Minimally Invasive Surgery

Knee Arthroscopy and Knee Arthroscopy Recovery

knee surgeryKnee arthroscopy is surgery that uses a tiny camera (arthroscope) to look inside your knee. Small cuts are made to insert the camera and small surgical tools into your knee for the procedure.

Your surgeon can use arthroscopy to feel, repair or remove damaged tissue. To do this, small surgical instruments are inserted through other incisions around your knee.

Preparation for Knee Arthroscopy:

Usually no significant pre operative testing is needed. Depending on your heath, your orthopaedic surgeon may order pre-operative tests. These may include blood counts, an EKG (electrocardiogram), and even a complete physical examination to assess your health and identify any problems that could interfere with your surgery.

Surgery for Knee Arthroscopy:

During the procedure, the orthopedic surgeon inserts the arthroscope (a small camera instrument about the size of a pencil) into your knee joint through a small incision in the knee. A sterile solution will be used to fill the knee joint and rinse away any cloudy fluid. This helps your surgeon see your knee clearly so that he may diagnose the problem and determine what treatment is needed.

Arthroscopy for the knee is most commonly used for:

  • Removal or repair of torn meniscal or articular cartilage
  • Reconstruction of a torn anterior cruciate ligament (ACL)
  • Removal of loose fragments of bone or cartilage
  • Removal of inflamed synovial tissue

After your procedure has concluded, a doctor will remove the instruments and close the incisions with a stitch.

Recovery from Knee Arthroscopy

Recovery from knee arthroscopy is much faster than traditional open knee surgery. You may have some slight swelling in the knee after surgery. Keep your leg elevated as much as possible for the first few days following surgery and ice your knee following the instructions given by your doctor. You may or may not be placed on crutches. Your surgeon will make that decision and discuss with you. Your surgeon will most likely prescribe physical therapy for 6-12 weeks, as well.

About Dr. John Xerogeanes

John Xerogeanes MD

John W. Xerogeanes, MD, Chief of Sports Medicine at Emory University, is known as Dr. “X” by his staff and patients. He is an Associate Professor of Orthopaedic Surgery at Emory University as well as an Adjunct Professor at Georgia State and Mercer University. Dr. X has been the Head Orthopaedist and Team Physician for Georgia Tech, Emory University, Agnes Scott College and the Atlanta Dream of the WNBA since 2001. He specializes in ACL and ACL revision surgery performing over 200 of these operations each year. He is board certified in orthopaedic surgery and has his sub-specialty certification in orthopaedic sports medicine.

Dr. Xerogeanes has been recognized as one of US News & World Report’s Top Doctors with a special distinction listing him among the top 1% in the nation in his specialty.

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Torn Meniscus and Torn Meniscus Surgery

Torn MeniscusWhen people talk about torn cartilage in the knee, they are usually referring to a torn meniscus. The meniscus is a rubbery, C-shaped disc that cushions your knee and acts as a shock absorber between your thighbone and shinbone. Each knee has two menisci, which help to keep your knee steady by balancing your weight across the knee.

Any person at any time can tear their meniscus, but athletes—particularly those who play contact sports—tend to be at a higher risk, the reason being that a meniscus tear is usually caused by twisting or turning quickly, often with the foot planted while the knee is bent. Players may squat and twist the knee, causing a tear.

As you get older, your meniscus gets worn which can make it tear more easily. Cartilage weakens and wears thin over time, increasing the likelihood of degenerative meniscal tears. One awkward twist when getting up from a chair may be enough to cause a tear, if the menisci have weakened with age.

Torn Meniscus Symptoms
Depending on the severity of the tear, symptoms will vary. Typically meniscal tears are categorized into three groups: minor, moderate and major tears. Generally, most people can still walk on their injured knee after a meniscal tear, but you may feel a “pop” when you tear a meniscus. Often athletes will keep playing with a tear, but over the course of two to three days the knee will likely become stiff and swollen.

Common symptoms of meniscal tears include the following:

  • Feeling a “pop” in the knee
  • Pain
  • Stiffness and swelling
  • Inability to move knee through full range of motion (such as not being able to straighten the knee)
  • Catching or locking of the knee
  • The sensation of the knee feeling “wobbly” or giving way without warning

In severe tears and those without proper treatment, a piece of meniscus may come loose and drift into the joint, causing your knee to slip, pop, or catch.

Torn Meniscus Diagnosis and Treatment
When diagnosing a meniscal tear, doctors will often perform what is known as a McMurray test. Your doctor will bend your knee, then straighten and rotate it. This puts tension on a torn meniscus. If you have a meniscal tear, this movement will cause a clicking sound. Your doctor may also order imaging tests such as an X-ray or MRI to confirm the meniscal tear.

How your doctor treats your meniscus tear depends on several things, such as the type of tear, where it is, and how serious it is. Your age and how active you are may also affect your treatment choices.

Common treatments include:

  • Rest
  • Ice
  • Physical therapy
  • Non-steroidal anti-inflammatory medicines (such as aspirin or ibuprofen)
  • Surgery

Surgical Treatment
Whenever possible, meniscus surgery is done using arthroscopy, rather than through a large cut in the knee. Knee arthroscopy is a commonly performed surgical procedure in which a miniature camera is inserted through a small incision to better view the knee. Your orthopaedic surgeon will then insert miniature surgical instruments through other small incisions to trim or repair the tear.

Depending on the tear, a variety of procedures can be done:

  • Meniscectomy. In this procedure, the damaged meniscal tissue is trimmed away (partial meniscectomy) or, in extreme cases, the entire meniscus will be removed (total meniscectomy). Total meniscectomy procedures are typically avoided because of the likelihood of causing osteoarthritis in the knee.
  • Meniscus repair. Some meniscal tears can be repaired by suturing (stitching) the torn pieces together.

It is preferable to preserve as much of the meniscus as possible. If the meniscus can be repaired successfully, saving the injured meniscus by doing a meniscal repair reduces the occurrence of knee joint degeneration compared with partial or total removal.

Recovery / Rehabilitation
How well the knee will heal depends on how bad the tear is. After surgery, your doctor may put your knee in a cast or brace to keep it from moving, and you may need to be on crutches for a period of time to keep weight off the knee. Your doctor will work with you on a rehabilitation program that helps you regain as much strength and flexibility as possible.

About Dr. Pombo

Mathew Pombo, MDMathew Pombo, MD, is a highly regarded orthopaedic surgeon, speaker, author and researcher who specializes in getting patients with injuries back to an active lifestyle. His professional interests include anatomic single and double bundle ACL reconstruction, rotator cuff tears, shoulder instability, meniscal/cartilage injury and repair, joint preservation in the aging athlete, and minimally invasive joint replacement surgery of the knee and shoulder. Dr. Pombo has conducted extensive scientific research, published multiple journal articles, written several book chapters, and has presented both at national and international meetings on topics related to sports medicine, concussions, and orthopaedic surgery. He is a member of several design teams for orthopaedic companies and enjoys participating in the engineering of the next generation of orthopaedic techniques and equipment. He has been instrumental in bringing awareness to Sports Related Concussions and the new Georgia “Return to Play” Act and is one of the top regarded experts in the area for the treatment of Concussions. He currently serves as the Director of the Emory Sports Concussion Program.

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How is Arthroscopic Hip Surgery Different?

ArthroscopyArthroscopy (also called Arthroscopic surgery) is a surgical procedure by which the internal structure of a joint is examined for diagnosis (and possibly treated) using an instrument called an arthroscope. Arthroscopy gives doctors a clear view of the inside of a joint, and helps them diagnose and treat joint problems. Hip arthroscopy has been slower to evolve than arthroscopy of other joints such as the knee or shoulder, mostly because the hip joint is much deeper in the body and therefore harder to access, but can be very effective at treating certain hip conditions.

Arthroscopic hip surgery is radically different than traditional open surgery, and may be considered before one opts for a full hip replacement surgery. Non-operative measures should always be considered first — rest, behavior modification, physical therapy and anti-inflammatories may work to alleviate reversible disorders. If non-operative measures aren’t effective and you do elect for surgery, a procedure may be done arthroscopically instead of by traditional surgical techniques, as it usually causes less tissue trauma, may result in less pain, and may promote a quicker recovery.

Patient Story: Cynthia & Minimally Invasive Spine Surgery

Did you know spine surgery can now be done with only a small incision? Minimally invasive spine surgery is a relatively new set of techniques that has opened up surgery as an option for people who might otherwise have continued to suffer without surgery.

Patients often have the preconceived notion that spinal surgery will put them in bed and unable to walk for a long period of time. The fact is most spinal surgery does not lead to such a disabled state. And with minimally invasive surgery, patients can get back on their feet, out the hospital, and back to their normal routine faster than they’d ever have thought possible.

Cynthia Burnett is a great example of a patient who’s had minimally invasive spine surgery at Emory with excellent the results. In 2008, 56-year-old Cynthia Burnett woke up one day with excruciating nerve pain down her leg. Over the next two years, she suffered with this pain, despite multiple epidural injections. The pain just would not go away, even with the best non-operative treatment. Cynthia said she felt as if she’d aged 10 years. Her daughter recommended she come to Emory, where Cynthia saw one of our physiatrists, a nonsurgical physician who specializes in diagnosing and treating spine pain. He diagnosed a spinal stenosis (nerve pinch) and a slippage of one of her vertebrae on another. After careful analysis and discussions of options, she was told she’d be a good candidate for surgery. That’s when Cynthia came to me to discuss the surgical option.

At first, Cynthia didn’t want surgery. She said later, “My big concern about having surgery was the invasiveness. I’m healthy. I don’t go to the doctor very much. I haven’t been very sick. I just really didn’t want to choose to go under the knife.”

While not all cases can be treated with minimally invasive techniques, Cynthia was a great candidate for minimally invasive surgery. If this had not been the case, we could have used a traditional surgical technique with good results. But it would have required using, a relatively large incision to visualize the problem areas of the spine, thus a longer recovery time.

VIDEO: Cynthia’s Story of Minimally Invasive Spine Surgery

Instead, with Cynthia, we used highly specialized retractors that are placed through small incisions with X-ray guidance to minimize the soft tissue damage. Through these small incisions, the spinal nerves were decompressed (“unpinched”), and the slipped vertebra was stabilized with a spinal fusion procedure. The factors that enabled me to do this include advanced surgical instruments, advanced imaging systems (three-dimensional computer-guided navigation), and years of surgical experience. These things lead to surgical results that are safer, less invasive, and more reliable than ever before.

Cynthia had the surgery December 16, 2010. Afterward, she said, “It was amazing to me how easy it was to walk around, and my nerve pain was gone immediately.” Cynthia also said, “It’s amazing to think they could do that with the small incision that I have. I wish I had done it years ago. And I’ve already told other people who are in pain, you need to go.”  She was truly thrilled. At Emory, our goal is to get patients back to health as quickly as possible. That’s what minimally invasive surgery is all about.

Have you had minimally invasive spine surgery, or would you like to learn more about minimally invasive spine surgery at Emory? We welcome your questions and feedback in the comments section below.

Dr. Tim Yoon, spine surgeonAbout S. Tim Yoon, MD:
S. Tim Yoon, MD, PhD, specializes in minimally invasive surgery and is assistant professor of orthopedic surgery and chief of Orthopedics at the Veterans Administration Medical Center at Atlanta. He is board certified in orthopedic surgery. Dr. Yoon started practicing at Emory in 2000.

Minimally Invasive Hip Surgery Gets Patients Active Faster – A Patient Story

Thomas Bradbury, MDWhen I first met Mark Putnam, he had chronic pain in his right groin and lower back caused by osteoarthritis of the hip. At 49, Mark felt twice his age. His local orthopedic surgeon was uncomfortable performing surgery because of the extent of the damage to the joint and instead referred Mark to the Emory Orthpaedics & Spine Center.

Mark needed a total hip replacement, and I knew he would be an excellent candidate for anterior total hip arthroplasty, an Emory-pioneered minimally invasive surgery that involved a new approach to the hip joint. Hip arthroplasty traditionally is performed through the posterior, or back, of the hip. This means the surgeon has to remove muscle and ligaments from the bone in order to reach the affected area. Because it takes a while for the tissues to heal after posterior total hip arthroplasty, the range of motion the hip can have for the first couple of months is restricted to prevent dislocation.

Anterior total hip arthroplasty has changed the way we perform hip replacement surgery at Emory. During the procedure, the orthopedic surgeon enters the front of the hip, as opposed to the back, via a single, very short incision to the patient’s leg. Because the surgeon can expose the hip without removing as much muscle and ligament from the bones around the hip joint, the patient retains a better range of motion in the hip and has greater hip stability following surgery.

While anterior total hip arthroplasty takes longer than traditional posterior surgery, the quick recovery time more than makes up for it. After surgery, Mark was pain free for the first time in years.

“It’s been terrific,” he said. “I was out the other day playing catch with my son, and I got down in a catcher’s squat and it didn’t even affect me.”

I encourage you to read up on the details of Mark’s total hip arthroplasty, and watch a video on Mark’s journey. Have you had anterior total hip arthroplasty? We’d like to hear about your experience. Please take a moment to give us feedback in the comments section below.

About Thomas Bradbury, MD

Thomas Bradbury, MD, is an assistant professor of orthopedic surgery. He holds clinic at Emory Orthopaedics & Spine Center at Executive Park and performs surgery at Emory University Orthopaedics & Spine Hospital (EUOSH). Dr. Bradbury’s professional goal is the improvement in quality of life for patients with pain secondary to hip and knee problems. He started practicing at Emory in 2007.