Arthroscopic treatment is a minimally invasive technique that combines diagnosis and therapy, primarily involving the use of an endoscope to explore the internal structures of the joint and perform necessary surgical repairs. This technique is suitable for joint diseases of the knee, shoulder, ankle, and other joints, allowing precise diagnosis of tissue injuries and simultaneous treatment, significantly reducing the trauma associated with traditional open surgery. Its core advantages include a clear visual field, shorter recovery time, and preservation of joint function, making it an important development in modern orthopedics.
Arthroscopic treatment is divided into two main categories: "Diagnostic Arthroscopy" and "Therapeutic Arthroscopy." Diagnostic arthroscopy uses a 3-5mm diameter endoscope inserted through small incisions into the joint cavity, transmitting high-resolution images to a monitor, allowing the physician to directly observe abnormalities in cartilage, ligaments, and other structures. Therapeutic arthroscopy, based on diagnosis, employs micro-instruments to repair meniscal tears, remove bone spurs, or repair ligaments, performing delicate operations with specialized tools.
The mechanism involves expanding the visual field and utilizing precise instruments to avoid the disadvantages of traditional surgery, which requires cutting through muscles and ligaments. High-brightness light sources and magnifying lenses can enlarge tissue structures more than tenfold, enabling accurate localization of lesions. During surgery, radiofrequency ablation heads or special suturing techniques may be used to repair tissues with minimal trauma.
Main indications include:
Special cases such as removal of intra-articular foreign bodies, arthroscopic-assisted patellar cartilage repair, or synovectomy for early rheumatoid arthritis are within the scope. Physicians will evaluate the suitability for minimally invasive treatment based on imaging results (such as MRI).
The procedure is usually performed under local or general anesthesia, with the patient lying supine or on their side on the operating table. The surgeon makes 2-4 small incisions (0.5-1cm) around the joint, injects sterile saline to expand the joint cavity, and inserts the endoscope. Therapeutic procedures involve passing instruments through channels to suture, excise, or repair tissues, with surgery duration ranging from 30 minutes to 2 hours depending on complexity.
Dosage control mainly pertains to the scope of tissue repair and the intensity of instrument use. For example, meniscal suturing requires precise placement of sutures, and radiofrequency ablation for bone spurs requires controlling energy output parameters. Postoperative care includes ice packs, immobilization with braces, and rehabilitation, with recovery typically taking 2 weeks to several months.
Main advantages include:
Clinical data shows that the re-tear rate of meniscal tears treated with knee arthroscopy is less than 5%, compared to up to 15% with traditional open surgery. The risk of joint stiffness post-arthroscopy is also reduced by 40%. This technique is regarded as the standard treatment in modern orthopedics.
Potential complications include:
Serious complications such as deep joint infection require immediate antibiotic treatment, and severe cases may necessitate removal of internal fixation devices. A few patients may experience joint stiffness after arthroscopy, requiring active rehabilitation to restore mobility. If persistent fever or severe joint pain occurs postoperatively, medical attention should be sought immediately.
Contraindications include:
Preoperative cessation of anticoagulants (such as aspirin) for 7-10 days is necessary, and diabetic patients should control blood sugar levels. The affected limb should be elevated within 24 hours post-surgery, and overexertion should be avoided. Performing surgery on contraindicated patients may lead to massive bleeding or spread of infection, so strict assessment is essential.
Interactions mainly involve anticoagulant management, requiring coordination with a hematologist to time medication cessation. Combining with physical therapy: postoperative rehabilitation is necessary, but weight-bearing should be avoided too early. Compared to traditional open surgery, it is less invasive, but complex cases may require conversion to open procedures.
In some cases, combining joint lavage or hyaluronic acid injections, such as in the treatment of degenerative arthritis, is beneficial. Physicians will decide whether to combine arthroscopy with biological therapies (such as PRP injections) based on the severity of the lesions to promote healing.
Clinical studies show that the one-year success rate of knee arthroscopic meniscal repair reaches 85-90%, with joint function recovery at 6 weeks surpassing conservative treatments. For ACL repairs, the re-tear rate with arthroscopic techniques is 20-30% lower than traditional surgery.
A 2020 systematic review indicated that arthroscopic treatment of degenerative arthritis combined with meniscal injury achieves a pain relief rate of 70%, with postoperative complication rates below 2%. This technique is recommended as the preferred treatment for ligament injuries and meniscal problems in many international orthopedic guidelines.
Conservative treatments include intra-articular corticosteroid injections, physical therapy, and anti-inflammatory medications, suitable for minor injuries or elderly patients. Traditional open surgery remains necessary for complex ligament reconstructions or large cartilage defects. Biological therapies such as autologous stem cell injections are still experimental and have not replaced arthroscopy as the main approach.
If patients cannot undergo surgery due to age or overall health, options include brace fixation and hydrotherapy rehabilitation. However, for complex ligament tears or loose body obstructions, alternative methods are less effective and carry higher risks, requiring careful risk-benefit assessment.
Preoperative assessments include blood tests and imaging examinations (such as X-ray or MRI) to evaluate joint conditions. The surgeon will explain the procedure in detail and require the patient to stop medications affecting blood clotting (such as aspirin). Additionally, a postoperative rehabilitation plan should be arranged, and someone should accompany the patient home.
How to manage postoperative pain and swelling?Postoperative pain can be managed with prescribed analgesics, and ice packs can be used to reduce swelling. Elevating the affected limb and avoiding excessive joint activity are recommended. If pain worsens or fever develops, medical attention should be sought immediately to rule out complications such as infection.
When can daily activities be resumed after surgery?Mild activities like walking can typically be gradually resumed after 1-2 weeks, but high-impact activities (such as running or lifting heavy objects) should be avoided. Full recovery time varies depending on the extent of the surgery; knee procedures may take 4-6 weeks, and physical therapy should follow the guidance of a physiotherapist.
What are the differences between arthroscopy and traditional open surgery?Arthroscopy is minimally invasive, requiring only 2-3 small incisions, with less bleeding and tissue damage, and a shorter recovery period. Traditional open surgery involves larger wounds and longer recovery, but may still be necessary for complex cases. The choice depends on the lesion location and severity.
What dietary or lifestyle habits should be observed during rehabilitation?Increasing intake of high-quality proteins can promote tissue repair, while reducing high-fat foods can prevent delayed healing. Short-term smoking cessation improves blood circulation, and avoiding alcohol reduces infection risk. During rehabilitation, maintaining joint mobility and avoiding prolonged bed rest are important to prevent joint stiffness.
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