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A recent article in The New England Journal of Medicine called knee
arthroscopy "needless surgery". This report is, by no means, the whole story,
and; in fact, will keep many patients from getting this helpful procedure. A
candidate for arthroscopic surgery is a patient with acute injury with a
meniscal cartilage tear or a patient with a chronic meniscal tear who has failed
conservative treatment of greater than six weeks. Patients younger than age 50
are treated more aggressively, and patients older than 50 years old are treated
more conservatively. Conservative treatment includes nonsteroidal
anti-inflammatory medication, physical therapy, and cortisone injection. Other
criteria include level of pain, amount of disability, and inability to perform
activities of daily living and sporting endeavors. The patient and physician
together review all these variables and formulate an individualized treatment
plan for recovery. Each patient's treatment plan is modified to relieve their
painful symptoms. The patient must trust the experience and expertise of the
orthopaedic surgeon to see if they are candidates for this arthroscopic surgery.
Knee arthroscopy is a surgical procedure in which a small
camera is placed into the knee. With this camera, the damage
can be recognized. With small instruments and small shavers,
the injured articular and meniscal cartilage can be repaired
or partially removed. Loose bodies can be removed and
inflammation can be excised. There are also new instruments
to help seal frayed and irregular articular cartilage to try
to stop the progression of arthritis.
In eight years of practicing sports medicine in this
orthopaedic practice, I have performed greater than 1200
knee arthroscopies. Over this period of time, only eleven
patients have gone on to total knee replacement. The
majority of patients have marked improvement and are walking
within two days without crutches or a walker. Return to
activities such as golf and tennis vary per individual
patient.
Not everyone is a candidate for arthroscopic surgery. It
there is severe articular cartilage loss and bare bone is
exposed, patients do not do as well arthroscopically. In
these cases, if the patient suffers from severe pain, a
total knee replacement can be performed. Other alternatives,
depending on the severity of pain and limitation of motion,
are anti-inflammatory drugs such as Celebrex, Vioxx, Bextra,
and corticosteroid injections. Physical therapy to increase
muscle strength and tone, weight loss to decrease the stress
on the affected joints and Visco supplementation such as
Synvisc can be beneficial.
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