Arthroscopic Surgery {FAQs}

Orthopedic operations done with the use of little gadgets like cameras and tools are known as Arthroscopic surgeries. With the advance technology at hand, unlike traditional operative systems here the infected or damaged part of patients don’t have to be slit open instead just made small incisions. The camera projects the image on a large screen and the surgeon then is able to see a magnified image, analyze the issue and then treat the defected joint.

The surgeon first marks the knee where incisions are to be made in such a way that an easy access is gained to the knee without damaging or rupturing the tendons, blood vessels and surrounding nerves. Then the patient is given general or local anesthesia depending upon both the patient and the surgeon. Now the incisions are made. One incision is used to insert a camera and place it at the joint. The other incisions are used to insert tools required for operation. After the surgery the knee is covered with soft bandages for the insertions to heal.

After the surgery is performed the patients are normally advised not to lay weight on the operated leg. Yet it depends on the type of damage and the operation done. Patients are advised to take physiotherapy sessions so that the strength and the movement of the joints can be regained. However there are many factors that influence the time period of recovery of the patient.

Arthroscopy of knees is very simple and considered a minimal risk procedure, however complications cannot be ruled out. Well some of complications these are:

(a) infection;
(b) swelling;
(c) blood clotting in the leg.

Tearing of Anterior Cruciate Ligament (ACL) does not necessarily mean the patient has to be operated. Dr. L Tomar, a very Senior Orthopedic Surgeon believes that certain vital aspects should be regarded before even thinking about ACL surgery such as:

(a) Does the patient often execute actions that need a fully functional ACL?
(b) Does the patient face knee flux issue?

ACL restoration is not required if the ligament is not torn or damaged thoroughly. In this case patients recover in matter of weeks however the knee flux issue may continue

Anterior Cruciate Ligament (ACL) is the restoration or reconstruction of ACL. In this the ligament is restored by replacing the damaged ligament with another ligament or tendon. There are many options to perform ACL surgery however the regular options are:

i. Single Bundle ACL Restoration
ii. Double Bundle ACL Restoration

The risks coupled with ACL surgery are:

i. Infection
ii. rigidity
iii. Continuous pain and flux
iv. Unable to regain performance pre-surgery level

The main focal point while recovering from ACL surgery is to see that the joint regains strength and movement, steadiness and is not prone to injuries in future. All patients are briefed with guidelines for quick recovery of ACL surgery however they are instructed not to overwork and rush the joint, instead advance as per the knee recovery permits. Physiotherapists are also recommended to the patients who help them to follow the guidelines on the road to recovery.

PCL stands for Posterior Cruciate Ligament. Normally a doctor starts by inquiring the cause of the injury. Then certain specific technical movements such posterior drawer test is carried out to check the functionality of the PCL. Apart from that, X-rays and MRIs are also conducted to confirm.

The initial tests a doctor conducts help to detect analyze and confirm the PCL tear. MRI and X-rays are useful in further investigation of the knee as to whether any other ligament or cartilage has been damaged during the process of injury. Doctor then grades the tear on the scale of I to III, depending upon the intensity of the injury.

The treatment depends upon the grading which doctor assigns during examination. The PCL tear at grade I and II are recommended for non-operative procedures and in case of grade III operation is recommended. Initially a patient with this kind of injury is in agonizing pain and there is lot of swelling. In this case the patients are advised to use crutches, apply ice and keep the leg in elevated position. Once the pain or the swelling are returned to normalcy levels then physiotherapy is given to the patients in order to regain strength and knee movements.

Dr. L Tomar is a renowned Senior Orthopedic Surgeon and is very conventional when it comes to treatment. He believes in surgery when absolute necessary only. Hence he recommends PCL restoration by surgery in case of :

i. PCL tears grade III type
ii. Multiple ligament damage
iii. Consistent knee flux where the normal chores of a patient are affected

Meniscus tear is the damage of 1 or more fibro-cartilage strip in the knee. Patients complain of common symptoms like knee pain, swollen knee, joint locking, clicking of the knee, rigid knee joint movement, and experiencing tenderness when meniscus is pressed.

There are many factors to be considered while treating Meniscus tear. They are: (a) doctor must consider the type of tear means what grade it lies under. (b) Regular activities of the patient must be considered. (c) Evaluate the response of the patient to the treatment.

In case the doctor considering all the factors deduces to go for surgery which is known as meniscectomy, in this torn meniscus parts are trimmed.

Patients that complain of knee pain are considered to have a meniscus tear. We perform specific tests which also include X-rays to document any transformation of knee joint due to arthritic changes and MRI to picture meniscus.

Rotator cuff tears mostly require non-operative treatment unless and until in extreme cases. This kind of external treatment involves physiotherapy, cortisone injection and anti-inflammatory pain killers. Initially in this treatment the focus is to reduce inflammation and strengthen the healthy muscles to compensate for the damaged ones around the shoulders.

Surgeon and doctors complete their part from pre-surgery to post-surgery. Now swiftness of recovery lies in the hands of the patients. Utmost care must be taken to strictly follow the guidelines of recovery given and not to stress the shoulder hampering the recovery process.

Rotator Cuff Tear, as mentioned earlier, might need an operative treatment in extreme cases. However Dr. L Toma, our Senior Orthopedic Surgeon suggests that before surgery certain factors must be evaluated such as: (1) what type of tear it is? (2) what is an intense activity level of the patient and (3) whether any previous attempts have been made to treat the shoulder or no?

After investigating these factors which treatment should be opted for is again in question depending on certain factors as: (1) where and how big is the tear? (2) which option of surgery does the surgeon prefer? (3) And lastly, what kind of chores the patient would like to do post surgery?

Considering all these factors the patient is then put under the blade with comfort and surgical procedure commences.

In this procedure the bone under the acromion is removed using micro motorized equipments and inserting them into subacromial space. Rotator cuff tendons move and glide freely between humeral head and acromion after the bone is removed. On completion of the complete procedure the incisions are single sutured and closed. The wound is then bandaged and patient is moved out of the operation theatre (OT).

Patients are generally discharged within a couple of hours post-surgery. They are handed over the pain subsiding prescription and complete strict instructions are given in terms of taking care of the surgical area to avoid any infections and further complications.

Like for the patients undergoing non-operative procedure, the main focus is physiotherapy for post operated patients too. There is a possibility of the consistent pain experienced by patients post surgery as it was pre-surgery in few cases. Patients however feel relieved of pain immediately post surgery most of the time.

Please do keep in mind that in scenarios when: (i) Body temperature is not in control and shoots above 100*C; (ii) Numbness and tingling sensation is experienced in the arm; and (iii) prescribed pain killers are unable to subside pain; then in these scenarios a doctor must be consulted immediately.

Bankart Repair surgery procedure has a very high success rate in most of the cases. Our Senior Orthopedic Surgeon Dr. L Tomar states that the patient has to be in the hospital just for an overnight only because there are only small incisions made around the shoulder area with quick recovery. The surgery is a step by step procedure beginning with the mobilization of shoulder ligaments and glenoid labrum. Then the glenoid edges are prepared for insertion by drilling holes to place the bone anchor. An opening of sutures is made for the labrum and gleno-humeral ligaments. Now the bone anchor is placed in the glenoid to repair glenohumeral and labrum ligaments connecting the edge of glenoid and the incisions are closed.

After the surgery the shoulder is suspended for approximately 6 weeks. Care should be taken not to lift the shoulder above 90*C angle and should not rotate above 30*C. Six weeks later the suspended shoulder can be mobilized freely after consulting the surgeon. Once the sling is removed then exercises with the help of a physiotherapist is necessary to strengthen the muscles and the shoulder. Avoid sports for atleast 9 months after surgery. This schedule must be followed for proper functioning of the shoulder.

Complications are a part and parcel as far as surgery is concerned. However there are only maximum 2% chances of complications such as: contamination, rigidity, nerve injury and maybe other problems.