Arthroscopy: Most Common Procedures and Meniscal Tear Treatment

What is the most common arthroscopic procedure?

The most common arthroscopic procedure globally is arthroscopic knee surgery, specifically for meniscal tears, often involving a partial meniscectomy.

Introduction to Arthroscopy

Arthroscopy is a minimally invasive surgical procedure that orthopedic surgeons use to visualize, diagnose, and treat problems inside a joint. The term "arthroscopy" comes from two Greek words: "arthro" (joint) and "skopein" (to look). During the procedure, a small incision (about the size of a buttonhole) is made, and a pencil-sized instrument called an arthroscope – containing a camera and light source – is inserted into the joint. Images from the camera are projected onto a monitor, allowing the surgeon to see the joint's internal structures in detail without making a large incision. This technique offers significant advantages, including smaller scars, reduced pain, faster recovery times, and lower infection rates compared to traditional open surgery.

The Most Common Procedure: Knee Arthroscopy for Meniscal Tears

While arthroscopy can be performed on various joints, including the shoulder, hip, ankle, wrist, and elbow, the knee joint is by far the most frequent site for arthroscopic intervention. Within knee arthroscopy, the most prevalent procedure is the treatment of meniscal tears, often through a procedure known as a partial meniscectomy or, less commonly, a meniscal repair.

Understanding Meniscal Tears

The menisci (plural of meniscus) are two C-shaped pieces of tough, rubbery fibrocartilage located within the knee joint, positioned between the femur (thigh bone) and the tibia (shin bone). Each knee has a medial meniscus (on the inner side) and a lateral meniscus (on the outer side).

Their critical functions include:

• Shock Absorption: Distributing forces across the knee joint during movement and impact.
• Joint Stability: Deepening the articular surface to improve the congruence between the femur and tibia.
• Lubrication and Nutrition: Assisting in the distribution of synovial fluid.

Meniscal tears can occur due to:

• Acute Trauma: Often seen in athletes or active individuals, resulting from sudden twisting movements, deep squats, or direct impact while the foot is planted. Sports like soccer, basketball, skiing, and football are common culprits.
• Degenerative Changes: More common in older adults, where the meniscus weakens and thins over time, making it susceptible to tearing with minimal or no trauma (e.g., simply standing up from a chair or twisting slightly). This is often associated with age-related osteoarthritis.

Symptoms typically include pain, swelling, stiffness, a popping or clicking sensation, and sometimes mechanical symptoms like locking (inability to fully straighten the knee) or giving way.

Why is Meniscus Surgery So Common?

Several factors contribute to the high prevalence of arthroscopic meniscectomy:

• Vulnerability of the Meniscus: The menisci are frequently subjected to high biomechanical stresses during daily activities, sports, and occupational tasks, making them prone to injury.
• Ageing Population: As people live longer and remain active, the incidence of degenerative meniscal tears increases significantly.
• Sports Participation: The growing popularity of sports and recreational activities across all age groups leads to a higher rate of acute meniscal injuries.
• Minimally Invasive Nature: Arthroscopy's less invasive nature makes it a preferred option for both patients and surgeons, often leading to quicker recovery and less post-operative discomfort compared to open surgery.
• Diagnostic and Therapeutic Utility: Arthroscopy serves both as a diagnostic tool (to confirm the tear and assess its type/location) and a therapeutic intervention (to treat the tear).

The Arthroscopic Meniscectomy Procedure

Once a meniscal tear is diagnosed (typically via physical examination and MRI), and conservative treatments (rest, ice, physical therapy) have failed to provide relief, surgery may be recommended.

During an arthroscopic meniscectomy:

1. Anesthesia: The patient receives regional (e.g., spinal) or general anesthesia.
2. Incisions: Two to three small incisions (portal sites) are made around the knee.
3. Arthroscope Insertion: The arthroscope is inserted through one incision, allowing the surgeon to visualize the knee joint on a monitor.
4. Fluid Irrigation: Sterile saline solution is pumped into the joint to expand it and provide a clear view.
5. Instrument Insertion: Small surgical instruments are inserted through the other incisions.
6. Tear Treatment:
   • Partial Meniscectomy: The most common approach. The surgeon carefully removes only the damaged or torn portion of the meniscus, leaving as much healthy tissue as possible. This is often done for tears in the avascular (poor blood supply) zone, which have limited healing potential.
   • Meniscal Repair: If the tear is in the vascular (good blood supply) zone and is suitable for repair, the surgeon may use sutures or specialized fixation devices to sew the torn edges back together. This is less common than meniscectomy but aims to preserve the entire meniscus, which is beneficial for long-term knee health.
7. Closure: Once the procedure is complete, the instruments are removed, and the small incisions are closed with stitches or sterile strips.

Recovery and Rehabilitation

Recovery from arthroscopic meniscectomy is generally faster than from open knee surgery. Patients typically go home the same day.

• Immediate Post-Op: Pain management, RICE (Rest, Ice, Compression, Elevation) protocol, and early mobilization are crucial.
• Physical Therapy: A structured physical therapy program is essential for restoring knee strength, flexibility, and function. This typically involves:
  • Early Phase: Reducing swelling, restoring range of motion, gentle strengthening exercises.
  • Intermediate Phase: Progressive strengthening, balance training, proprioceptive exercises.
  • Advanced Phase: Sport-specific drills (if applicable), return to activity protocols.
• Return to Activity: Full recovery and return to normal activities or sports can range from a few weeks to several months, depending on the extent of the tear, the type of procedure (repair takes longer than partial meniscectomy), and individual adherence to rehabilitation.

When is Arthroscopy Indicated?

Beyond meniscal tears, knee arthroscopy is also commonly used to address:

• Ligament Reconstruction: Such as anterior cruciate ligament (ACL) reconstruction.
• Cartilage Defects: Repairing or debriding damaged articular cartilage.
• Removal of Loose Bodies: Fragments of bone or cartilage that can cause pain or locking.
• Synovitis: Inflammation of the joint lining.
• Patellar (Kneecap) Problems: Addressing issues like patellar maltracking.

Conclusion

The high incidence of knee injuries, particularly meniscal tears, combined with the significant advantages of minimally invasive arthroscopic techniques, solidifies arthroscopic knee surgery as the most common arthroscopic procedure performed worldwide. Understanding the biomechanics of the knee, the nature of meniscal injuries, and the rationale behind surgical intervention is critical for both patients and fitness professionals in guiding appropriate recovery and long-term joint health strategies.