Keyhole surgery makes life easier for injured athletes
Sports injury surgery is often the last and final treatment option for certain sports injuries. For some, surgery comes after many weeks or months of conservative treatment and is the final attempt at a full recovery.
Conditions like chronic ankle instability, patella femoral syndrome, and tendinopathy may benefit from surgery when rehabilitation fails. Other injuries like ACL tears, shoulder labral tears, and meniscus tears require surgery to reconstruct or repair the tissues. Conservative rehabilitation is usually not a long-term option because these structures do not heal on their own.
This type of surgery is called Arthroscopy. It is a minimally invasive alternative to standard open surgical techniques and now the most commonly performed orthopedic surgical procedure. Minimally invasive surgeries result in less postoperative swelling than open techniques and reduce pain, risk of complications, and recovery times.
Many injuries, particularly those that would have been career-end for athletes, are now being addressed with arthroscopy allowing a quicker return to full function. Arthroscopy has resulted in an overall decrease in morbidity compared to open techniques. It is most commonly used on the knees, ankles, shoulders, elbows, wrists and hips.
An arthroscopy involves the use of a device called an arthroscope to examine the joints. This is a thin, metal tube about the length and width of a drinking straw that contains a light source and a camera. Images are sent from the arthroscope to a video screen or an eyepiece, so the surgeon is able to see inside the joint. It is also possible for tiny surgical instruments to be used alongside an arthroscope to allow the surgeon to treat certain joint conditions.
As the equipment used in an arthroscopy is small, only minor cuts need to be made in the skin. This means the procedure has some potential advantages over traditional, “open” surgery, including: > Less pain after the operation > Faster healing time > Lower risk of infection > One can often go home the same day > One may be able to return to normal activities more quickly
An arthroscopy might be recommended if you have problems such as persistent joint pain, swelling or stiffness, and scans have not been able to identify the cause. While these problems can be addressed with extended open techniques, the comorbidity associated with open procedures often prevents such patients from returning to their pre-injury functional status.
Arthroscopy can also be used to treat a range of joint problems and conditions. It can be used to repair damaged cartilage (meniscus tear), remove fragments of loose bone or cartilage treat conditions such as frozen shoulder or ligaments reconstruction (ACL for knee and lateral complex ligaments for the ankle), rotator cuff tear repair for the shoulder, recurrent shoulder dislocation and instability repair, femoral-acetabular impingement for the hip, triangular fibrocartilage complex repair for the wrist, shoulder and ankle impingement removal.
What happens during an arthroscopy?
The arthroscope is inserted through a small cut in the skin made next to the joint. Further small incisions may also be made to allow an examining probe or surgical instruments to be inserted. The surgical incisions from arthroscopy are small. They usually consist of one or more 5 mm (1/4 inch) incisions on either side of the joint, which are bandaged after surgery.
Your surgeon will then examine the joint using the arthroscope and, if necessary, remove or repair any problem areas. This will usually be done under general anaesthetic, although sometimes a spinal or local anaesthetic is used. The procedure is usually performed as a day case, which means you’ll normally be able to go home on the same day as the surgery.
The time it takes to recover from an arthroscopy can vary, depending on the joint involved and the specific procedure you had. For several days after arthroscopy, patients will generally be asked to rest and elevate the joint while applying ice packs to minimise pain and swelling.
After surgery, an exercise programme is gradually started that strengthens the muscles surrounding the joint and prevents scarring (contracture) of surrounding soft tissues.
It’s often possible to return to work and light, physical activities within a few weeks, but more demanding physical activities such as lifting and sport may not be possible for several months.
Dr Atef Awad is an orthopedic surgery specialist at International
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