Arthroscopic Knee Surgery
Except for TKR, almost all other knee surgery involves the arthroscope for at least some part of the procedure. Arthro refers to joints, and the scope is just a stick about the size of a pencil that contains a fiber-optic light. We attach a camera to one end, allowing the image of the inside of your knee to be projected on a TV screen. When the scope is used, salt water(saline solution) is pumped into your knee to allow the surgeon to move the camera safely and see the various knee structures.
Through another portal or "keyhole" poked in the knee, instruments are inserted that remove any damaged cartilage, put in stitches, drill holes, and so forth. Your surgeon will describe what was done at your first post-op appointment with the help of models and photographs.
The process of pumping up the knee with saline, all by itself, causes the knee to be upset. Because of this trauma, even a high-level athlete will be out for a few weeks after arthroscopic surgery, even if only minor damage was found in the knee.
Doctors describe anterior cruciate ligament surgery as being "arthroscopically aided" since after the small arthroscopic portals are established, longer incisions are also made to drill bone tunnels that will contain the new graft. This extra work makes ACL surgery more traumatic to your knee and thus lengthens the recovery period, making a proper rehab program even more important.
Do I Really Need Surgery?
People often assume that if their knee is swollen and painful, they need surgery to get it fixed. This is simply notthe case. As I mentioned earlier, there are many knee injuries--including torn knee cartilage, mild arthritis, and some ligament sprains--that often calm down on their own with the appropriate nonsurgical treatments. As a result, orthopedic surgeons do not sharpen their knives the minute someone enters the office. They might order X-rays to make sure there is no bone damage. Occasionally a magnetic resonance image (MRI) is obtained so the doctor can take a look at the soft tissues (ligaments, tendons, and cartilage) that cannot be seen on an X-ray. After most knee injuries, doctors discuss ways to make the knee feel better (described in the following chapters), recommend home exercises or formal physical therapy, and schedule a follow-up exam. The doctor might also recommend an anti-inflammatory like Advil or Aleve. These medicines help decrease swelling and pain. (For a more detailed discussion of this topic, see Chapter 6.)
As long as you can fully straighten (extend) and fully bend (flex) your knee, you can let it "declare itself." In other words, if it seems to be getting better, you can hold off on any operation. There are lots of folks out there with torn or damaged cartilage who are doing just fine. Again, it is the rare person over forty who does not have some cartilage damage. MRI reports are not a reason to have knee surgery. A painful knee with a repairable problem is.
This might be a good time to mention another unhappy aspect of injuring your knee: It usually costs money. Luckily, with most insurance schemes, once you meet your deductible (and you will almost always meet your deductible with any significant problem) insurance will cover 80 percent or more of your expenses. This includes X-rays, MRIs, physical therapy, braces, and so on. Some insurances will also help with the cost of health clubs, personal training, exercise equipment, massage therapy, shoe inserts, etc., with a prescription from your doctor. Get familiar with what paperwork you need, whether from your primary care doctor ororthopedic doctor. A little research and a couple of phone calls up front could save you significant grief later.
[Just as you should not have surgery until your knee is ready, you should not have surgery until your mind is ready. No matter what part of your knee is damaged, doctors still call knee surgery "elective," that is, it can usually be done when it fits into your life. I routinely schedule surgery months in advance to correspond to the end of summer, school vacation, or even just to be ready for ski season. The important thing is to come to the operating room firing on all cylinders, physically and mentally. If you're worried about work or your kid's soccer game, you won't give your knee the attention it deserves. Schedule your surgery when you can dedicate the time and energy it needs to get better. This usually means completely clearing your calendar for at least one week for a knee arthroscopy, three weeks for an anterior cruciate ligament reconstruction, and two months for a total knee replacement.]
As I mentioned, when it comes to your body there is no such thing as "minor" surgery. Furthermore, there is no such thing as minor surgery if it involves a trip to the hospital and an anesthetic. These are significant stressors on your mind and body, and you want to--and need to--prepare for them. There are certain details of your surgery that are beyond the scope of this book, but that doesn't mean that you should not understand the planned procedure. The more you know, the easier it will be for you and the medical staff. Ask questions! Injuring your knee, having surgery, dealing with hospitals, and living with a scar (and possibly metal parts) forthe rest of your life are not things we look forward to. They are, however, better than the alternative, which is to give in to your disability and end up on the sidelines watching other people being active and having fun. I cannot stress enough how important it is that you take an active role in your surgery and rehabilitation. The road you are taking is one you must endure for your own sake, but it's not one you have to travel alone. Every page in this book is designed to help you get better faster and with less pain. Take this "portable knee doctor" along as your guide.