Name of the Procedure:

Arthroscopy, knee, surgical; drilling for osteochondritis dissecans with bone grafting, with or without internal fixation (including debridement of base of the lesion)

Summary

Arthroscopy for knee osteochondritis dissecans involves using a small camera to view the inside of the knee joint. During this minimally invasive surgery, the surgeon drills into the damaged area and may use a bone graft to promote healing. Sometimes, the procedure includes internal fixation to secure any loose fragments. Debridement is performed to clean the base of the lesion.

Purpose

• Medical Condition: Osteochondritis dissecans, a condition where a segment of bone and its cartilage covering lose blood supply and become loose.
• Goals: To restore normal joint function, relieve pain, and prevent further joint damage by promoting healthy bone and cartilage growth.

Indications

• Persistent knee pain.
• Swelling and catching or locking of the knee.
• Loose bone or cartilage fragments in the joint.
• Inadequate response to non-surgical treatments.

Preparation

• Fasting for 8 hours before the procedure.
• Adjusting or stopping certain medications as advised by the healthcare provider.
• Pre-procedural diagnostic tests: MRI or X-ray to assess the lesion.

Procedure Description

1. Anesthesia: Administering general or regional anesthesia.
2. Arthroscopy: Inserting a small camera (arthroscope) into the knee joint through a small incision.
3. Drilling: Making small holes in the damaged area to stimulate blood flow and bone healing.
4. Bone Grafting: Harvesting a bone graft, often from the patient’s own body, and placing it in the drilled area.
5. Internal Fixation: Using screws or pins to secure any loose fragments if needed.
6. Debridement: Cleaning out any damaged or loose tissue from the base of the lesion.

Duration

Typically, the procedure takes about 1 to 2 hours.

Setting

Performed in a hospital or an outpatient surgical center.

Personnel

• Orthopedic Surgeon
• Surgical Nurses
• Anesthesiologist

Risks and Complications

• Infection at the incision site.
• Bleeding or blood clots.
• Damage to nearby nerves or blood vessels.
• Stiffness or reduced range of motion in the knee.
• Continued pain or incomplete healing of the lesion.

Benefits

• Relief from knee pain and improved joint function.
• Enhanced ability to perform daily activities and sports.
• Prevention of further joint degradation.

Recovery

• Patients may go home the same day or the following day.
• Use of crutches or a knee brace for support.
• Physical therapy to regain strength and mobility.
• Pain management with prescribed medications.
• Recovery time: 6 weeks to several months, depending on the extent of the surgery and patient's adherence to postoperative instructions.
• Follow-up appointments for monitoring progress.

Alternatives

• Non-surgical treatments: rest, physical therapy, medications.
• Microfracture surgery: creating small fractures to stimulate cartilage growth.
• Knee osteotomy: realigning the knee bones.
• Pros and Cons:
  • Non-surgical methods may be less invasive but often provide temporary relief.
  • Microfracture has similar benefits but might not be suitable for larger lesions.
  • Osteotomy involves a longer and more painful recovery.

Patient Experience

• During the procedure: Asleep or numbed due to anesthesia, no pain felt.
• After the procedure: Some discomfort, swelling, and pain managed with medications.
• Importance of adhering to physical therapy and recovery protocols for optimal outcomes.