Name of the Procedure:

Arthroscopy, knee, surgical; with lysis of adhesions, with or without manipulation (separate procedure)

Summary

Arthroscopy of the knee with lysis of adhesions is a minimally invasive surgical procedure where a small camera (arthroscope) and specialized instruments are inserted into the knee joint to remove scar tissue. The procedure can also involve manipulating the knee to improve range of motion.

Purpose

This procedure is designed to address stiffness and limited movement in the knee caused by adhesions (bands of scar tissue). The main goals are to reduce pain, improve mobility, and enhance overall knee function.

Indications

• Chronic knee pain unresponsive to conservative treatments.
• Restricted knee movement due to adhesions.
• Previous knee surgery or trauma resulting in scar tissue formation.
• Difficulty performing daily activities because of knee stiffness.

Preparation

• Patients may be instructed to fast 6-12 hours before the procedure.
• Adjustments to current medications may be necessary; blood thinners are often paused.
• Pre-procedure diagnostic tests such as X-rays or MRIs may be conducted to assess the condition of the knee joint.

Procedure Description

1. Anesthesia: The patient is placed under regional or general anesthesia.
2. Incisions: Small incisions (portals) are made around the knee.
3. Arthroscope Insertion: A camera-tipped instrument (arthroscope) is inserted into the knee joint.
4. Lysis of Adhesions: Special tools are used to locate and remove scar tissue.
5. Manipulation: The surgeon may also manually move the knee to break up any remaining adhesions.
6. Closure: Incisions are closed with sutures or sterile strips, and a dressing is applied.

Duration

The procedure typically takes around 30 minutes to 1 hour.

Setting

Arthroscopy is usually performed in a hospital or an outpatient surgical center.

Personnel

• Orthopedic surgeon
• Anesthesiologist
• Surgical nurses
• Operating room technician

Risks and Complications

• Infection
• Bleeding
• Blood clots
• Nerve or vessel damage
• Stiffness or reduced range of motion
• Anesthesia-related complications

Benefits

• Reduced knee pain
• Improved flexibility and range of motion
• Enhanced overall knee function Patients often start to see benefits within a few days to weeks.

Recovery

• Post-procedure care includes rest, ice application, and elevation of the knee.
• Pain management with prescribed medications.
• Physical therapy may be recommended to strengthen the knee and improve mobility.
• Recovery time varies, typically ranging from a few weeks to a couple of months.
• Follow-up appointments to monitor progress and adjust treatment as necessary.

Alternatives

• Physical therapy without surgery
• Medications such as anti-inflammatories or pain relief injections
• Open knee surgery for severe cases
• Pros and cons:
  • Non-surgical treatments may be less effective for severe adhesions.
  • Open surgery has a longer recovery period and is more invasive compared to arthroscopy.

Patient Experience

• During the procedure, patients will be under anesthesia and won't feel pain.
• Post-procedure, some discomfort and swelling can be expected.
• Pain is typically managed with medications and gradually decreases.
• Patients may need crutches or a knee brace initially and will engage in physical therapy to aid recovery.