About Knee Problems
with Donald K. Middleton, M.D
Arthroscopy may not be the most innovative change in modern surgery, but for many patients it has had tremendous impact - often reducing hospital stays from a few days to a few hours, and recovery time by many weeks. Casts on repaired limbs have been replaced with soft dressings and temporary braces.
All of this is possible because of a tiny cameras and surgical instruments that can be maneuvered to the spot of an injury, allowing surgeons to view the surgical site and repair damage without making any large cuts through the skin and, more importantly, the ligaments and muscles.
The first arthroscopic surgeries were done about 30 years ago. "Since then, the equipment has made a lot of advances in terms of optics and the ability to visualize. Then there are people who are very clever and designed some wonderful instruments that allow surgeries to be done just through punctures," said Dr. Donald K. Middleton, an orthopaedic surgeon with Columbia St. Mary's said.
Dr. Middleton, who also does knee and hip replacements, is a sports medicine specialist and as such, often does arthroscopic surgeries for joint injuries and to relieve symptoms of arthritis, particularly in the knee.
Arthroscopic surgery for ACL tears is described in depth in the Medical Moment interview with
Dr. Rosemary Schultz. However, arthroscopic surgery can also be used for other knee problems and adults suffering from worn and torn cartilage due to arthritis may have their symptoms relieved and joint mobility increased through arthroscopic surgery.
The scope of arthroscopic surgery
Dr. Middleton said the uses for arthroscopy are growing. It is often used to repair torn meniscus cartilage or damaged articular cartilage, to reconstruct ligaments or realign kneecaps. "For this type of problem, arthroscopy is extremely effective," Dr. Middleton said.
Recent advances in arthroscopy have enabled surgeons to repair some of the early damage of arthritis on the knee joints, reducing the need for a knee replacement. Dr. Middleton noted that arthroscopic surgery for arthritis is not for everyone, but can be effective for some problems, alleviating pain and the need for a knee replacement, especially in younger people.
Donald K. Middleton, M.D., Orthopaedic Surgeon
Columbia St. Mary's
"There have always been pioneers who push the envelope for arthroscopic surgery. Their work might not seem that impressive to begin with, but their work allows others to fine tune the procedures. In many cases equipment companies design new surgical equipment and before you know it, that surgery is accepted as a standard of care."
|
"As we age, cartilage can wear out and tear more easily. Arthroscopy also has a part in relieving symptoms of arthritis. For example, if someone with arthritis has a problem with the knee locking, arthroscopy can take out loose fragments and loose bodies of torn cartilage," Dr. Middleton said.
In addition, if someone has a localized area where cartilage is gone, surgeons harvest cartilage from another part of the knee and plug it in there. "This technique has been evolving and becoming more embraced by surgeons," Dr. Middleton said.
Arthroscopy can also be used to smooth out damaged cartilage. Surgeons use a mechanical shaver or radio frequency (RF) waves. This is often used as a way of treating early onset arthritis in active adults. "We are seeing more and more of these cases as people remain active beyond high school age. Now they are in young middle age, when knee replacement is not an attractive option," Dr. Middleton said.
Arthroscopic surgery
This type of surgery is usually done in the outpatient surgical center of a hospital, though Dr. Middleton often uses the Orthopaedic Hospital of Wisconsin where state of the art arthroscopic instruments are used. It can be done with local anesthetic but in most cases a general anesthetic is used.
"In order to put the scope in some places in the knee, you have to put the knee into some pretty strange positions. I prefer that a patient is relaxed and asleep. Anesthesiologists are aware that a patient will need to be ready to go home in thirty to forty minutes and they arrange for very little anesthetic so there is little nausea or anesthetic hangover," Dr. Middleton said.
People usually go home with soft dressing or crutches though it depends on what type of surgery is done. If reconstruction of an ACL tear is done, people will tend to have a brace on. But for surgery for cartilage, often it's just a soft dressing.
Post op physical therapy
Prior to surgery, Dr. Middleton's patients have a short session with therapists on how to use crutches properly then are instructed in basic exercises to do on their own. Many people recover from arthroscopic surgery without any need for formal therapy. Dr. Middleton did note that people who are having trouble with balance, or who have higher demands on their repaired limb (from sports or physical occupations) may need some physical therapy to restore strength.
"In my practice, most people are on crutches for four to five days before they decide they'd do better without them," Dr. Middleton said. He added that for most types of surgery, people have a full recovery in four to six weeks, often long before that. An exception is ACL surgery, which may require three to six months for full recovery.
Read more about
ACL surgery with Rosemary Schultz, M.D. - Orthopaedics, Fellowship Trained, Sports Medicine, of Advanced Healthcare.
