Knee Arthroscopy

1. Knee Arthroscopy University Orthopaedics & Sports Medicine Presentation designed for patient education Updated 2/11

2. University Orthopaedics & Sports Medicine Offices • Clifton (Medical Arts Building) • Westchester • www.ucortho.com • 513-475-8690

3. University Orthopaedics & Sports Medicine Surgery • Holmes Hospital (Clifton) • Outpatient Surgery Center • Mercy Fairfield • Main • Outpatient Surgery Center • Westchester Medical Center • University Pointe Ambulatory Surgical Hospital (ASH) • University Hospital

4. What is Knee Arthroscopy? • Simply looking around the joint with a camera • A complete inventory of the knee can be performed • Many pathologic conditions can be addressed.

5. Indications (Reasons) for Knee Arthroscopy • Meniscus Tears • Articular cartilage injuries • Ligament repairs and reconstruction (i.e. ACL reconstrucion) • Removal of loose or foreign bodies • Lysis of adhesions (cutting scar tissue to improve motion) • Debridement • Irrigating out infection • Lateral Release (cutting tissue to improve patella pain) • Fixation of fractures or osteochondral defects (bone/cartilage defects) • Diagnostic ↑ Meniscus Tear Debrided and Repaired Meniscus Tear

6. Arthroscopic Instruments • Camera • Probe • Shaver- “shaves and debrides” loose or torn tissue • Baskets- “nibble away” damaged tissue • Scissors • Cautery-coagualates small bleeding vessels

7. How is surgery done? • The surgery begins with an examination of your knee while you are asleep • This allows for testing of your knee ligaments to make sure they are stable without the resistance of your muscles • “Examination Under Anesthesia”

8. Arthroscopic Examination • A camera is inserted into your knee thru a tiny poke hole in the front of your knee called a portal • The doctor moves the camera around your joint while looking at a monitor • A complete inventory of your knee will be performed looking at all the structures inside your joint • A second portal is created for the insertion of working instruments • Usually only two portals are necessary, but occasionally additional portals are needed to get the job done effectively

9. Normal Arthroscopic Anatomy Knee Cap ↓ Thigh Bone ↓ Meniscus ↓ ↑ ↑ ↑ Thigh Bone Shin Bone Anterior Cruciate Ligament (ACL)

10. Addressing Pathology • Instruments can be used to inspect the knee structures • Other instruments can be used to debride or repair structures Probe used to evaluate torn meniscus Shaver used to debride a bone tunnel for ACL reconstruction

11. Pathologic conditions Meniscus Tear and Arthritis ↑ ↑ ↑ Loose Bodies ↑ ↑ Torn ACL Scar tissue and adhesions

12. Various Pathology • An infinite number of problems can be treated with arthroscopy and we are continually expanding the array of diseases that can be effectively treated with the camera Tibial spine fracture with pulled off ACL Arthroscopically assisted fracture repair and restoration of ACL anatomy

13. Post Operative Rehabilitation • Usually you can go home the same day • Ice and elevate your leg as much as possible for the first 72 hours • You may or may not have a brace depending on what surgery was done • Your doctor will tell you how much weight you can put on your leg

14. Post Operative Rehab • You can usually take your dressings down on the third post op day and shower • Do not scrub or submerge your wound • No soaking, swimming or hot tubs • Do not apply any ointments to your wound—this includes polysporin or other antibiotic ointments • Other than bathing keep your wound clean and dry • After your shower you can leave your leg open to air if nothing is draining • If your knee is draining then apply a clean dry dressing and notify your doctor • You will be given pain medications and a pill for nausea • Please take an Aspirin 325 mg per day until your follow up appointment

15. Post op • You will usually see your doctor 5-7 days post op • At that point you will get into physical therapy • You will work on range of motion • The thigh muscle (quadriceps) goes to sleep after many knee injuries and after surgery. Thus, much of your rehab will be aimed at quadriceps strengthening exercises

16. Physical Therapy • The amount of physical therapy that you will need depends on what was done in surgery • The rehab is quite different for different arthroscopic knee surgeries • Please make sure you understand the expected rehab goals • Physical therapy is very important in optimizing your outcome • It is critical to do exercises at home on your own as well • Your therapist will give you a home exercise program that should be done every day

17. Return To Work or Sport • Desk job—3-5 days • Prolonged standing or heavy lifting—usually about a month • This is highly variable depending on surgery and rehab and most importantly what kind of work you do or what sport you play • This is also very much dependant on your rehab progress • It is best to anticipate the expected length of recovery before surgery • Sometimes the recovery is shorter or longer than expected but often can be estimated before surgery

18. When Can I Drive? • Must be off all narcotics • Should be able to hold a straight leg raise for 10 seconds • Ask you doctor before you drive? • Practice in a parking lot first

19. Conclusions • Knee arthroscopy is a very useful tool of the orthopaedic surgeon • We are constantly getting better and better to expand the types of procedures that can be done • The recovery is variable, but you should be able to get a ballpark estimate based on the anticipated procedure • Your doctor or therapist can be a useful resource for any and all questions. Do not hesitate to ask questions at your appointment or call the office when questions arise • 513-475-8690

20. Thank You