Combining the "first do no harm" principle in ancient times with today's space age technology, arthroscopic surgery is a diagnosis and treatment method that aims to provide the most benefit while causing the least damage to the patient's body integrity. Arthroscopy is a recent surgical intervention method, which is performed by entering into the joint through a few holes of approximately 1 cm with the help of a small camera called an arthroscope. It is now known that arthroscopic methods are much more successful in the early stages of surgery, even if there are no serious differences between open methods and closed methods in the long term. Patients stay in the hospital for a few days at most, have to use a lot of painkillers, and because it can be done by entering through a few small holes instead of a large surgical incision, the risk of infection is almost non-existent. The risk of bleeding is much less and the recovery time is much faster. At the same time, the time for the patient to return to his normal daily life after the surgery is much faster. The disadvantages are the availability of modern surgical equipment and the practicing physician has sufficient training and experience in this regard. Today, arthroscopic surgeries are the gold standard in many joint surgeries. It can be done more and more without any problems.

Since the surgical effect is minimal in arthroscopy, postoperative pain and recovery time are also less. Patients start their early movements after surgery and are usually discharged on the same day without hospitalization.

Joint Diseases Treatable with Arthroscopy

Today, the joint without arthroscopic intervention is almost nonexistent. Mainly in knee, shoulder, ankle, hip, elbow, hand and ankle joints; It is successfully applied in the treatment of diseases such as hip joint compression, hip calcification (Coxarthrosis), hip joint infection, intra-knee infections, meniscus, anterior and posterior cruciate ligament operations, some of the articular cartilage diseases, advanced knee calcifications, outward rotation and dislocations of the kneecap.

In Knee Joint

• Intra-knee infections
• Removal of torn meniscus pieces
• Suturing some meniscus tears
• Anterior and posterior cruciate ligament operations
• Early treatment of calcification
• Treatment of fractures involving the knee joint
• Cartilage transplants
• Correction of patella (kneecap) axis
• Treatment of kneecap extraversion and dislocations
• Removal of joint inflammations
• Synovectomy (removal of diseased joint membrane)
• Opening the movement restrictions that occur after an accident or illness
• Removal of intra-articular benign tumors and cysts
• Removal of intra-articular free bodies
• Treatment of joint cartilage diseases

On the Shoulder

• Treatment of muscle tightness and recurrent shoulder dislocations
• Treatment of bankart tears that cause shoulder dislocations
• Rotator cuff tears, SLAP tears
• Cartilage and muscle chord diseases
• Osteoarthritis (calcification) treatment
• Synevectomy in rheumatic diseases
• Opening shoulder movement restrictions
• Removal of intra-articular free bodies

On Ankle

• Intra-articular fractures, osteochondritis
• Meniscoid lesions (tissue compression after repetitive sprains)
• Osteoarthritis (calcification) treatment
• Treatment of rheumatic diseases

On the Wrist

• Treatment of intra-articular fractures
• Release of nerve compressions
• Treatment of ligament tears between the wrist bones
• Treatment of articular cartilage damage
• Correction of the special cartilage pad in the joint

At the elbow

• Treatment of osteochondritis
• Removal of free bodies
• Filing of bone protrusions that impede movement
• Synevectomy in rheumatic diseases
• Removal of intra-articular benign tumors and cysts

Treatment approaches in meniscal tears

Meniscus and anterior cruciate ligament injuries, which are frequently encountered by football players and cause the end of their sports life, continue to be the fearful dream of not only athletes but also everyone who has strained their knee in any way. However, thanks to advances in knee surgery, meniscus tears can now be treated in a short time. Menisci are C-shaped structures located in the knee joint. They are located between the femur (thigh) and tibia (leg) bones that make up the knee joint. There are two menisci in each knee, one inside and one outside. The meniscus is an important structure of the knee that provides the stability of the knee and prevents cartilage injury by suspending it.

Causes of meniscus damage

• There are two menisci in the knee joint, the inner and outer meniscus. The function of the meniscus, which is in the shape of a crescent and in a cartilage structure, is roughly to transmit load and to provide joint harmony. While meniscal injuries are frequently seen in the young patient group due to traumatic reasons, the reason for the decrease in meniscus quality in older ages can occur without being traumatic.

What are the meniscus symptoms?

• Pain is the first symptom in meniscus tears and injuries. While the pain usually manifests itself in knee-bending movements (climbing up and down stairs, using the toilet, praying), it may not show symptoms while walking on a straight road. Depending on the size of the tear, there may be complaints such as locking, snagging, and noise in the knee, while swelling may accompany the knee. Patients with meniscal injury usually apply to the outpatient clinic with complaints of pain, swelling, and locking in the knee joint. If there is a suspicion of meniscus and accompanying additional injury, MRI should be requested in order to detect this. Intra-articular and extra-articular ligaments, menisci and muscle tissues support the knee joint. Bone, ligament and meniscus injuries can occur alone or together.

Meniscus tear treatment

• Treatment of meniscal injuries is related to the location of the tear, the type and grade of the tear, and the patient's activity level. Although not every meniscus tear can be treated with surgery, there are also tears for which surgery is inevitable.

• Non-surgical treatments

It is the first treatment that should be applied in cases where the patient's complaints are low and the severity of the tear is low. Pain relief and edema relief drugs, use of knee braces, physical therapy methods, PRP and stem cell applications are the main treatment methods.

• Arthroscopy (Closed Method)

Arthroscopic surgeries are on the agenda in patients who do not respond to non-surgical treatments. Open methods are now abandoned. The method accepted today; It is a closed method called arthroscopic surgery. With the method called arthroscopic meniscectomy, the parts of the meniscus that have become problematic are removed, repaired when necessary, and the procedure is terminated, with the help of special surgical instruments, by imaging the intra-articular with a set of thin-tipped cameras with a camera at the end. Immediately after such a procedure, the patient can be discharged and go home. However, it may take up to 3 to 4 weeks before they can return to their daily life activities.

Post-operative process

The operation is usually performed under spinal anesthesia (anesthetizing below the waist) and takes between 15-30 minutes. Patients can walk without support after the numbness in the feet subsides after 2-3 hours. Discharge is done on the same day or the next day. According to the intervention, return to work is between 10-20 days.

How is the success of the surgery?

Success rates reported in our country and in the world after anterior cruciate ligament surgery are more than 90%.

Approaches in anterior cruciate ligament injuries

The anterior cruciate ligament is one of the structures that connects the femur and tibia bones in the knee joint. This ligament, which is very important for the normal function of the knee, is the most important structure that prevents abnormal forward displacement of the tibia bone.

How do anterior cruciate ligament injuries occur?

Anterior cruciate ligament injuries usually occur during sudden rotation on a fixed foot. It often happens during a movement performed by the athlete himself. Less frequently, anterior cruciate ligament injuries may occur after direct blows to the knee, traffic accidents, falling from a height and work accidents. In this case, injuries to the posterior cruciate ligament, lateral ligaments and menisci can be added to the anterior cruciate ligament injuries. While injuries in adults are in the form of rupture of the ligament from the body, injury in children may be in the form of a piece of the ligament from where it attaches to the bone.

What are the symptoms of anterior cruciate ligament injuries?

During an anterior cruciate ligament injury, severe pain occurs with a sudden rupture sensation in the knee. Some patients may hear the sound of the ligament breaking and often fall to the ground. Swelling occurs due to rapidly developing bleeding inside the knee joint. If the injured is an athlete, he usually cannot continue the sport and has to leave the competition. Due to pain and swelling, limitation of motion in the knee occurs and limping occurs. Some athletes may feel their knees popping in and out.

Within a few weeks, swelling and pain in the knee joint will decrease. Knee movements are gained and the limp disappears. However, this time, there is a feeling of space and insecurity in the knee, especially during sudden turns, during sudden deceleration and when descending the stairs. Sports such as swimming and cycling can be done on knees with anterior cruciate ligament rupture; However, it is not possible to perform sports with sudden jumps, turns and accelerations such as football, basketball, handball, volleyball, skiing at a high level. If the athlete wants to continue these sports without the anterior cruciate ligament, the risk of new injuries and increased damage to the knee is very high.

How is the diagnosis made in anterior cruciate ligament injuries?

The diagnosis of an anterior cruciate ligament tear begins with a detailed description of the way the injury occurs. This is followed by a careful examination. Only with this history and examination, the diagnosis of anterior cruciate ligament tear can be made at a rate of over 90%. Sometimes, an adequate examination may not be performed because the knee is very painful at first. In this case, a second examination within 10 days is diagnostic. X-rays should be taken in all patients with a serious knee injury and it should be investigated whether there are fractures in the bones. X-rays are usually normal in anterior cruciate ligament injuries. Magnetic resonance imaging has an accuracy rate of over 90% in the diagnosis of anterior cruciate ligament tears. In addition, concomitant meniscus, lateral ligament and cartilage injuries and bone edema can be diagnosed. However, although rare, MRI can be misleading, Although the ligament is injured to a point where it cannot function, it can be seen that the continuity of the ligament is preserved on MRI. Therefore, MRI is not the only determinant when deciding on treatment, examination and history findings should also be considered.

Treatment of anterior cruciate ligament injuries

The treatment of anterior cruciate ligament injuries in young people who play sports or have an active lifestyle is surgery. Surgical treatment may not be performed in individuals of advanced age who are not at a high level of activity, do not do sports, and do not have complaints such as gaps and insecurity in the knee in daily life.

In children who did not complete their growth, it was recommended to wait until the growth was completed and then surgical treatment was recommended. However, nowadays, after it was seen that irreversible meniscus and cartilage injuries occurred in the knee in children who did not undergo surgical treatment, it has shifted to perform surgery at an earlier age, taking into account certain criteria.

If non-surgical treatment is chosen, muscle strengthening programs are recommended to reduce the feeling of insecurity and emptiness that may occur in the knee, and protective knee pads can be used in sports that require the knee. However, when severe strain occurs, neither can prevent the knee from dislodging, and additional injuries to the knee may occur.

What are the goals of anterior cruciate ligament surgery?

The aim in individuals with anterior cruciate ligament injury is to eliminate the feeling of space and insecurity in the knee and to obtain a knee that the person can press safely during sports or challenging activities. Another aim is to protect the meniscus if it was not damaged during the first injury and to prevent the wear and tear that may occur in the knee in the following years by repairing the meniscus tears that can be repaired. Another purpose of surgery is to return the athletes to the sports level they were in before the injury and to prevent new injuries to the knee.

How is anterior cruciate ligament repair done?

This procedure is mostly done arthroscopically, in rare cases open surgery may be necessary.

In adults, the anterior cruciate ligament is torn, mostly by separating the fibers in its body. It is not possible to repair the ligament in the form of a fringed tissue and the ligament must be repaired with a new tissue during surgery. The tendons of the muscles around the knee are often used for ligament repair.

Postoperative period

The length of stay in the hospital after surgery may vary between 1-3 days. It is possible to stand up with crutches after the effect of the anesthesia wears off. Knee movements are started on the same day or the next day and it is aimed to bend your knee up to 90 degrees. It may be necessary to protect the knee from overloads by using crutches for several weeks after surgery. Within three weeks, full knee motion should be gained. If the patient's own exercises are not sufficient, rehabilitation can be performed under the guidance of a physiotherapist. It takes 6 weeks for the placed tissue to adhere to the bone tunnels by fusing. After this period, it is possible to walk and drive normally. It is possible to start sports activities after the 5th month.

How is the success of the surgery?

Success rates reported in our country and in the world after anterior cruciate ligament surgery are between 80-90%. Adequate success may not be achieved in 10-20% of patients due to technical problems, newly formed injuries and whether the tissue placed in the knee matures as a new ligament.