Surgical procedure allowing the exploration of the joint using a tube a few millimeters in diameter, introduced into the knee through several orifices (2 to 4) minimal (approximately 1 cm). This tube, equipped with optics coupled to a miniaturized video camera, is connected to a color television screen on which the main elements of the knee will be viewed:
The cartilages of the femur, tibia and patella.
The cruciate ligaments (anterior and posterior).
The menisci (internal and external).
The arthroscopy of the knee is a minimally invasive technique (2 to 3 punctiform incisions), which facilitates functional recovery. Throughout the operation (carried out in the operating room under general or loco-regional anesthesia), the knee is inflated with liquid (physiological serum).
Arrival the day before or the same morning, report to the nurse any recent fever, even trivial, or any local problem, potential source of infection (wound, pimple, scab...), this risks canceling the intervention.
Generally, premedication is prescribed (light sedative but mostly relaxing).
Anesthesia (local, loco-regional or total depending on the case).
Introduction of the instruments then exploration of the articulation under video control.
Surgical gestures adapted to the case to be treated.
Photo recordings of gestures performed (medico-legal value).
Skin closure (absorbable sutures or plastic dressings).
Constraint or not by splint.
Transfer to recovery room.
Discharged the same day or the next day if diagnostic arthroscopy, generally 3/4 days later if therapeutic procedure (reconstruction of a particular ligament).
Delivery of the operating report with photos of the procedures performed.
What are the results to expect?
This type of intervention should improve the symptoms presented (pain, cracking, instability, stiffness). However, this improvement varies according to the pathology in question. Thus, the only ablation of a foreign body makes it possible to hope for rapid consequences (a few days) whereas for the reconstruction of a cruciate ligament.
The final benefit should not be evaluated for several months. The advantage of arthroscopic treatment (without conventional extensive surgical approach) is the rapid resumption of normal daily life. For patients immobilized after the intervention (necessity due to waiting for healing of a repaired lesion), the recovery of autonomy is longer.
What are the complications?
Like any intervention, an anesthetic accident is possible. It is currently extremely rare. Surgical complications are varied but rare and most often benign:
Regressive knee swelling within a few days (arthroscopic vision is only possible in the presence of water, which gradually diffuses into adjacent tissues during the procedure).
Persistent flow of fluid from puncture sites (for the same reasons).
Sometimes, this post-operative swelling persists longer and often reflects too much activity. He must consult if he does not regress and especially if he is accompanied by persistent fever and pain.
Injury to a vein, artery or stretched nerve (exceptional) .
Superficial or deep infection (always feared and most often requiring a second intervention and antibiotic treatment.
One of the feared and less rare complications is the occurrence of phlebitis, which can be the source of a pulmonary embolism. It can occur in anyone who has undergone lower limb surgery, despite systematic prevention by heparin by subcutaneous injection.
Finally, in difficult cases, the impossibility for the surgeon to achieve his goals can (rarely) make required a "conversion", i.e. an "open-air" surgery.
Knee arthroscopy, a mainly therapeutic procedure today, has become a routine technique for many surgeons. These indications are now well established and no longer evolve much, only the material used changes regularly. It makes it possible to carry out highly technical procedures (ligament reconstruction in particular).
This is a minimally invasive approach to the knee, requiring regular practice (the same immediate operative result should be achieved as using conventional surgical techniques). These benefits are indisputable. For some treatments, it has become the reference technique.