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With improvements of arthroscopes and higher resolution cameras, the procedure has become highly effective for both the accurate diagnosis and proper treatment of knee problems.

Anatomy

The anatomy of the normal knee.

The knee is the largest joint in the body, and one of the most easily injured. It is made up of the lower end of the thigh bone (femur), the upper end of the shin bone (tibia), and the knee cap (patella), which slides in a groove on the end of the femur. Four bands of tissue-the anterior and posterior cruciate ligaments and the medial and lateral collateral ligaments-connect the femur and the tibia and provide joint stability. Strong thigh muscles give the knee strength and mobility.

The surfaces where the femur, tibia, and patella touch are covered with articular cartilage. Articular cartilage is a smooth substance that cushions the bones and enables them to glide freely. Semicircular rings of tough fibrous cartilage tissue, called the lateral and medial menisci, act as shock absorbers and stabilizers.

The articular cartilage cushions the knee joint.

The bones of the knee are surrounded by a thin, smooth tissue capsule lined by a thin synovial membrane. The synovium releases a special fluid that lubricates the knee, reducing friction to nearly zero in a healthy knee.

Knee Problems

Normally, all parts of the knee work together in harmony. Sports, work injuries, arthritis, or weakening of the tissues with age can cause wear and inflammation, resulting in pain and diminished knee function.

Arthroscopy can be used to diagnose and treat many of these problems:

Problems in the knee joint that usually can be seen with an arthroscope.

• Torn meniscal cartilage.
• Loose fragments of bone or cartilage.
• Damaged joint surfaces or softening of the articular cartilage, known as chondromalacia.
• Inflammation of the synovial membrane, such as rheumatoid or gouty (crystalline arthropathy) arthritis.
• Abnormal alignment or instability of the kneecap.
• Torn ligaments, including the anterior and posterior cruciate ligaments.

By providing a clear picture of the knee, arthroscopy can also help the orthopaedic surgeon decide whether other types of reconstructive surgery would be beneficial.

Is Arthroscopy for You?

An injured knee requires imediate attention.

Your family physician can refer you to an orthopaedic surgeon for an evaluation to determine whether you could benefit from arthroscopy.

Signs that you may be a candidate for this procedure include swelling, persistent pain, catching, giving way, and loss of confidence in your knee. When other treatments, such as the regular use of medications, knee supports, and physical therapy, have provided minimal or no improvement, you may benefit from arthroscopy.

Most arthroscopies are performed on patients between 20 and 60 years of age. Patients younger than 10 years of age and older than 80 years of age have benefited from the procedure as well.


















If you feel you may have an injury, please contact us to set an appointment for a knee exam.

Figure 1

The surgical technique associated with an Achilles tendon allograft (Fig 1) is described in this section. The Achilles tendon connects the muscles of your calf to your foot at the heel. Unlike the patellar and hamstring tendons, It is not possible to take the Achilles tendon from you and can only be supplied as an allograft (from donor).

When prepared the Achilles tendon has bone at one end . This is the end that was originally attached to the heel. This bone plug is seen on the left of Figure 1. This differs from the patellar tendon which has bone at both ends and the hamstring tendon which has no attached bone.

The majority of the ACL reconstruction is the same regardless of the tissue used (patellar tendon, hamstring, or Achilles). To see a more detailed ACL reconstruction description see the patellar tendon technique page.

Figure 2

However some small differences between the techniques do exist. When inserted the Achilles allograft should be oriented such that the end of the graft with the bone block is located in the tibial tunnel (Fig 2).

Figure 3

Fixation is accomplished within both the femoral and tibial tunnels with a bioabsorbable cannulated interference screws. Tendon to bone fixation (Fig 3) and bone to bone fixation is accomplished in the femoral and tibial tunnels respectively. Postoperative rehabilitation is the same regardless of the tissue used. ]]> http://akorthospec.com/?feed=rss2&p=160 0 http://akorthospec.com/?p=384 http://akorthospec.com/?p=384#comments Tue, 02 Jun 2009 17:32:25 +0000 admin http://akorthospec.com/?p=384

Figure 1

The posterolateral reconstruction surgical technique mirrors that of the anterolateral reconstruction. The only significant difference is the location of the distal and proximal tunnels. To establish the proximal tunnel, a site just anterior to the lateral collateral ligament is identified. A guide wire is placed in this position. The foot is then internally rotated, thereby exposing the head of the fibula.

Figure 2

To establish the distal tunnel, a guide wire is drilled obliquely through the head of the fibula, angling from posterior proximal to anterior distal, and then exiting through the skin anteriorly. Like the anterolateral reconstruction, isometry is evaluated using a suture.

Figure 3

The final tunnels are drilled and with the knee in approximately 90 degrees of flexion the graft is placed. Direct tendon to bone fixation is accomplished using bioabsorbable interference screws. Under tension, the femoral insertion is fixed first, followed by the fibular insertion. Excessive external foot rotation, as demonstrated by the dial test, should be eliminated.

Figure 1

In order to minimize donor site morbidity a semi-tendinosis or Achilles tendon allograft may be used. However, if allograft tissue is not available, autologous tissue may be substituted.

Figure 2

A lateral incision is made through the subcutaneous tissue from the lateral femoral epicondyle to Gerdy’s tubercle. The fascia lata is divided longitudinally. Gerdy’s tubercle is identified along with the site just posterior to the insertion of the lateral collateral ligament on the femur. Slot-eyed Beath pins are then placed in these positions. Initially, the pins are drilled a short distance into the bone.

Figure 3

Then a suitably strong suture material is then stretched between these two pins. The knee is then put through a full range of motion. Tension changes in the suture so placed should be less than two millimeters. This is a simple but useful approximation of isometry. If the tension in the suture is inadequate or the suture breaks indicating a non-isometric position, the pins are reinserted at a more suitable site until satisfactory isometry is established.

Figure 4

Once this relatively isometric position is established, the femoral pin is drilled through the femoral cortex exiting medially and sufficiently proximal to avoid the femoral tunnel of the previously reconstructed ACL. In order to avoid the tibial tunnel, the tibial pin is advanced distally and medially. Once adequate pin position is achieved a 7 mm cannulated reamer is advanced over the Beath pins and both tunnels are drilled to a depth of 25 mm.

Figure 5

A wire suture is placed at both ends of the graft, which is then advanced into the tunnels with the aid of the slot-eyed Beath pins. With the knee held in 20° of flexion, the graft is tensioned to approximately five kg, and direct tendon to bone fixation is accomplished with 7 mm x 20 mm bioabsorbable interference screws placed over a guide wire. The femoral insertion is fixed first followed by the tibial insertion. Stability is then checked. The pivot-shift phenomenon should be completely eliminated. The wound is then closed with sub-cuticular absorbable sutures.