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Arthroscopy has revolutionised the treatment of joint injuries.
In the past, treatment of orthopaedic injuries involved extensive surgery, including large incisions, a hospital stay, and a prolonged recovery period. But today, with the help of an arthroscope, today’s orthopaedic surgeon can easily examine, diagnose, and treat problems in the joint that previously may have been difficult to identify.
The arthroscope is a small fibre-optic viewing instrument made up of a tiny lens, light source and video camera.
The surgical instruments used in arthroscopic surgery are very small (only 3 or 4 mm in diameter), but appear much larger when viewed through an arthroscope.
Shown at right — both as it appears on the operating table and when viewed arthroscopically — is a probe, used for examination of internal structures (in this case the underside of a patella, or kneecap).
The surgeon inserts the arthroscope into the joint through a tiny incision (about 1/4 of an inch) called a portal. Two or three incisions may be made for portals. Other portals are used for the insertion of surgical instruments, such as the probe shown above. Typical incision sites and sizes for knee arthroscopy are shown at left. These incisions result in very small scars which in many cases are unnoticeable.
With small incision sites and direct access to most areas of the joint, an arthroscopic surgeon can diagnose and surgically correct a vast array of joint problems such as arthritis and ligament tears.
For example, almost any region of the knee may be treated arthroscopically. A normal meniscus — shown above — appears through the arthroscope appears as a smooth, white wedge-shaped structure.
Arthroscopic surgery is not limited to the knee: also common is arthroscopy of the shoulder, ankle, wrist, elbow, and hip.
The ACL is a ligament in the centre of your knee that becomes damaged when twisted too far, such as in a skiing injury. ACL Reconstruction is performed using a combination of open surgery and arthroscope
The ACL when healthy is firmly attached to the femur and tibia.
A badly torn ACL that will usually need to be reconstructed as it provides much of the stability within the knee.
Before the ACL reconstruction process begins, your surgeon will examine your knee arthroscopically, and repair any additional damage to the knee, such as a torn meniscus, or worn articular cartilage.
Reconstruction of the ACL begins with a small incision in your leg where small tunnels are drilled in the bone.
Next your new ACL is brought through these tunnels, and then secured. As healing occurs, the bone tunnels fill in to secure the tendon.
There are three methods of creating a replacement ACL. The first uses the patellar tendon, which connects the patella to the tibia.
The middle third of the tendon and a small portion of bone on either end is harvested and used as the new ACL. This is called a patellar tendon autograft, because your own tissue is used.
Another autograft method uses the semitendinosus-gracilis (hamstring) tendons, which connect muscles in the back of the thigh to the lower leg. Two small portions of these tendons are harvested and removed through a small incision in your leg, then they are looped to form a strong new ACL.
The third method of creating a replacement ACL uses an allograft, meaning the tendon comes from a source other than your own body, such as a donated achilles tendon.