Knee Keyhole Surgery
" No, let the candied tongue lick absurd pomp,
And crook the pregnant hinges of the knee . . ."
- William Shakespeare (1564-1616),
Hamlet. Act iii. Sc. 2. (1603)
THE fear of surgery is ancient and visceral. Who wants to lie prostrate, anesthetized, then cut up? There is the fear of the unknown, of pain, and the idea of being scarred. Apprehensions are not allayed, knowing that traditional surgeons pride themselves in making incisions as long as an MRT line (bigger incision, bigger surgeon).
Fortunately, in selected conditions, there is now an alternative to being cut up.
Technology has a way to changing how surgeons do things.
"Arthroscopic" or keyhole surgery in joints is now accepted as the standard of treatment in several orthopedic conditions. Its counterparts in other specialties, "endoscopy" and "laparascopy," are also making their marks locally. In previous articles, I have written on how general surgeons can repair hernias, remove an inflamed appendix or gallbladder, and do many more operations using their version of keyhole surgery.
Introducing Arthroscopy. This procedure is not new. Prof. Takagi of Japan performed an ankle arthroscopy in 1939. But it was only in the 1970s when it was "rediscovered" and took off with a big push from advances in optics and video. In fact, arthroscopy is really about inserting a miniature camera into a joint, which is attached to a video monitor. With the use of small instruments (also inserted but opposite the camera for proper visualization), the surgery is performed. Now, combine these with a whole new generation of young surgeons suckled on Nintendo and PlayStation and what do you have? Play as work. Who would have thought that all that hand-eye coordination in front of the computer or TV was the exact same skill in scoping a joint?
Indications for Arthroscopy. A 2002 New England Journal of Medicine article slammed arthroscopy as no better than placebo (sham surgery) for knee osteoarthritis. Since then, better patient selection has been the rule.
A patient may consider arthroscopy if his knee is chronically painful and swollen. A better indication is a demonstrable "mechanical" problem such as locking, clicking, or tightness. Arthroscopy can be used to diagnose and treat the following conditions:
* Torn meniscus (the shock absorbers of the knee between the thigh and leg bones)
* Loose fragments of bone or cartilage
* Damaged joint surfaces because of softening of the cartilage (chondromalacia)
* Abnormal alignment of the kneecap
* Torn ligaments of the knee - the ACL or anterior cruciate ligament or the PCL or posterior cruciate ligament
* Inflammation of the lining of joints (synovium) because of gout or rheumatoid arthritis
Before Arthroscopy. …