Newer Advances in Arthroscopic Surgeries of Knee and Shoulder

The meniscus is the only shock absorber between the femur and the tibia, taking on all the compressive and shear stress of walking, running and sport, and preventing the two bones' cartilage from grinding directly against each other. Once it is removed, that cartilage-on-cartilage contact leads to arthritis within a few years. A patient can function without an ACL, but without a meniscus, arthritis is inevitable.

Not at all, this is a different situation from minimally invasive spine or brain surgery. Arthroscopy actually gives a clearer view of the joint than open surgery would; even opening the knee completely to repair the posterior horn of the meniscus does not give as clear a view as the arthroscope does. In twenty years of practice, an arthroscopy has never needed conversion to an open procedure, provided the surgeon is patient and knows the anatomy well.

All surgery carries some residual risk, similar to how buying a car involves a small residual risk of a road accident that is rarely front of mind. The reassuring fact is that all the major blood vessels and nerves sit outside the knee and shoulder joint capsule, so as long as the anatomy is well understood and the surgery carefully planned, arthroscopy is one of the safest procedures available. Most arthroscopies are done as day-care procedures, with patients going home the same day.

Hip arthroscopy is a little different because the hip is a deeper joint, but designated portals developed over many years of anatomical study make it safe as long as a surgeon sticks to those landmarks. Labral repairs, loose body removal and cartilage surgery can all be done through the hip arthroscope. Surgeons early in their hip arthroscopy experience can use a safer mini-open approach, a small skin incision leading to the joint before introducing the scope.

With the newer all-inside technique and fiber tape augmentation, patients can weight-bear from day one using a walking aid for three to four days until pain settles, though supervised physiotherapy is still required. Full graft incorporation into bone takes about six weeks. Running and jogging can resume at three months, and return to sport is not advised before three months, since many failures happen when patients return to pivoting activity too soon.

The field has moved from simple open repairs, to reconstruction using grafts, to reinforcing those grafts, and is now moving toward genuine tissue regeneration and surgery personalised to each individual patient's anatomy and demands.

The goal is always to restore the anatomy, the biomechanics, and the biology that nature originally provided, rather than applying the same fixed technique to every patient.