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from Section 24 - Orthopedic Surgery
Published online by Cambridge University Press: 05 September 2013
Arthroscopy is the most performed procedure in orthopedics, with the knee being the most common site of surgical treatment. Advances in surgical technique and technology have led to increasing indications for knee arthroscopy. The advantages of arthroscopic surgery include the ability to function in an outpatient surgical setting, limited incisions and resultant improved cosmesis, and lowered risks for perioperative complications such as infection, substantial blood loss, and thromboembolic disease. Image capture systems and the ability to take still photographs and videos intraoperatively provide illustrations of specific pathology and procedures carried out, thereby fortifying the medical record and enhancing postoperative communication with the patient. The benefits carry over to the postoperative period in the form of lower requirements for analgesia and earlier initiation of rehabilitation protocols.
While the utility of knee arthroscopy has primarily been observed in its ability to administer therapeutic maneuvers, the arthroscope remains the gold standard as a powerful diagnostic tool. The process of preoperative counseling with the patient and obtaining informed consent is paramount, as the treatment plan can be modified based on arthroscopic findings. Surgeries performed most regularly include partial meniscectomy, meniscal repair, and anterior cruciate ligament (ACL) reconstruction. The arthroscope is also utilized for complex isolated or multiligamentous reconstructions including posterior cruciate ligament (PCL) and medial collateral ligament (MCL) work, meniscal transplantation, articular cartilage restoration, the irrigation and debridement of a pyoarthrosis, and osseous injuries such as low-energy tibial plateau fractures. A requisite for the arthroscopic management of intra-articular soft-tissue derangements is motion, as preoperative knee motion is the best predictor of postoperative motion. An exception is a locked knee joint secondary to a large bucket-handle meniscal tear.
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