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Laparoscopic knee surgery is a minimally invasive surgical procedure employing thin tubes called trocars that are inserted into the knee joint through a small incision. Threaded through the tube are a miniature camera, a light source, and various surgical instruments. With the aid of a magnified video monitor, a surgeon can manipulate these tools to repair injured knees, essentially by virtual remote control. The technique has been dubbed “keyhole surgery.”
Surgeons by training have always had a mental image of a body’s interior and what needed to be safely done surgically to help a patient. The main risk to a patient came from the traumas of open surgery — anesthesia, exposure of the body cavity, and recovery. In 1902, a surgical device to view the inside of a dog was first used, and the first successful human operation followed eight years later. The laparoscope’s elimination of the general traumas of major surgery cannot be overstated.
Since the turn of the 20th century, a number of technological and social changes have enabled the success of laparoscopic surgery. Originally, the basic method was only practical for laparotomies — surgeries of the spacious abdomen, where large organs could be anesthetized and treated. With the advent of electronics, the tools became smaller and more precise. Technological improvements in cameras and optics provided clearer and more detailed imaging. The economics of a sports entertainment industry also demanded that injured knees be easily and quickly repaired.
Laparoscopic knee surgery is used to treat several common injuries. One of two shock absorbers — called the meniscus — on either side of the knee can tear painfully when the knee is twisted violently. Hyperextension can tear the anterior cruciate ligament (ACL), a tough tissue connecting the upper femur to the lower tibia bones to restrict the knee’s movement to within biometric range. Lesions and micro-fractures of cartilage, or softer bone tissue, are often caused by blunt trauma or repetitive stress. Weak, painful, swollen, or locked knees are all symptoms that should be referred to a bone and joint specialist.
Exploratory laparoscopy is useful for diagnostics, arguably the most important part of a medical treatment. It provides first-hand visual inspection. It might give confirmation, show potential complications, or reveal other undiagnosed injuries. Should it be decided that surgery is necessary, its likely success will have improved based on the level of information available about the injury.
Laparoscopic knee surgery, for its minimal risk and injury to a patient, has also been called “band aid surgery.” There is rarely ever a complication of excess hemorrhaging. Patients are conscious throughout the operation, with only the knee area anesthetized. In contrast to a prolonged recovery from past open surgeries, including the monitoring of potential hospital-acquired infections, the laparoscopic procedure is usually an outpatient procedure with little post-operative pain. A patient is typically walking without crutches in two weeks, while a professional athlete who may have been forced to retire prior to this advanced surgical technique can be rehabilitated to peak performance in just a few months.
Surgery on any joint with a laparoscope is called arthroscopy. The miniaturized surgical instruments used are ideally suited to maneuver around the tight spaces of knee anatomy. To facilitate this, the joint is deliberately swelled with the injection of a large quantity of saline irrigation fluid. There are no nearby sensitive organs in the knee that might hinder a surgeon’s access or be accidentally damaged. Knee problems frequently require repeated surgeries, and minimizing trauma and scarring can improve the outcome of successive treatments.
A typical incision for laparoscopic knee surgery is less than 0.4 inch (1 cm), more than enough room for instruments half its size in diameter. Modern scopes use charge coupled device (CCD) chips for imaging and carry the signal through optic fiber. Illumination is supplied by cold halogen or xenon light. Often, a second incision is made to insert multiple surgical instruments needed for specific procedures. The only significant technical difficulty of the procedure is the extreme precision of the very small instruments and the disjointed feedback of manipulating them by remote video monitor.