A diagram of the knee.
Laparoscopic knee surgery is a minimally invasive surgical procedure that uses thin tubes called trocars, which are inserted into the knee joint through a small incision. Tucked into the tube are a miniature camera, a light source, and various surgical instruments. With the aid of a magnified video monitor, a surgeon can manipulate these tools to repair injured knees, essentially by virtual remote control. The technique has been dubbed “keyhole surgery”.
A scalpel is a small, sharp knife used in surgery to make incisions.
Surgeons by training have always had a mental picture of the inside of a body and what needed to be done surgically safely to help a patient. The main risk to a patient came from the traumas of open surgery – anesthesia, body cavity exposure and recovery. In 1902, a surgical device to see the inside of a dog was used for the first time, and the first successful human operation took place eight years later. The elimination of the laparoscope from the general trauma of major surgery cannot be overstated.
Keyhole surgery is less invasive than traditional surgery.
Since the turn of the 20th century, a series of technological and social changes have allowed laparoscopic surgery to be successful. Originally, the basic method was only practical for laparotomies – surgeries on the spacious abdomen, where large organs could be anesthetized and treated. With the advent of electronics, tools became smaller and more accurate. Technological improvements in cameras and optics provided clearer and more detailed images. The economics of a sports entertainment industry also demanded that injured knees be repaired easily and quickly.
Laparoscopic knee surgery can be used to repair an injured knee joint.
Laparoscopic knee surgery is used to treat a number of common injuries. One of the two shock absorbers – called the meniscus – on each side of the knee can painfully tear when the knee is twisted violently. Hyperextension can tear the anterior cruciate ligament (ACL), a tough tissue that connects the upper femur to the lower tibia bones to restrict knee movement within the biometric range. Injuries and microfractures of cartilage, or softer bone tissue, are often caused by blunt trauma or repetitive stress. Weak, painful, swollen or locked knees are symptoms that should be referred to a bone and joint specialist.
Laparoscopic surgery is used to treat many different injuries to the knee.
Exploratory laparoscopy is useful for diagnosis, arguably the most important part of medical treatment. It provides first-hand visual inspection. It may give confirmation, show potential complications, or reveal other undiagnosed injuries. If it is decided that surgery is necessary, its likely success will have improved based on the level of information available about the injury.
Laparoscopic knee surgery, because of its minimal risk and injury to the patient, is also called “Band-Aid surgery”. There is rarely a complication of excessive bleeding. Patients are conscious throughout the operation, with only the knee area anesthetized. In contrast to a prolonged recovery from previous open surgery, including monitoring for possible hospital-acquired infections, the laparoscopic procedure is generally an outpatient procedure with little postoperative pain. A patient typically walks without crutches in two weeks, while a professional athlete who may have been forced to retire before this advanced surgical technique can be rehabilitated to peak performance in just a few months.
Surgery on any joint with a laparoscope is called arthroscopy. The miniaturized surgical instruments used are ideal for maneuvering around the tight spaces of the knee anatomy. To facilitate this, the joint is deliberately swollen by injecting a large amount of saline irrigation fluid. There are no sensitive organs near the knee that could impede the surgeon’s access or be accidentally damaged. Knee problems often require repeated surgery, and minimizing trauma and scarring can improve the outcome of successive treatments.
A typical incision for laparoscopic knee surgery is less than 0.4 inch (1 cm), more than enough room for instruments half their diameter. Modern oscilloscopes use charge-coupled device (CCD) chips for imaging and transport the signal through optical fiber. Illumination is provided by cold halogen or xenon light. Often, a second incision is made to insert various surgical instruments needed for specific procedures. The only significant technical difficulty of the procedure is the extreme precision of the very small instruments and the disjointed feedback of manipulating them by remote video monitor.