29887 Arthroscopy, knee, surgical; drilling for intact osteochondritis dissecans lesion with internal fixation

Name of the Procedure:

Arthroscopy, knee, surgical; drilling for intact osteochondritis dissecans lesion with internal fixation.

Summary

This procedure involves using a small camera (arthroscope) to look inside the knee joint and drill into an area of bone affected by osteochondritis dissecans (OCD). Internal fixation devices, like screws or pins, are used to stabilize the area.

Purpose

The purpose of this procedure is to treat osteochondritis dissecans, a condition where a segment of bone and cartilage separates from the surrounding area due to a lack of blood flow. The goal is to re-establish blood flow, promote healing, and secure the affected bone and cartilage, reducing pain and improving joint function.

Indications

• Persistent knee pain and swelling unresponsive to conservative treatments.
• Knee locking or catching.
• Diagnosed osteochondritis dissecans with an intact, but unstable lesion.
• Patients who are typically younger and have a high activity level.

Preparation

• Fasting for 6-8 hours before the procedure may be required.
• Adjustments or discontinuation of certain medications as instructed by the healthcare provider.
• Pre-operative imaging tests like X-rays, MRI, or CT scans to assess the lesion's size and location.

Procedure Description

1. The patient is anesthetized (general or regional anesthesia).
2. Small incisions are made around the knee.
3. An arthroscope is inserted to provide visuals of the knee joint.
4. Specialized tools are introduced to drill small holes into the lesion to stimulate blood flow.
5. Internal fixation devices (e.g., screws, pins) are placed to secure the bone and cartilage.
6. Incisions are closed with sutures or surgical tape.
7. A sterile dressing is applied.

Duration

The procedure usually takes about 1 to 2 hours, depending on the complexity of the lesion.

Setting

The procedure is performed in a hospital or an outpatient surgical center.

Personnel

• Orthopedic surgeon
• Surgical nurses
• Anesthesiologist

Risks and Complications

• Infection
• Bleeding or blood clots
• Damage to surrounding nerves or blood vessels
• Stiffness or decreased range of motion
• Recurrence of osteochondritis dissecans

Benefits

• Relief from pain and swelling.
• Improved knee function.
• Enhanced ability to participate in physical activities.
• Prevention of further joint damage.

Recovery

• Post-procedure: Rest and ice application to reduce swelling.
• Pain management: Prescribed pain relievers or anti-inflammatory medications.
• Physical therapy: Begins shortly after surgery to restore motion and strength.
• Recovery time: Often 3-6 months with activity restrictions to allow healing.
• Follow-up: Regular appointments to monitor progress and remove fixation devices if necessary.

Alternatives

• Conservative treatments: Rest, physical therapy, and activity modification.
• Non-surgical interventions: Bracing or casting.
• Other surgical options: Open surgical techniques or cartilage grafting.

Patient Experience

Patients may feel some pain and discomfort post-procedure, which can be managed with medications. Swelling and stiffness are common initially but will improve with physical therapy. Pain and discomfort gradually diminish as healing progresses, with significant improvement in symptoms expected in a few months.