Arthroscopic knee surgery

If the non-surgical treatments for knee complaints offer insufficient results, the orthopedic surgeon can decide together with you to intervene surgically. Performing an operation for knee complaints can consist of joint-sparing operations such as arthroscopic surgery (keyhole surgery) or an osteotomy (position adjustment) or joint replacement operations. Which procedure is most suitable depends on the cause of the knee complaints and sometimes also the individual wishes of the patient.

Joint-sparing operations

The joint-sparing operations mainly consist of keyhole surgery of the knee or an osteotomy.

Arthroscopic surgery (keyhole surgery)

This procedure is usually performed under an epidural and sometimes under general anesthesia. An epidural has the great advantage that only the lower body is temporarily numb (for a number of hours) and that the patient can watch on a monitor during the procedure. This increases understanding of the deviation and provides clear insight into the cause. During keyhole surgery, a camera and instruments are inserted into the knee joint through small cuts in the skin around the knee. Through this camera, the inside of the knee can be clearly imaged. The meniscus, cartilage, cruciate ligaments and mucosa are thus seen. If there is an abnormality or damage to one of these structures, this will be revealed during the exploratory operation. And if necessary, immediate action can be taken.

Keyhole surgery takes about 15 to 30 minutes and is usually performed as an outpatient procedure.

Indication

There are many reasons to opt for this surgical treatment of knee complaints. Below is a list of the main indications:

• Meniscus injury;
  The most common reason for keyhole surgery is a tear in the meniscus. During keyhole surgery, the broken piece of the meniscus can be removed. Sometimes it is possible to suture the meniscus. However, this depends on the type of the crack.
• Corpora libera (loose tissue/cartilage/bone);
  Sometimes loose pieces of bone or cartilage are the cause of the knee complaints. These can be removed relatively easily during keyhole surgery. However, damaged cartilage cannot be repaired. However, the underlying bone can be drilled up to stimulate the body to recover.
• Cruciate ligament injury;
  If a cruciate ligament injury is suspected prior to the procedure based on the physical examination and additional diagnostics, an exploratory operation can be decided. During this keyhole operation, the cruciate ligaments can be inspected and loose frays can be cleaned. This may suffice with little to no instability complaints of the affected knee. If there are instability complaints, it may be decided to reconstruct the torn cruciate ligament. This is largely done with keyhole surgery. During this operation, the torn (anterior) cruciate ligament is replaced by two hamstring tendons or by part of the patellar tendon.

Post-treatment

The follow-up treatment after keyhole surgery of the knee depends on the complexity of the operation.

A compression bandage is always applied after the operation. You can remove these yourself 24 hours after the operation. The wounds must remain dry for the first 5 days, after which the adhesive plasters may be removed and the wounds may become wet. During the first two weeks after exploratory surgery, the knee may be even thicker than normal due to a reaction of the mucous membrane of the knee.

Physiotherapeutic support is usually not necessary. However, if the (anterior) cruciate ligament has been reconstructed, intensive practice will be necessary. It is therefore important in that case to undergo extensive rehabilitation under the supervision of a physiotherapist.

Wear

If wear and tear of the cartilage of one or more compartments of the knee (osteoarthritis) has been detected during keyhole surgery, the complaints of the knee may persist after the operation. It also takes longer for knees with osteoarthritis before the swelling and pain decrease after the operation (+- 6 weeks).

Complications

Fortunately, complications after keyhole surgery of the knee are rare.

• Wound leakage;
  Sometimes the puncture wounds in the skin, the cuts through which the instruments and camera were inserted in the knee, can still leak. Usually it is sufficient to change the bandage, an additional suture is rarely necessary.
• Infection;
  The chance of an infection of the knee is nil. However, if the knee becomes red, swollen, warm and painful and you develop a fever, you should immediately contact your treating physician at the Eisenhower Clinic.
• Thrombosis leg;
  The chance of a bone thrombosis after keyhole surgery is small. Due to the operation and being less mobile afterwards, the flow of blood in the operated leg is somewhat reduced. This can cause a blood clot to form in a blood vessel. You will receive a single injection of fraxiparine on the day of the operation to reduce this risk. Being overweight, using contraceptive pills and smoking increase the risk of thrombosis

The treatment of knee problems with an arthroscopy of the knee is frequently done in the Netherlands. Within our team,  Rutger Tordoir is the expert in knee arthroscopy. During the appointment you will discuss the possibilities with one of them.

Cruciate ligament reconstruction

A common knee injury is the torn anterior cruciate ligament. Because the cruciate ligament is torn, it can no longer adequately perform its stabilizing effect. Normally, the anterior cruciate ligament prevents the tibia from moving forward in relation to the femur. If the anterior cruciate ligament is torn, the feeling of sagging and instability can occur.

The diagnosis can be made on the basis of a physical examination and additional diagnostics by means of an MRI scan. First of all, training of the upper leg muscles will always be started (whether or not under the supervision of a physiotherapist). This can create a lot of stability.

However, if this does not provide sufficient stability, or if the orthopedic surgeon estimates that the knee will sustain more damage without surgery, reconstruction of the anterior cruciate ligament can be considered.

The operation

During keyhole surgery of the knee, the torn (anterior) cruciate ligament is replaced by two hamstring tendons or by part of the patellar tendon (bone-patella-bone technique).

During the procedure, the remnants of the torn cruciate ligament will first be removed and the knee will be inspected for other injuries. The tendons of the hamstrings or the patellar tendon are then obtained through an extra incision next to the small incisions for keyhole surgery. After the optimal location has been found, holes are then drilled in the femur and tibia. The tendons are pulled through these boreholes (“tunnels”). On both sides, the new cruciate ligament is secured in the tunnels with a screw or a flip-over system.

Post-treatment

A cruciate ligament reconstruction operation takes about 1 hour and is usually performed as an outpatient procedure. After the procedure, the rehabilitation program begins with the physiotherapist. This rehabilitation to return to sports takes about 8 to 9 months.

Complication risks

The complication risks are comparable to those of keyhole surgery of the knee