29875 Arthroscopy, knee, surgical; synovectomy, limited (eg, plica or shelf resection) (separate procedure)

Name of the Procedure:

Arthroscopy, knee, surgical; synovectomy, limited (e.g., plica or shelf resection)

Summary

Arthroscopy is a minimally invasive surgical procedure used to diagnose and treat problems inside the knee joint. During a synovectomy, the surgeon removes inflamed synovial tissue, such as a plica or synovial shelf, through small incisions using an arthroscope and specialized instruments.

Purpose

To address inflammation and irritation within the knee caused by synovial tissue issues, such as plica syndrome. The goals are to relieve pain, improve knee function, and prevent further joint damage.

Indications

• Persistent knee pain not relieved by non-surgical treatments.
• Swelling or inflammation inside the knee joint.
• Mechanical symptoms such as catching, locking, or instability.
• Diagnosis of plica syndrome or other synovial tissue disorders through imaging or clinical assessment.

Preparation

• Patients may be instructed to fast for several hours before the procedure.
• Certain medications, especially blood thinners, might need to be adjusted or paused.
• Preoperative imaging studies like MRI or X-rays to assess the knee condition.
• Physical examination and medical history review.

Procedure Description

1. The patient is administered anesthesia (typically general or regional).
2. Small incisions (portals) are made around the knee.
3. An arthroscope (a thin tube with a camera) is inserted into the knee joint.
4. The surgeon visualizes the joint on a monitor and uses specialized instruments inserted through other portals to remove the problematic synovial tissue.
5. The area is irrigated to ensure all inflammatory tissue is removed.
6. The instruments and arthroscope are removed, and the incisions are closed with sutures or steri-strips.
7. A bandage or dressing is applied over the incisions.

Duration

Typically, the procedure lasts about 30 to 60 minutes.

Setting

Performed in a hospital operating room or an outpatient surgical center.

Personnel

• Orthopedic surgeon
• Anesthesiologist or nurse anesthetist
• Surgical nurses and technicians

Risks and Complications

• Infection
• Bleeding or blood clots
• Injury to surrounding tissues or structures
• Stiffness or reduced range of motion
• Allergic reactions to anesthesia
• Recurrence of symptoms

Benefits

• Pain relief
• Improved knee function and mobility
• Shorter recovery time compared to open surgery
• Reduced inflammation inside the knee

Recovery

• Patients may go home the same day.
• Pain and swelling management with ice, elevation, and medications.
• Physical therapy to restore knee strength and mobility.
• Avoiding weight-bearing activities for a few days or weeks.
• Follow-up appointments for suture removal and progress assessment.

Alternatives

• Conservative treatments such as physical therapy, anti-inflammatory medications, or corticosteroid injections.
• Open surgery for more extensive synovial tissue removal or other knee issues.
• Pros of alternatives: Non-surgical options have lower immediate risks; open surgery may be necessary for severe cases.
• Cons of alternatives: Conservative treatments might be less effective for chronic or severe inflammation; open surgery has longer recovery times.

Patient Experience

• Minimal pain during the procedure due to anesthesia.
• Some discomfort and swelling post-procedure, manageable with pain medications.
• Gradually resuming normal activities as the knee heals, with guidance from the healthcare team.
• Important to follow post-operative care instructions to ensure a smooth recovery.