At the end of the procedure, the doctor may recommend applying ice to the area of the operated joint to relieve swelling, elevated position of the limb and complete rest for two days after the operation.
The ice itself must be wrapped in a cloth and applied every hour for no more than 20 minutes. The doctor prescribes painkillers and antibiotics for 5-7 days.
The fixing bandage should not be removed for 7 days.
In addition, you should contact the doctor who performed the examination if the following symptoms occur:
- Increasing pain and swelling.
- The stitches are torn or bleeding.
- The area of the operated area became hot to the touch, a feeling of heat and hyperemia appeared.
- Body temperature has increased.
If the above symptoms appear, self-medication is strictly prohibited. You should immediately consult a doctor.
As a rule, the residual effects of diagnostic arthroscopy (pain, swelling, stiffness of movement) disappear after 4-5 days.
How are arthroscopy results interpreted?
After the arthroscope has been inserted into the cavity of the joint being examined, an image of all its structures is displayed on the monitor right in the operating room. This procedure allows you to find exactly the angle and area that are necessary for treatment or diagnosis. Throughout the entire process, photographs are taken using an arthroscope and video recordings are made, which are automatically saved.
Recovery after joint endoscopy
Immediately after arthroscopy, it is important to follow all doctor’s recommendations.
Physical activity must be increased gradually. If the operation was performed on the lower extremities, then you can begin to walk with the help of a cane or crutches, depending on the characteristics of the operation.
You also need to perform special gymnastics to restore and strengthen the muscles that are around the joint. The exercises are selected by a rehabilitation doctor.
- At the initial stage, it is recommended to do exercises in bed, lying on your back.
- In case of severe swelling, a drainage massage will have a very good effect, which should be done as carefully and smoothly as possible along the flow of the lymphatic vessels without the use of auxiliary means and after consultation with the doctor.
- Two months after arthroscopy, in the absence of contraindications, the patient is allowed free motor activity, excluding sudden movements with high amplitude.
Human joints are responsible for moving the body in space. If you experience pain or any other discomfort, you need to see an orthopedist or traumatologist.
Many pathologies have a common clinical picture, but a completely different etiology (origin). A timely visit to a specialist will help identify the cause of the disease, receive effective treatment and avoid possible complications.
In the video below you can watch about knee arthroscopy.
Source: https://SimptomyInfo.ru/issledovaniya/9-artroskopiya.html
Therapeutic diagnostic arthroscopy of the knee joint
Arthroscopy of the knee joint is prescribed for the diagnosis and treatment of pathologies affecting the structures of the knee joints. Traumatology and orthopedics are increasingly using this minimally invasive method of surgical treatment.
The indications for the operation are strict, so that the procedure goes without complications, you need to properly prepare for it. The main advantages of the operation are minimally invasive and quick recovery.
But not all patients are allowed to undergo arthroscopy, because such surgery has contraindications.
The essence of the procedure
Diagnostic arthroscopy of joints is carried out in cases where other instrumental diagnostic methods do not allow identifying and determining the exact cause of the development of joint pathologies. Surgery is prescribed for therapeutic purposes; the doctor performs the necessary manipulations in the joint cavity, removing the affected structures.
There is also sanitation arthroscopy, during which:
- removal of blood from hemorrhage into the joint capsule;
- extraction of damaged and dead particles;
- elimination of excess pathological exudate;
- pumping out pus and treating the joint cavity with antiseptic and regenerating drugs.
The procedure is performed under local anesthesia. The specialist uses special endoscopic equipment and instruments with which it is possible to carry out the necessary manipulations.
The arthroscope used in knee surgery looks like a thin tube with a fiber optic camera at the end. The optics produce a clear image that specialists can see on the monitor screen.
The operation is recorded on a hard drive, so that in the event of complications, it will be possible to evaluate the correctness and adequacy of the surgeon’s actions. Arthroscopic surgery is performed through 2 punctures - an arthroscope is inserted into one, and a probe instrument is inserted into the second.
The surgical consumable kit consists of a set of needles of different diameters, with the help of which you can better examine the inside of the knee joint from different angles.
Indications for the procedure
Knee arthroscopy for diagnostic purposes is prescribed in cases where X-ray examination and MRI do not provide a clear picture of the disease. Therapeutic arthroscopy of the right or left knee is performed in the following cases:
- damage to the menisci of varying severity;
- cruciate ligament rupture;
- the presence of foreign bodies or bone fragments in the joint cavity;
- instability and hypermobility of the joint due to trauma;
- osteoarthritis, in advanced stages of which excision of inflamed structures or prosthetics is required;
- progression of podragic arthrosis, in which destroyed cartilage tissue or salt deposits are removed.
Source: https://dagomys.su/lechenie/lechebno-diagnosticheskaya-artroskopiya-kolennogo-sustava.html
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