Arthroscopic Surgery: A Look at How It Works
Arthroscopic surgery is one of the most important advances in treating sports injuries. It’s also one of the most interesting surgical procedures. Here’s how it’s done. In the first place, even though arthroscopy requires incisions no more than a quarter of an inch long, it is surgery – some sort of anesthesia is required. Most arthroscopic procedures are done with the patient under general anesthesia – that is, entirely asleep.
But sometimes what are called “anesthetic blocks” are used. These include injecting anesthetics into the spine, thereby blocking pain to the area being worked on, or utilizing local anesthesia. Much as a dentist injects Novocaine to numb your mouth, the surgeon numbs only that part of the body that’s undergoing operation.
The surgeon then makes the tiny incision and fills the joint (in about 75 percent of cases it’s the knee) with fluid – usually a clear saline solution. The fluid expands the joint, allowing the structures inside to be visible to the arthroscope. Were it not for the fluid it would be difficult to see clearly or maneuver instruments inside.
The arthroscope itself is a tiny telescope slightly smaller in diameter than a wooden pencil. Around the lens of the telescope is a bundle of fiberoptic fibers that, like a miniature headlight, transmit light into the joint. No matter where you point the arthroscope, light illuminates the area.
Usually the telescope is attached to a miniature color television camera about the size of a pack of cigarets. So whatever the lens “sees” is reproduced on a TV screen next to the operating table. The image is magnified; it can be startling to see the inside of a knee, for example, in living color on a large TV screen.
The TV camera not only allows the surgeon to precisely see the joint, but it also affords the possibility of making a videotape of part or all of the operation. The surgeon then has an accurate record of the status of the joint. If, down the line, a patient may experience more trouble, the videotape is a reference for decisions on treatment or rehabilitation.
The surgeon may then make one or two other incisions, depending on the work needed. It’s through these incisions that you insert the tiny instruments used to snip away or otherwise remove torn or diseased joint structures.
When the operation is over, all that is needed to close the incisions is tape or single small stitches. Then the joint is placed in a pressure bandage to help decrease swelling following the surgery.
One of the advantages of arthroscopy is that patients are often able to get back on their feet shortly after surgery, thus allowing them to quickly build up their muscle strength and avoid the wasting away of muscle tone associated with being confined to bed. For knee or ankle operations, it may be necessary to use crutches for a few days.
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