LOOK INTO MY KNEES...

Saturday, June 17, 2006 | 0

By Jomar Almeda, MD (Faculty, WorkCompSchool)

"You know you're getting older when your knees buckle, but your belt won't". - unknown author

The capability to look into the knees is considered one of the major advances in the field of orthopaedic surgery. Arthroscopic surgery was developed over 30 years ago and created the most impact in the diagnosis and treatment of knee joint injuries. The term arthroscopy was derived from the Greek words "arthro", which means joint, and "skopein", which means to look.

Through a tiny skin incision the joint's interior can be visualized with the insertion of an arthroscope, with a diameter just about the size of a pen. The instrument is consists of a fiber optic light source and a specialized lens that can be attached to a camera. With the image magnified by a video monitor, and by manipulating the arthroscope within the knee, the different compartments, gutters, ligaments, cartilages, and other structures within the knee can be very well visualized. By distending the joint space with sterile fluid, bleeding is kept at a minimum, which further improves visibility.

Arthroscopy can both be diagnostic and corrective. In certain instances when physical examination and imaging studies are non-confirmatory, a diagnostic arthroscopy may be performed when indicated. With a specific set of similar sized or even smaller instruments as the arthroscope, certain surgical procedures can also be precisely performed through a separate skin incision (portal) in the joint.

In contrast to conventional surgical procedures requiring more extensive incisions and dissection, wound healing from tiny portals and recovery period following an arthroscopic procedure is significantly lessened. Among the most common knee joint conditions that can be corrected arthroscopically are cartilage and ligament injuries or tears. With the development of new techniques and instrumentation, some degenerative knee joint conditions (arthritis), are now being effectively treated by arthroscopic surgery.

In the knee, transplantation of cartilage to replace damaged ones, and implantation of autologous cultured chondrocytes to fill in large articular cartilage defects due to acute or repetitive trauma, can now also be done with great success in carefully selected patients.

Most arthroscopic procedures are performed on an out-patient basis, and patients are usually able to return home shortly after the surgery. In the absence of complications (infection, neurovascular injury, instrument breakage), which are actually rare, routine activities can be resumed within a few days. Recovery also depends on the nature of the joint problem and the operative procedure that was done. In certain situations, a combination of both arthroscopic and the conventional open surgical method may be necessary.

Although the knee is the most commonly treated joint by arthroscopic means, there are conditions of the shoulder, elbow, wrist, hip, and ankle that can also be effectively managed by this method. Aside from cartilage and ligament injuries of the knee, among the other joint problems that can be remedied arthroscopically include rotator cuff tears and impingement syndrome, carpal tunnel syndrome, loose bodies of bone or cartilage within the joints, and synovitis.

The advent of arthroscopy saw the emergence of many distinguished and promising orthopaedic surgeons dedicated to research and development of new surgical techniques. With further advances in technology, instrumentation, and arthroscopic skills, more joints can be "looked into", and more conditions can eventually be treated by arthroscopic means in the years to come.

Postscript: Kudos to my friend and colleague Jamie Charter, for her excellent new website. Visit her at www.employerresourceconsultants.com.

Congratulations to Ricardo Almeda Poblador, Jr., of De la Salle University - Manila, for passing the Mechanical Engineer Licensure Examination given last April 2006.

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Prior to his involvement with Workers' Compensation, Jomar Almeda, M.D., a graduate of the U.E.R.M. College of Medicine, has over 12 years of active orthopaedic practice in Manila, Philippines. He was Arthroscopy Journal's Traveling Fellow in 2000, and later become an International Member of the Arthroscopy Association of North America in the same year. Jomar also received extensive training at the Nobuhara Orthopaedic Hospital and Institute of Biomechanics in Japan, at the National University Hospital in Singapore, and at Warwick Valley Orthopaedic Surgery, PC in New York.

Jomar is also certified in Occupational and Industrial Medicine and had served as a medical consultant for various multi-national companies in his native country. He is currently with the Workers' Compensation Department of Integrative Industrial and Family Practice Medical Clinics.

Jomar, a graduate of a comprehensive WorkCompSchool program, is now sharing his professional expertise in WorkCompSchool's faculty, with a premier online course currently in the production stages. He can be reached at jomar@lamedcenter.com.

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The views and opinions expressed by the author are not necessarily those of workcompcentral.com, its editors or management.