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Chapter 116 - Arthroscopic knee surgery
- from Section 24 - Orthopedic Surgery
- Edited by Michael F. Lubin, Emory University, Atlanta, Thomas F. Dodson, Emory University, Atlanta, Neil H. Winawer, Emory University, Atlanta
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- Book:
- Medical Management of the Surgical Patient
- Published online:
- 05 September 2013
- Print publication:
- 15 August 2013, pp 711-714
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Summary
Arthroscopy is the most performed procedure in orthopedics, with the knee being the most common site of surgical treatment. Advances in surgical technique and technology have led to increasing indications for knee arthroscopy. The advantages of arthroscopic surgery include the ability to function in an outpatient surgical setting, limited incisions and resultant improved cosmesis, and lowered risks for perioperative complications such as infection, substantial blood loss, and thromboembolic disease. Image capture systems and the ability to take still photographs and videos intraoperatively provide illustrations of specific pathology and procedures carried out, thereby fortifying the medical record and enhancing postoperative communication with the patient. The benefits carry over to the postoperative period in the form of lower requirements for analgesia and earlier initiation of rehabilitation protocols.
While the utility of knee arthroscopy has primarily been observed in its ability to administer therapeutic maneuvers, the arthroscope remains the gold standard as a powerful diagnostic tool. The process of preoperative counseling with the patient and obtaining informed consent is paramount, as the treatment plan can be modified based on arthroscopic findings. Surgeries performed most regularly include partial meniscectomy, meniscal repair, and anterior cruciate ligament (ACL) reconstruction. The arthroscope is also utilized for complex isolated or multiligamentous reconstructions including posterior cruciate ligament (PCL) and medial collateral ligament (MCL) work, meniscal transplantation, articular cartilage restoration, the irrigation and debridement of a pyoarthrosis, and osseous injuries such as low-energy tibial plateau fractures. A requisite for the arthroscopic management of intra-articular soft-tissue derangements is motion, as preoperative knee motion is the best predictor of postoperative motion. An exception is a locked knee joint secondary to a large bucket-handle meniscal tear.
108 - Arthroscopic knee surgery
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- By Alonzo T. Sexton II, Emory University, School of Medicine, Atlanta, GA, John W. Xerogeanes, Emory University, School of Medicine, Atlanta, GA
- Edited by Michael F. Lubin, Emory University, Atlanta, Robert B. Smith, Emory University, Atlanta, Thomas F. Dodson, Emory University, Atlanta, Nathan O. Spell, Emory University, Atlanta, H. Kenneth Walker, Emory University, Atlanta
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- Book:
- Medical Management of the Surgical Patient
- Published online:
- 12 January 2010
- Print publication:
- 10 August 2006, pp 713-718
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- Chapter
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Summary
Advances in surgical technique and technology have led to increasing indications for arthroscopy. The advantages of arthroscopic surgery include small incisions with lowered risks for operative complications such as infection and excessive blood loss. Video capture systems and the ability to take still photographs provide illustrations of specific points during the operation for the medical record. The benefits also carry over to the postoperative period in the form of lower requirements for analgesia, shortened hospital stays, and earlier initiation of rehabilitation protocols. Arthroscopic surgery is the most common type of orthopedic surgery, with the knee being the most frequent site of surgical treatment.
While the utility of arthroscopy has primarily been observed in its ability for administering therapeutic maneuvers, the arthroscope is also a powerful diagnostic tool for knee pathology. Therefore, the diagnostic portion of the case is the most important step in any arthroscopic procedure, as it allows for the identification of any pathology present and for development of a treatment plan. Surgeries that are performed most regularly include partial meniscectomy, meniscal repair, and ACL reconstruction. The arthroscope is also utilized for complex ligament reconstructions (ACL, MCL, PCL), meniscal transplantation, articular cartilage transplantation, and septic joint irrigation and debridement.
Indications for arthroscopy include the various injuries to the ligamentous and cartilaginous structures about the knee. Patients with meniscal pathology will often report a specific injury to their knee, describing a sharp pain on the medial or lateral side of the knee or occasionally in the back of the knee.