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Minimally invasive knee surgeries
1. Minimally Invasive Knee Surgeries
Arthroscopy is a minimally invasive technique that is associated with a faster recovery time
compared to traditional surgeries. The orthopedic surgeon can assess and treat many knee
problems using this method.
Meniscectomy
An arthroscopic meniscectomy is a procedure used to remove some or all of a meniscus
from the knee joint. A partial meniscectomy involves removing only a portion of the
meniscus, which may vary from removing a section of the rim or trimming a frayed edge.
Since the meniscus serves an important function, the surgeon attempts to save as much of
it as possible. With a complete meniscectomy, the surgeon removes the meniscal rim. A
meniscectomy is a minimally invasive procedure done on an outpatient basis. The majority
of meniscus surgeries (93%) are partial meniscectomies.
Meniscus Repair
With meniscus repair, the surgeon repairs a torn meniscus. Repair of a lesion is considered
to preserve meniscal tissue in active patients. After receiving anesthesia, the surgeon
makes small incision around the knee joint and inserts an arthroscope. The portions of the
torn meniscus are sutured together. After removing any debris and shaving away bony
prominences, the incisions are closed with sutures. Meniscus repair is less common than
partial meniscectomy because repair is only done if the tear is in a portion of the meniscus
that has adequate blood supply.
Plica Surgery
Plica is the medical term used to describe a fold in the knee joint lining. There are four plica
synovial folds in the knee, and if one is irritated or injured, it can cause pain. When the non-
surgical treatment for plica syndrome is ineffective, arthroscopic excision is an option.
Arthroscopic excision of the plica takes around 20-40 minutes. After receiving general
anesthesia, small incisions are made over the knee. The arthroscope is gently inserted into
the knee, and fluid is injected into the joint. The surgeon them can view the plica on a TV
monitor and remove it using small instruments. Afterwards, the incisions are closed using
sutures.
Patella Tendon Repair
The patella tendon is a strong, fibrous cord of tissue that attaches the muscles in front of
the thigh to bone. This tendon allows the leg to straighten. Any tears of this tendon can
impair mobility. Surgery to repair the tendon will prevent scarring and tightening. After
being given general anesthesia, the surgeon makes small incisions to insert the arthroscope
and small surgical instruments. To reattach the tendon, sutures are placed into the tendon
and then threaded through strategically placed holes in the patella. If needed, the surgeon
attaches the tendon using suture anchors (small metal implants). The surgeon makes these
repairs while viewing the inside of the joint on a computer monitor.
2. ACL Reconstructive Surgery
The anterior cruciate ligament (ACL) of the knee is an important structure. It provides 85%
of the restraining force to tibia shifting and knee flexion, and also provides support and
stability to the knee. With arthroscopic surgery, an ACL tear can be repaired via
reconstruction. The surgeon makes tiny incisions, inserts the arthroscope, and reconstructs
the ligament. Sometimes, a graft is taken from the patient’s hamstrings tendon (or other
body structure) to use in the reconstruction.
Total Knee Replacement
With minimally invasive total knee replacement, the surgeon can make a shorter incision
than with traditional surgery (4-6 inches compared to 8-10). This allows for less tissue
disturbance and improved healing. The quadriceps sparing, midvastus, and subvastus
techniques all allow for smaller incisions in the muscle and are less invasive strategies. This
surgery involves removal of worn cartilage and bone and replacing those structures with
prosthetic components. After changes and reconstruction is done, the incision is closed with
sutures.
Resources
Battaglia MJ, Cordasco FA, Hannafin JA, Rodeo SA, O’Brien SJ, Altchek DW, Cavanaugh J,
Wickiewicz TL, Warren RF: Results of Revision Anterior Cruciate Ligament Surgery. Am J
Sports Med, 35:2057-2066, 2007.
Cordasco FA (2014). Knee Arthroscopy for ACL Reconstruction, Meniscal Repair, and Other
Knee Problems. Retrieved from:
https://www.hss.edu/conditions_knee-arthroscopy-acl-meniscal-other-problems.asp