Common problems either treated or assisted by arthroscopy in knee joint
In young people, most of the problems are mechanical or traumatic while in old age population it is degenerative i.e. osteoarthritis
There are two menisci in the knee; medial (inner) and lateral (outer). These are cartilaginous “C” shaped structures which separate the femoral from the tibial surfaces.
These can get torn as a result of twisting injury to the knee. Symptomatic meniscal tears are treated with arthroscopy with either a repair (in certain selected cases) or a partial meniscectomy.
ACL (Anterior Cruciate Ligament) Injury
ACL is one of the key ligaments situated in the center of the knee. It helps in providing rotational stability to the knee.
A twisting injury, where the foot remains stuck on the ground and the rest of the body twists, causing a rotational stress at the knee is the commonest mechanism of injury.
The commonest complaint is that of instability or insecurity of the knee while performing any activity which involves some amount of rotational force. E.g. cutting and running, dancing and so on.
In symptomatic young patients, an arthroscopic ACL reconstruction helps to restore stability to the knee allowing patients to resume an active lifestyle. The hamstring tendons (semitendinosus) or the patellar tendon are the two commonest grafts used.
Recently there has been a trend to advocate an anatomical or a double bundle ACL reconstruction. This technique restores the dual bundle pattern (anteromedial & posterolateral) of the ACL and is thought to provide better rotational stability.
PCL (Posterior Cruciate Ligament) Injury
PCL is a short and strong ligament situated within the knee connecting the femur to the tibia.
Along with the posterior and lateral capsule, it is a key structure in providing anteroposterior stability to the knee.
The commonest mechanism of injury is the hyperextension of the knee or a direct impact on the front of the tibia with the knee in the flexed position (Dashboard injury).
Apart from instability, the patient might complain of anterior knee pain due to a chronic overload of the patellofemoral joint.
In symptomatic cases, an arthroscopic PCL reconstruction with or without posterior capsule or corner repair is recommended.
Synovium is the membrane lining the inside of the knee. In certain conditions (rheumatoid arthritis, infections eg.TB) this synovium swells up and the condition is known as Synovitis.
Synovitis over a prolonged period of time can cause damage to the cartilage of the knee joint and precipitate secondary arthritis.
When the medical management cannot adequately cure or control the synovitis, an arthroscopic synovectomy helps to physically get rid of the inflamed synovium.
Due to some intraarticular pathology or trauma piece of cartilage along with bone get detached from parent bone to form a loose body. This may lead restriction to joint movement causing severe pain and instability. the patient may get multiple such episodes of locking.
In this case, it is mandatory to remove the loose body to prevent damaging of joint cartilage.
OATS, artificial cartilage biopsy, and transfer are amenable to arthroscopy
Intraarticular fracture fixation
ACL and PCL bony avulsion injuries are treated with the help of arthroscopy.
Upper-end tibia fracture, joint alignment can be reestablished with the help of arthroscopy
Either due to traumatic or certain congenital dislocation of the patella, it may not track properly in the patella grove while bending knee joint. Which gives rise to tilting of patella resulting in a restriction in the movement, persistent pain, patellofemoral arthritis. To prevent all problems related to mal-tracking arthroscopic or open realignment procedures can be done successfully.