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Arthroscopic reconstructive surgeries for sports injuries

Arthroscopic reconstructive surgeries

What is arthroscopic surgery?

Arthroscopy is a procedure used by surgeons to diagnose and treat problems related to the joints in a human body like torn ligaments or cartilages. The word arthroscopy is derived from two Greek words, “arthro” (joint) and “skopein” (to look). The term literally stands for “to look within the joint.” This procedure allows the surgeon to visualize the inside of the joint through a small incision or cut. Through this incision, the surgeon can then repair the damage in the joint using very thin surgical instruments. Arthroscopy is now the most commonly performed orthopedic surgical procedure and is used both as a diagnostic as well as a therapeutic tool for different orthopedic joint disorders including traumatic joint injuries.

Why is arthroscopy necessary?

Certain diseases or disorders, as well as injuries, can damage the bones, cartilages, muscles, tendons, and linings of joints. These injuries are generally diagnosed traditionally via X-rays, magnetic resonance imaging (MRI), or computed tomography (CT) scans. Arthroscopy adds another new dimension for the treating orthopedic specialist as these injuries can be diagnosed definitively as well as treated effectively with arthroscopic surgery with less recovery time for the affected individual. Arthroscopy is useful to treat the following conditions: 

  • Inflammatory conditions of the joints: For instance, the lining of the joint i.e. synovial membrane in the knee, shoulder, wrist or ankle may get red and swollen (inflamed). Arthroscopic surgery can be used to treat this condition.
  • Acute or chronic joint injuries such as:
    • Shoulder: Rotator cuff tendon tears, impingement syndrome and recurrent dislocations
    • Knee: Meniscal or cartilage tears and anterior cruciate ligament tears
    • Wrist: Carpal tunnel syndrome

What are sports injuries? In what kind of sports injuries is arthroscopic reconstructive surgery done?

Sports injuries are those which happen while playing indoor or outdoor sports or while doing physical exercise. These injuries can result from accidents, improper or non-usage of protective devices, improper training or inadequate stretching or warm-up prior to sporting activity.

The following types of sports injuries can be treated by arthroscopic reconstructive surgery:

  • Arthroscopic knee surgery for reconstruction of the torn or damaged anterior cruciate ligament (ACL) of the knee.
  • Repair or reconstruction of torn ligaments other than ACL e.g. elbow ligament reconstructive surgery.
  • Repair or removal of a torn meniscus of the knee.
  • Repair of damaged or torn cartilage.
  • Repair of scarring within joints due to repetitive sports injuries.
  • Rotator cuff injuries by shoulder arthroscopy.
  • Removal of loose bone fragments or cartilage from a joint.
  • Removal of inflamed synovial lining of the shoulder, knee, elbow, ankle, or wrist.

happen if surgery is avoided

Is arthroscopic surgery a major surgery?

Arthroscopic surgery is a type of minimally invasive surgery on a joint. The surgery is performed through a small incision made on the joint using smaller than traditional instruments. The surgery is generally performed under local anaesthesia which reduces the risks further. The recovery time after the surgery is less due to the smaller incision and reduced trauma to the surrounding tissues due to the surgery. Arthroscopic surgery is thus a low-risk procedure with reduced rates of complications and majority of these procedures are performed on an outpatient basis where the individual can return home on the same day of surgery.

How is arthroscopy performed?

The surgery is generally performed while the individual is under local or general anesthesia in certain cases. The area to be operated is shaved (if necessary) and is cleaned with a sterile solution. Thereafter, a small incision is made (buttonhole incision) on the skin to allow the orthopedic surgeon to insert the arthroscope. The arthroscope is a small video camera that transmits high-quality images of the joint to a TV screen for the surgeon to view and perform the surgery accurately. Several small incisions are made around the joint to allow insertion of specially designed small instruments in the joint cavity. The surgeon then performs the repair inside the joint or any other process like removal of bone fragment or cartilage as applicable. Once the surgery is done, the surgeon closes the incision and a sterile dressing is applied to the area of the incision.

What are the possible risks or complications of arthroscopic surgery?

Generally, arthroscopic surgery is very safe and the complications are quite rare. As with any surgery, risks of arthroscopic surgery include reactions to anesthesia (e.g. allergic reactions), bleeding from the surgical site and infection.

Arthroscopy is a technical procedure and requires many types of equipment like cameras, monitors, probes, scopes, pumps, etc. There can be technical failures or malfunctions that can result in complications.

Additionally, there can be tissue or nerve damage due to the insertion of arthroscopy instruments within the joint cavity. There can be bleeding or formation of blood clots with the joint cavity. Some individuals can experience stiffness of the joint post-surgery.

The orthopedic surgeon will discuss specific risks associated with arthroscopic surgery prior to the procedure with the individual undergoing the surgery.

What are the advantages of arthroscopic surgery?

As compared to traditional open joint surgeries, arthroscopic surgery is minimally invasive. This results in:

  • Less post-operative pain
  • Lesser risk of complications like bleeding, infection, swelling and clotting.
  • Lesser chance of scarring
  • Lesser hospital stay post-surgery
  • Shorter recovery time
  • Faster rehabilitation, especially useful for athletes with sports injuries

In most individuals, the surgery can be performed on an out-patient basis which reduces hospitalization costs.

What can happen if surgery is avoided?

Arthroscopic surgery is generally indicated for serious joint injuries or disorders like torn ligaments or cartilages, bone fragments, inflamed joint tissue, etc. These conditions are generally not self-treatable or self-limiting and not opting for arthroscopic surgery or any orthopedic surgery would result in constant pain, decreased joint motion or complete loss or restriction of joint motion, joint weakness, numbness or weakness of limbs, difficulty in weight bearing and, in some cases, early onset of arthritis.

For individuals who are involved in doing physical work or sportspersons, it will result in decreased performance or non-performance due to the injury.

Thus, it is advisable for individuals who are suffering from any of the above conditions to get prompt medical attention and determine a treatment approach after consultation with their doctors. Arthroscopic surgery provides a cost-effective and minimally invasive option to treat such conditions.

What to expect before, during and after arthroscopic surgery?

Before procedure

Before the procedure, the surgeon will explain to the individual about what to expect before undergoing arthroscopic surgery. A complete physical exam will be done along with the necessary diagnostic tests to determine fitness for anesthesia and surgery. The doctor will additionally review the medications that the individual is taking and alter them as required. Based on an individual’s underlying medical conditions, an individualized approach will be taken so that those conditions do not impede the surgery and the recovery process. The night before surgery, the individual will be advised to fast, and no food or liquid is to be consumed at least 8 hours prior to surgery.

During procedure

Generally, arthroscopic surgery is done on an outpatient basis i.e. there is no need for hospitalization. There might be certain situations where hospital stay is deemed necessary by the orthopedic surgeon. The surgery can be done under local or general anesthesia depending on the suitability of the patient for the type of anesthesia, the general condition of the patient as well as the site of operation. The surgery is then performed by a qualified arthroscopic orthopedic surgeon as described earlier. During the surgery, the anesthetist will monitor the individual’s heart rate, blood pressure, breathing, and blood oxygen level. Post surgery, the incision is closed, and a sterile bandage applied, and the individual is sent to the recovery room.

What is arthroscopic surgery

After procedure

The arthroscopic surgery procedure is not a long one, post which the individual is shifted to a recovery room. Majority of the procedures happen on an outpatient basis and the individual can return home the same day. Post the surgery, there are a few instructions that the individual needs to follow:

  • Medicines: The doctor will prescribe medicines for pain relief for a few days after the surgery.
  • I.C.E.: This stands for rest, ice application at the surgical site and compression and elevation of the joint for reducing swelling and pain.
  • The doctor will also recommend certain exercises or physiotherapy to rehabilitate the joint.

The individual needs to monitor for any signs and symptoms of infection (fever and chills) or any abnormality at the surgical site like excessive pain, redness, swelling or any numbness of the limbs. In such instances, the individual should contact the treating doctor.

How long is the recovery after arthroscopic surgery?

The recovery time after arthroscopic surgery depends upon the nature of the injury, the location of the joint as well as the extent of surgery and the general health of the individual. However, being a minimally invasive surgery, the arthroscopy recovery time is generally less as compared to conventional open surgery. For instance, the individual can return home the same day as in most cases the surgery is performed on an outpatient basis. The pain is also less as compared to conventional surgery and can be managed by pain relief medicines prescribed by the doctor. The individual can do the normal routine activities like taking a shower. However, there should be a few instructions that need to be kept in mind i.e. keeping the surgical area dry and limiting the motion of the affected joint for the first few days.

Depending on the arthroscopic procedure, the individual may need a temporary sling, splint or crutches to support and protect the joint. In some individuals, special mechanical pumps or compression bandages are to be used to improve blood flow.

The arthroscopy specialist will suggest suitable physical therapy and rehabilitation to strengthen the muscles & improve the range of motion of the affected joint. This can begin a few days after the surgery and can be customized as per the individual’s needs.

An individual would be able to drive when the pain reduces and when he/she can safely perform an emergency stop. This may not be for a few weeks or several months after surgery depending on the location of the affected joint and the extent of the surgery.

Individuals can go to work or school or start their daily activities within a few days of arthroscopic surgery. However, an individual’s underlying medical conditions, overall general condition and extent of arthroscopic surgery will ultimately determine recovery time.

Can all doctors perform arthroscopic reconstructive surgery?

Arthroscopic reconstructive surgery is a specialized form of orthopedic surgery that is generally performed by an orthopedic surgeon who is trained in arthroscopy procedures. The orthopedic surgeon generally undergoes a fellowship or training and certification in arthroscopic procedures. Apart from the training, the experience of the surgeon in performing specific arthroscopic surgical procedures is of paramount importance as well.

How can one choose a hospital for arthroscopic reconstructive surgery for sports injuries?

Arthroscopic reconstructive surgery for sports injuries is generally done at a tertiary care hospital setup or a specialty orthopedic hospital that have all the facilities as well as resources to perform these surgeries.

The first and foremost requirement is to have a qualified orthopedic surgeon trained in arthroscopic surgeries with sufficient experience to carry out these procedures. Along with that, there should be a multi-disciplinary team of doctors, anesthetists, and physiotherapists for preoperative, operative and postoperative care as well as for rehabilitation.

Apart from these resources, the center should possess modern facilities like a state of the art operation theatre, necessary arthroscopy instruments, diagnostic facilities like MRI, CT, X-Ray, DEXA scans, etc. and physiotherapy unit for rehabilitation.

What factors govern the cost of arthroscopic reconstructive surgeries for sports injuries?

One of the most important factors that can greatly affect the cost of arthroscopic reconstructive surgeries is whether the procedure is performed in an inpatient facility i.e. whether the individual is hospitalized, or as an outpatient surgery. Before, arthroscopic surgeries were only performed in a hospital. Now, arthroscopic reconstructive surgeries are being done in outpatient surgery centers.

Other factors governing the cost of arthroscopic surgery are:

  • Complexity, type, and extent of the injury as well as the muscles and bone joint involved
  • Material and implant costs (if applicable)
  • Post-operative care costs – including the cost of medicines, physical therapy, and rehabilitation costs.
  • Length of hospital stay which is governed by the underlying health of an individual
Conclusion:

Arthroscopic surgery is one of the greatest advances in modern orthopedic surgery. It offers an individual a cost-effective and minimally invasive alternative to conventional open approach surgery. Decreased recovery time, good success rates, as well as a reduced rate of complications, make it a favored option amongst doctors as well as individuals in need of treatment.

References:
  • Mayo Clinic. Arthroscopy. Available at https://www.mayoclinic.org/tests-procedures/arthroscopy/about/pac-20392974. Accessed on 05th March 2019.
  • National Library of Medicine. Minimally Invasive Orthopedic Surgery: Arthroscopy. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3117522/. Accessed on 05th March 2019.
  • Medscape. Ankle Arthroscopy. Available at https://emedicine.medscape.com/article/1356046-overview. Accessed on 05th March 2019.
  • John Hopkins Medicine. Arthroscopy. Available at https://www.hopkinsmedicine.org/healthlibrary/test_procedures/orthopaedic/arthroscopy_92,p07676. Accessed on 05th March 2019.
  • OrthoInfo. Arthroscopy. Available at https://orthoinfo.aaos.org/en/treatment/arthroscopy/. Accessed on 05th March 2019.

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