LOOKING INTO YOUR KNEE PROBLEM

Think of the work your knees do, day in and day out. It's little wonder that they can fall prey to problems.  You might have a sudden injury, from a twist or blow, or an injury caused by overuse, such as from repeated squatting.  Knee problem can also be a natural part of aging.  Whatever the cause, knee problems are often successfully diagnosed and treated with arthroscopy, a technique that allows our doctors to see clearly inside your knee, with only small incisions.

Our Evaluation
Before treatment, Dr. Kalbac will evaluate your knee to diagnose your problem.  An evaluation may include a medical history, physical exam, and one or more diagnostic tests.   To confirm the diagnosis, arthroscopy is often done.  It's usually an outpatient procedure.  In many cases we can treat the problem at the same time.

Medical History and Physical Exam
Your medical history may include questions about your symptoms and whether they began after an injury occurred.  Your doctor will examine your knee for swelling and any tender areas.  The stability of your knee joint may be evaluated.  How far you knee can move in different directions may also be checked.

The Arthroscopic Procedure
You may have lab tests before admission, and you'll be asked not to eat or drink anything after midnight the day before the procedure.  At the beginning of the procedure, you will receive an anesthetic.  It will make you sleep (general anesthesia), numb you from the waist down (spinal anesthesia), or just numb your knee (local anesthesia).   Then, the surgeon makes a few incisions (portals) in your knee.  Sterile fluid is inserted through one portal to expand your knee joint.  This makes it easier to see and work inside your joint.  After inserting the arthroscope through another portal, your surgeon confirms the type and degree of knee damage.  Whenever possible, your surgeon treats your knee during arthroscopy, by using surgical instruments such as shavers or laser.

Risks and Complications
As with similar procedures and surgeries, arthroscopy carries the risk of bleeding, infection, and stiffness, as will as recurring knee problems.

INSIDE YOUR KNEE

Learning the parts of a healthy knee may help you better understand your knee problem.  Which treatment option is best for you depends on the type and seriousness of your knee problem.

A Healthy Knee Your knee acts like a hinge to connect the upper and lower leg bones (femur and tibia).  Articular cartilage (tough, fibrous tissue) covering the ends of these leg bones and the underside of your kneecap (patella) helps your joint glide with ease.  The Meniscus is a crescent of cartilage that provides cushioning between your leg bones. Ligaments, tendons, and muscles are soft tissues that give your knee stability and strength.

Common Knee Problems

Meniscus Cartilage Tears
A sudden twist or repeated squatting can tear the meniscus.  This may cause your knee to hurt or swell.  Your knee may also catch or lock when you bend.

Ligament Tears
A fall, twist, or direct blow may tear the anterior cruciate ligament.   Tears can cause pain, and swelling as well as instability, which can make your knee give way.

Articular Cartilage Wear
Aging or injury may wear away articular cartilage.  A piece may even break off in the joint (called a loose body).  Damage to cartilage may cause pain, stiffness, or grinding.

Patella Problems
Aging, overuse, or a direct blow may damage the cartilage under your patella, restricting joint movement.  Structural problems, such as an off-center patella, may cause uneven wearing or pain.

Common Treatment Problems

Cartilage Shaving or Removal
The surgeon may use an instrument or laser to remove rough articular cartilage.  If the cartilage has worn away, exposing the bone beneath, your surgeon may burr or drill the bone to try to stimulate cartilage growth.  If a loose body or other debris is present, your surgeon may insert an instrument through a portal to remove it.

Patella Smoothing or Realignment
Your treatment will depend on whether you have a wear-and-tear or a structural problem. To smooth the patella, the surgeon may shave or use a laser to remove bands of cartilage under your patella.  If your patella is off center, the doctor may clip, or release, bands of tissue (called a lateral release) to realign you patella.

AFTER ARTHROSCOPY

You'll spend a brief time in recovery following arthroscopy.  Once you're home, take it easy.  Since arthroscopy needs only small incisions, you can expect less scarring and pain and often a quicker recovery than open surgery.

In the recovery room
After arthroscopy, expect to have your knee bandaged and elevated.  An ice pack is put on to help reduce pain and swilling.  Pain medication may be given either orally or through an IV (intravenous) line.  A nurse will monitor your temperature, blood pressure, and heartbeat.  When you're awake and alert, the nurse will help you get ready to go home.

Going Home
You may be able to go home two or three hours after arthroscopy.  Because the anesthetic and pain medication may make you sleepy, you'll need to arrange ahead of time to have someone drive you home.  Before leaving, make sure you have any prescriptions or home care instructions you'll need until your first follow-up visit with us.

Your Home Recovery
At home, elevate your knee, exercise, and follow the doctors instructions.   To check your progress, you may need to come in one or two times during the first few weeks after arthroscopy.  Call us if you have bleeding, pain uncontrolled by pain medication, fever, numbness, or shortness of breath.

Relieving your Pain
Don't dangle your leg for ling periods.  Elevate your knee above the heart level to reduce swelling and pain.  Ice and rest can also help.  During the first two days after the procedure, ice your knee for 20 to 30 minutes a few times a day.   Straighten your knee several times a day while you heal.

Showering
Wait to take your first shower until you are able to stand comfortably for 10 to 15 minutes.  Cover your leg with plastic to avoid getting your bandage and incisions wet, which increases your chance of infection.

MOVING TOWARD RECOVERY

Dr Kalbac's arthroscopic skills, combined with your dedication to recovery, can help you get up and moving soon.  Physical therapy may make your recovery go even more smoothly.  After knee arthroscopy, many people are able to return to desk jobs within a week and to more strenuous activities within a month.