UNDERSTANDING ARTHROSCOPY

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Claud Montgomery
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1 UNDERSTANDING ARTHROSCOPY Diagnosing and Treating Your Joint Problem

Looking into a Problem Joint Whether you re taking a step or raising your hand, your

A worn, torn, or injured joint can make an active lifestyle painful.

The surgeon can also treat many problems during this procedure.

incisions. A long, thin, lighted instrument called an arthroscope is used.

Deciding About Arthroscopy You and your surgeon will discuss the risks and benefits

2 Looking into a Problem Joint Whether you re taking a step or raising your hand, your joints help you move freely. A worn, torn, or injured joint can make an active lifestyle painful. Your orthopaedic surgeon has suggested arthroscopy to look inside a problem joint. The surgeon can also treat many problems during this procedure. After arthroscopy, you may be able to return to many of the activities you once enjoyed. What Is Arthroscopy? Arthroscopy allows your surgeon to see and work inside your joint through small incisions. A long, thin, lighted instrument called an arthroscope is used. During surgery, a tiny camera on the arthroscope sends live video images from inside the joint to a monitor. Using these images, the surgeon can diagnose and treat your joint problem. Deciding About Arthroscopy You and your surgeon will discuss the risks and benefits of arthroscopy. Understand what arthroscopy can and can t do for you. Discuss any other treatment options that might help relieve symptoms. If you choose arthroscopy, follow your surgeon s advice to help ensure a smooth recovery. And be sure to get any questions you have answered. Surgical instrument Arthroscope 2

The scope is inserted through one portal.

3 An orthopedic surgeon specializes in bones and joints. Preparing for the Procedure Tell your surgeon what medications you take. This includes prescription and over-the-counter medications, vitamins, supplements, and herbal remedies. You may need to stop taking some or all of them before the procedure. Also stop eating and drinking as directed before the procedure. Starting the Procedure The joint to be operated on will be marked. You may also be asked your name and procedure more than once. This is for your safety. Before the procedure begins, you are given anesthesia. This is medication to keep you relaxed and free of pain. Then, two or three small incisions (portals) are made in the joint. The scope is inserted through one portal. Tools used for treatment are put through the other portals. Sterile fluid is used to expand the joint. This makes it easier for the surgeon to see and work. The rest of this booklet tells you more about specific joint problems and what may be done during arthroscopy to treat them. Risks and Complications Arthroscopy is very safe, but it does have certain risks. These include: Bleeding, infection, or blood clots Stiffness or ongoing pain in the joint Damage to blood vessels, nerves, or skin around the joint Damage to cartilage or ligaments in the joint Need for further surgery Other risks as outlined by your surgeon! 3

Arthroscopy of the Hip Common hip problems and their treatments are discussed below. Your surgeon will talk with you about your condition and the best procedure for you.

Acetabulum (socket) This type of joint allows a wide range of movement. The acetabulum, Labrum or socket, encloses the femoral head, or ball.

4 Arthroscopy of the Hip Common hip problems and their treatments are discussed below. Your surgeon will talk with you about your condition and the best procedure for you. You will likely go home the day of your arthroscopy. Before going home, you will be told how to care for your hip as it heals. The Healthy Hip The hip is a ball-and-socket joint. Acetabulum (socket) This type of joint allows a wide range of movement. The acetabulum, Labrum or socket, encloses the femoral head, or ball. Articular cartilage is firm tissue that covers the ball and Articular cartilage lines the socket. This allows smooth movement. The labrum is a strong, flexible ring of cartilage attached to the edge of the socket. Ligaments Capsule are bands of tissue that connect bone to bone. The capsule is a bundle of ligaments that enclose the joint, holding the ball in the socket. Loose Bodies Loose bodies are bone or cartilage fragments that have chipped off inside the joint. If left in place, they can damage joint surfaces and restrict movement. Loose bodies in the hip can cause painful joint locking and catching. During arthroscopy, the loose bodies are removed. If they are large, they are first broken up into smaller pieces. A loose body is removed. Femoral head (ball) Ligament Common Hip Problems 4

Sutures attached to the anchor hold the tear in place, allowing it to heal. Femoroacetabular Impingement (FAI) With FAI, excess bone forms on the edge of the femoral head and/or the acetabulum.

5 Labral Tears If the labrum is torn, it can cause pain, catching, clicking, or locking in the joint. A torn piece of labrum may be removed by cutting, shaving, or ablation (heating the tissue to remove it). Or, the tear may be repaired. A repair may be done using an anchor placed in the bone. Sutures attached to the anchor hold the tear in place, allowing it to heal. Femoroacetabular Impingement (FAI) With FAI, excess bone forms on the edge of the femoral head and/or the acetabulum. This can cause pain and limit movement. To treat FAI, the area is reshaped by removing excess bone. FAI can lead to other problems, such as labral tears or arthritis. If present, these problems may also be treated. After Arthroscopy The torn labrum may be removed or repaired during arthroscopy. During FAI repair, excess bone is reshaped. After surgery, your joint may be swollen, painful, and stiff. Recovery times can vary. You re likely to be given crutches or a walker to take home with you. You ll be told how long to use them. At home, follow your surgeon s guidelines for healing. Also: Do exercises as directed by your surgeon or physical therapist. Use ice as instructed to reduce swelling and pain. Take pain medication as directed. 5

Arthroscopy of the Ankle Common ankle problems and their treatments are discussed below. Your surgeon will talk with you about your condition and the best procedure for you.

It takes its shape from the lower leg bones (fibula and tibia) and one of the foot bones (talus). These bones support the body s weight. They also keep the joint stable.

6 Arthroscopy of the Ankle Common ankle problems and their treatments are discussed below. Your surgeon will talk with you about your condition and the best procedure for you. You will likely go home the day of your arthroscopy. Before going home, you will be told how to care for your ankle as it heals. The Healthy Ankle The ankle is a strong, mobile joint. It takes its shape from the lower leg bones (fibula and tibia) and one of the foot bones (talus). These bones support the body s weight. They also keep the joint stable. Cartilage covers the ends of the bones and aids in movement. Common Ankle Problems Loose Bodies Loose bodies are bone or cartilage fragments that have chipped off inside the joint. If left in place, they can damage the joint surface and restrict ankle movement. Your surgeon can remove loose bodies from the joint. This will help restore normal, smooth ankle motion. Fibula Cartilage Tibia Talus A loose body is removed. 6

Bone Spurs Impingement occurs when the tissue in a joint is pinched. This problem is often caused by bone spurs (growths) that have formed on the joint.

$The surgeon can remove the bone or secure it in place. Or, microfracture (tiny holes drilled into healthy bone) may be used to stimulate new cartilage growth. Open surgery may also be needed.$

7 Bone Spurs Impingement occurs when the tissue in a joint is pinched. This problem is often caused by bone spurs (growths) that have formed on the joint. Pressure from the spur may cause pain when you move your ankle. Your surgeon will remove the spur and smooth the bone surface. OCD Because of an injury to its blood supply, a piece of bone and cartilage can become loose inside the joint. Called OCD (osteochondral defect), this problem can cause pain and swelling. The surgeon can remove the bone or secure it in place. Or, microfracture (tiny holes drilled into healthy bone) may be used to stimulate new cartilage growth. Open surgery may also be needed. After Arthroscopy After a bone spur is removed, the surface of the bone is smoothed. The affected piece of bone is secured in place. After surgery, your joint may be swollen, painful, and stiff. Recovery times can vary. If you had a loose body or bone spur removed, you may be able to put weight on your affected ankle when the pain is gone. With OCD treatment, you will likely have a surgical boot or cast. You may need to use crutches and keep weight off your leg for some time. At home, follow your surgeon s guidelines for healing. Be sure to: Elevate and ice your ankle as instructed to reduce pain and swelling. Use a bandage to compress your ankle as instructed. Take pain medication as directed. 7

Arthroscopy of the Knee Common knee problems and their treatments are discussed below. Your surgeon will talk with you about your condition and the best procedure for you.

8 Arthroscopy of the Knee Common knee problems and their treatments are discussed below. Your surgeon will talk with you about your condition and the best procedure for you. You will likely go home the day of your arthroscopy. Before going home, you will be told how to care for your knee as it heals. The Healthy Knee The knee is a mobile joint that connects the upper and lower leg bones. Articular cartilage covers the ends of the bones and the underside of the patella (kneecap) to aid in movement. Meniscus cartilage acts as a cushion between the bones. The anterior cruciate ligament (ACL) is one of several ligaments that help keep the knee stable. Common Knee Problems Meniscus Tears There are several types of meniscus tears. Your surgery will depend on the type and extent of your injury. Your surgeon can remove the damaged tissue or sometimes fix the tear. Treatment should ease the pain and swelling. It can also help keep the joint from locking. Patella (kneecap) Articular cartilage Meniscus A portion of damaged cartilage is removed. Anterior cruciate ligament (ACL) 8

ACL Tears A torn ACL can make the knee unstable. You may have pain and swelling, and your knee may give out.

Or, it can come from a human donor who has died (allograft). Your surgeon will discuss this with you.

Bone or cartilage fragments can also break off inside the joint (loose bodies). Either problem can limit movement and cause pain.

After Arthroscopy Graft A graft of strong, healthy tissue is attached to replace damaged tissue. A loose body is removed.

9 ACL Tears A torn ACL can make the knee unstable. You may have pain and swelling, and your knee may give out. Your surgeon can reconstruct the ACL to restore stability to the knee. To do this, your surgeon uses a graft. This tissue can come from your own body (autograft). Or, it can come from a human donor who has died (allograft). Your surgeon will discuss this with you. Arthritis Constant use of the knee over time can cause arthritis. This is when the articular cartilage wears away and roughens. Bone or cartilage fragments can also break off inside the joint (loose bodies). Either problem can limit movement and cause pain. Your surgeon may use a burr or shaver to smooth the joint surface. This will aid in healing. Loose bodies can also be removed. After Arthroscopy Graft A graft of strong, healthy tissue is attached to replace damaged tissue. A loose body is removed. After surgery, your joint may be swollen, painful, and stiff. Your recovery time will depend on what was done. You may be given crutches. You ll be told how much weight you can put on your affected leg. At home, follow your surgeon s guidelines for healing. Be sure to: Elevate and ice your ankle as instructed to reduce pain and swelling. Keep your knee bandaged as instructed. Take pain medication as directed. 9

Arthroscopy of the Wrist Common wrist problems and their treatments are discussed below. Your surgeon will talk with you about your condition and the best procedure for you.

The Healthy Wrist The wrist is a mobile joint that can move up and down, and from side to side. It can also rotate. Its many small bones, bound to one another by ligaments, allow such movement.

10 Arthroscopy of the Wrist Common wrist problems and their treatments are discussed below. Your surgeon will talk with you about your condition and the best procedure for you. You will likely go home the day of your arthroscopy. Before going home, you will be told how to care for your wrist as it heals. The Healthy Wrist The wrist is a mobile joint that can move up and down, and from side to side. It can also rotate. Its many small bones, bound to one another by ligaments, allow such movement. The triangular fibrocartilage complex (TFCC) cushions and supports the joint. Common Wrist Problems Ligament Tears The ligaments between the bones of the wrist can tear. This most often occurs between the lunate and scaphoid bones or the lunate and triquetrum bones. Such tears can cause pain, swelling, and a weak grip. With a full tear, the bones may pull apart and limit motion. To perform repairs, your surgeon may shift to open surgery. Triquetrum Triangular fibrocartilage complex (TFCC) Ligament damage is revealed. Scaphoid Lunate Ligament 10

TFCC Damage Injury or constant use over time can cause a tear in the TFCC. During surgery, the tear may be shaved off or repaired. Bone or cartilage fragments may be removed.

Cartilage Damage If your cartilage is wearing down (called arthritis), your surgeon may be able to shave or smooth the worn area.

11 TFCC Damage Injury or constant use over time can cause a tear in the TFCC. During surgery, the tear may be shaved off or repaired. Bone or cartilage fragments may be removed. After healing, you should be able to move your wrist with greater ease and less pain. Cartilage Damage If your cartilage is wearing down (called arthritis), your surgeon may be able to shave or smooth the worn area. Bone or cartilage fragments that have chipped off in the joint (loose bodies) will be removed. The removal of loose bodies can help restore smooth, pain-free wrist movement. After Arthroscopy Tissue is shaved during a TFCC repair. A loose body is removed. After surgery, your joint may be swollen, painful, and stiff. Recovery times vary, depending on what was done. You may wear a bandage, splint, or cast for some time. Avoid gripping objects tightly or lifting. At home, follow your surgeon s guidelines for healing. Be sure to: Elevate and ice your wrist as instructed to reduce pain and swelling. Wear your wrist dressing to let the joint heal. Take pain medication as directed. 11

Arthroscopy of the Elbow Common elbow problems and their treatments are discussed below. Your surgeon will talk with you about your condition and the best procedure for you.

The Healthy Elbow The elbow plays two roles: It lets the arm bend and straighten, and it allows the palm to turn up and down.

12 Arthroscopy of the Elbow Common elbow problems and their treatments are discussed below. Your surgeon will talk with you about your condition and the best procedure for you. You will likely go home the day of your arthroscopy. Before going home, you will be told how to care for your elbow as it heals. The Healthy Elbow The elbow plays two roles: It lets the arm bend and straighten, and it allows the palm to turn up and down. This joint connects the two forearm bones (ulna and radius) with the upper arm bone (humerus). Inside the joint, cartilage covering the bones keeps the elbow moving smoothly. Common Elbow Problems Loose Bodies Loose bodies are bone or cartilage fragments that have broken loose inside the joint. Left in place, they can cause pain. Your elbow may catch, or become hard to bend and straighten. Loose bodies can be removed with arthroscopy. This will help restore normal, pain-free arm movement. Cartilage Ulna Humerus A loose body is removed. Radius 12

OCD Inside a joint, a piece of bone or cartilage can become loose because of an injury to its blood supply. Called OCD (osteochondral defect), this problem can cause pain and swelling.

13 Bone Spurs Bone spurs (growths) in a joint can cause the bones to pinch one another (impinge). These growths can cause pain and restrict movement. The ulna is the most common site for bone spurs in the elbow. To treat your problem, the surgeon will remove the spur and smooth the bone surface. OCD Inside a joint, a piece of bone or cartilage can become loose because of an injury to its blood supply. Called OCD (osteochondral defect), this problem can cause pain and swelling. The surgeon can remove the bone or secure it in place. Open surgery may also be needed. After Arthroscopy A bone spur is removed. The affected piece of bone is secured in place. After surgery, your joint may be swollen, painful, and stiff. Recovery times vary, depending on what was done. Your surgeon will give you guidelines for using your arm as it heals. At home, follow your surgeon s guidelines for healing. Be sure to: Elevate and ice your elbow as instructed to reduce pain and swelling. Keep your elbow compressed in a sling, bandage, or splint as instructed. Take pain medication as directed. 13

Arthroscopy of the Shoulder Common shoulder problems and their treatments are discussed below. Your surgeon will talk with you about your condition and the best procedure for you.

The Healthy Shoulder Ligament The shoulder is a very mobile Acromion joint. It is linked to the body by the clavicle (collarbone). Bursa Ligaments and the acromion form the top of the joint.

14 Arthroscopy of the Shoulder Common shoulder problems and their treatments are discussed below. Your surgeon will talk with you about your condition and the best procedure for you. You will likely go home the day of your arthroscopy. Before going home, you will be told how to care for your shoulder as it heals. The Healthy Shoulder Ligament The shoulder is a very mobile Acromion joint. It is linked to the body by the clavicle (collarbone). Bursa Ligaments and the acromion form the top of the joint. The head of the humerus bone fits into the Humerus glenoid (a socket). Rotator cuff muscles and tendons allow for Capsule joint movement. The capsule is a pocket that keeps the joint from moving too far. It is attached to the labrum (a rim of cartilage). A bursa (lubricating sac) helps the joint move smoothly. Common Shoulder Problems Rotator Cuff Problems The acromion can pinch (impinge) the bursa and rotator cuff when the arm is raised overhead. This can cause pain, swelling, or even a tear. To free up space in the joint, your surgeon can remove the bursa, trim the ligament, and smooth the acromion. If the rotator cuff tear is torn, it may be repaired. Clavicle Rotator cuff muscle and tendon Glenoid and labrum (under capsule) A tear in the rotator cuff is repaired. 14

Instability The leading cause of shoulder instability is an injury that forces the humeral head out of its socket. If the humerus pushes completely out of the joint, it s called dislocation.

To stabilize the joint, the surgeon can tighten a loose capsule or reattach a torn labrum to the glenoid. Arthritis Arthritis is a roughening of the joint surface caused by cartilage wear.

15 Instability The leading cause of shoulder instability is an injury that forces the humeral head out of its socket. If the humerus pushes completely out of the joint, it s called dislocation. If it only pushes partway out, it s called subluxation. These injuries can tear the labrum, stretch the capsule, or both. This leads to instability, where the joint moves too much. To stabilize the joint, the surgeon can tighten a loose capsule or reattach a torn labrum to the glenoid. Arthritis Arthritis is a roughening of the joint surface caused by cartilage wear. It often leads to loose bodies (fragments of bone or cartilage that have chipped off inside the joint). Your surgeon may be able to smooth worn cartilage from the joint and remove loose bodies. Treatment can reduce your pain. After Arthroscopy A torn labrum is repaired. A loose body is removed. After surgery, your joint may be swollen, painful, and stiff. Recovery times vary, depending on what was done. You may need to wear a sling for a time. Your surgeon will tell you when to resume movement. At home, follow your surgeon s guidelines for healing. Also: Ice your shoulder as instructed to reduce pain and swelling. Wear a sling if instructed. Take pain medication as directed. 15

Work with Your Surgeon Arthroscopy offers many benefits.

and after surgery. Ask your surgeon or nurse for any special instructions.

medications, supplements, or herbal remedies you take.

Arrange for an adult family member or friend to give you a ride to and from

Don t eat or drink anything for as long as instructed before If you smoke,

Also available in Spanish After Surgery Use ice as instructed to reduce

16 Work with Your Surgeon Arthroscopy offers many benefits. Be clear about what results you can expect from surgery and what it can and can t do for you. Work with your surgeon to have all your questions answered before moving forward. Your Surgery Checklist Use this checklist to remind you what to do before and after surgery. Ask your surgeon or nurse for any special instructions. Before Surgery Tell your surgeon what prescription and over-the-counter medications, supplements, or herbal remedies you take. Ask if you should stop taking any of them before surgery. Arrange for an adult family member or friend to give you a ride to and from surgery. Don t eat or drink anything for as long as instructed before surgery. If you smoke, talk to your surgeon. Also available in Spanish After Surgery Use ice as instructed to reduce swelling and pain. Wear a sling as directed (if needed). Care for your incisions as directed. Follow all instructions for bathing and showering to protect your incision. See your surgeon for follow-up visits. Do physical therapy exercises as prescribed. Ask your surgeon when you can drive and return to work. TAKE OUR PATIENT SURVEY. Help us help other patients. Please visit to provide your feedback on this booklet. This booklet is not intended as a substitute for professional medical care. Only your doctor can diagnose and treat a medical problem. 2014, 2016 The StayWell Company, LLC All rights reserved. Made in the USA

Ankle Arthroscopy. Removing Loose Bodies and Spurs

Ankle Arthroscopy. Removing Loose Bodies and Spurs Ankle Arthroscopy Removing Loose Bodies and Spurs What Is Arthroscopy? Your joints help you move freely. But living with a worn or injured joint can make an active lifestyle painful. Your orthopaedic surgeon