Name of the Procedure:

Arthroscopy, knee, surgical; drilling for intact osteochondritis dissecans (OCD) lesion.

Summary

Arthroscopic drilling for an intact osteochondritis dissecans lesion is a minimally invasive surgical procedure performed on the knee. Using a small camera and instruments, the surgeon drills tiny holes in the bone beneath the affected cartilage to stimulate healing.

Purpose

This procedure addresses osteochondritis dissecans, which is a condition where a piece of cartilage, along with its underlying bone, detaches from the end of a bone due to poor blood supply. The goal is to enhance blood flow to the affected area and promote natural healing of the cartilage.

Indications

• Persistent knee pain and swelling
• Loose fragments within the joint
• Limited knee mobility
• Patients typically include young, active individuals or athletes experiencing these symptoms.

Preparation

• Patients may be required to fast for several hours before the procedure.
• Adjustments in medications, especially blood thinners, might be necessary.
• Preoperative imaging tests like MRI or X-rays to evaluate the lesion.

Procedure Description

1. The patient is placed under general or regional anesthesia.
2. Small incisions are made around the knee to insert an arthroscope (a small camera) and surgical instruments.
3. The surgeon visualizes the knee joint on a monitor.
4. Tiny holes are drilled into the bone beneath the intact OCD lesion to allow blood and bone marrow cells to reach the area and promote cartilage repair.
5. The instruments are removed, and the incisions are closed with sutures or surgical tape.

Duration

The procedure typically takes about 1 to 2 hours.

Setting

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

Personnel

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

Risks and Complications

• Infection
• Bleeding
• Blood clots
• Damage to surrounding tissues or nerves
• Persistent pain or stiffness
• Incomplete healing or need for additional surgery

Benefits

• Relief of knee pain
• Improved knee function and range of motion
• Potential to return to normal activities or sports
• Initial benefits may be observed within a few weeks, with full recovery taking several months.

Recovery

• Post-operative care includes rest, ice application, compression, and elevation (RICE).
• Pain management with medications prescribed by the doctor.
• Physical therapy is often recommended to restore strength and mobility.
• Weight-bearing restrictions may apply initially, depending on the surgeon’s advice.
• Follow-up appointments to monitor healing progress.

Alternatives

• Non-surgical options like physical therapy, bracing, and activity modification.
• Medications for pain and inflammation.
• Other surgical options such as microfracture or mosaicplasty.
• Pros: Non-surgical methods have fewer risks.
• Cons: Might be less effective for severe cases compared to arthroscopic drilling.

Patient Experience

During the procedure, the patient is under anesthesia and will not feel pain. Post-operative discomfort is managed with pain relief medications. Soreness, swelling, and bruising around the knee are common but usually improve in a few days. Full recovery might involve several months of physical therapy and restricted activities to ensure proper healing.