Arthroscopic Surgery

In many cases, injuries to the menisci, ligaments, tendons, and other joint structures can be treated with arthroscopic surgery.

But arthroscopy is not needed for every joint pain. The decision to operate is made after establishing the cause of the symptoms and assessing whether surgery can genuinely improve function.

Arthroscopy is a minimally invasive surgical technique in which a special optical instrument — an arthroscope — is inserted into the joint through a small incision.

The image of the joint's internal structures is displayed on a monitor, allowing the surgeon to assess them in detail.

Through additional small incisions, specialized instruments are inserted to perform the necessary surgical procedure.

In this way, arthroscopy not only allows the pathology inside the joint to be visualized, but in appropriate cases also allows damaged structures to be repaired or reconstructed through minimal surgical access.

A consultation with an orthopedic surgeon is worthwhile if you are experiencing:

• pain in the knee or shoulder joint
• recurring joint swelling after exertion
• a sensation of locking or the knee "catching"
• instability or a feeling that the knee is "giving way"
• shoulder pain when raising the arm
• shoulder weakness after an injury
• repeated dislocations or instability of the shoulder joint
• restricted range of motion
• the after-effects of a sports injury
• symptoms that persist despite conservative treatment

The first step is to establish the cause of the symptoms.

Only after that can it be determined whether arthroscopic surgery is needed.

The knee is one of the joints where arthroscopic techniques are especially widely used.

The menisci play an important role in load distribution and stability of the knee joint.

A meniscus tear can occur after an injury, presenting with pain, swelling, clicking, or mechanical locking of the knee.

Not every tear requires surgery.

When arthroscopic treatment is indicated, the key question is:

• can the meniscus be preserved?

In appropriate cases, preference is given to repair and meniscal suture. If the nature of the injury does not allow this, only the unstable, damaged portion may be removed.

The goal is to preserve as much functional meniscal tissue as possible, rather than simply removing it.

A tear of the anterior cruciate ligament (ACL) can cause knee instability, especially during running, sudden changes of direction, and sporting activity.

The decision to reconstruct depends on more than just the MRI.

The following are taken into account:

• clinical instability
• age
• level of physical activity
• sporting and occupational demands
• concomitant meniscal and cartilage injuries
• patient expectations

If surgery is indicated, ligament reconstruction is performed to restore stability of the knee joint.

Arthroscopy can also be used for certain localized injuries to the joint cartilage, loose intra-articular bodies, and other pathological conditions.

The approach is determined by the nature of the defect, the patient's age, and the overall condition of the joint.

Shoulder pain can be related to various structures — the rotator cuff tendons, the labrum, ligaments, and other components of the shoulder complex.

That is why it is important to identify the specific source of the problem before surgery.

The rotator cuff is a group of tendons that provide stability and movement of the shoulder joint.

Damage to it can cause:

• pain
• night pain
• weakness
• difficulty raising the arm
• reduced shoulder function

Not every tear requires surgery.

But when indicated, the damaged tendon can be repaired arthroscopically and fixed back to the bone.

After a traumatic shoulder dislocation, the structures that provide joint stability may be damaged.

In some patients, repeated episodes of instability occur after the first dislocation.

This is especially relevant for young and physically active people.

In appropriate cases, arthroscopic surgery allows the damaged stabilizing structures to be repaired.

It is important to assess not only the soft tissues but also any potential bone loss, since a significant bone defect may require a different reconstructive strategy.

This is one of the key questions addressed on this page.

Not every meniscus tear needs surgery.

Not every rotator cuff tear requires immediate surgery.

Not every joint pain can be cured with arthroscopy.

The decision depends on the cause of the symptoms, the nature of the injury, age, activity level, duration of the problem, and the results of prior treatment.

The mere presence of changes on an MRI does not automatically mean surgery is necessary.

We treat the patient and the impairment of their joint function — not the MRI image.

MRI reports often contain wording that sounds alarming to a patient: "meniscus tear," "degenerative changes," "cartilage damage," "tendon tear."

But an MRI result needs to be assessed together with:

• your symptoms
• the history of the injury
• clinical examination
• age
• physical activity
• the overall condition of the joint

Sometimes the changes described on an MRI are not the main cause of the pain.

So an MRI helps inform the decision, but it does not make that decision instead of the doctor.

The outcome depends on the specific condition and the type of procedure.

The goal of arthroscopic treatment may be:

• reducing pain
• eliminating mechanical locking
• restoring stability
• repairing a damaged meniscus
• reconstructing a ligament
• repairing a tendon
• improving range of motion
• returning to everyday and sporting activity

It is important to understand that arthroscopy cannot "make the joint new" and does not eliminate every cause of pain.

This is especially true for advanced arthritis, where the problem is no longer a single damaged structure but significant, widespread damage to the joint as a whole.

We identify the nature of the symptoms, the mechanism of injury, activity level, and functional limitations.

We perform clinical tests to assess specific joint structures.

Depending on the condition, X-ray, MRI, and in certain cases CT scans are used.

We determine whether the problem can be treated conservatively, or whether surgery offers a clear, justified advantage.

The necessary procedure is performed through small incisions, according to the pathology identified.

Rehabilitation depends on the surgery performed.

After a minor procedure, recovery can be relatively quick. After a meniscal repair, ligament reconstruction, or rotator cuff repair, a longer, supervised process is required.

The decision to operate is made based on a combination of symptoms, clinical examination, and imaging results.

A change seen on MRI is not, by itself, an indication for arthroscopy.

If a meniscus or other structure can reasonably be repaired, a tissue-sparing approach is preferred.

The end goal is a stable, mobile, and functional joint.

The outcome of ligament reconstruction, meniscal repair, or tendon repair depends heavily on properly structured post-operative recovery.

In cases of advanced arthritis or other significant structural damage to the joint, arthroscopic surgery may not deliver the expected result.

In such situations, it is important to identify a different, more suitable treatment option.

The patient had previously undergone surgical treatment of the knee. During a follow-up MRI, a complete rupture of the anterior cruciate ligament (ACL) graft was found, together with a vertical tear of the lateral meniscus and a meniscocapsular injury of the posterior horn of the medial meniscus (a ramp lesion).

The MRI also showed associated post-traumatic and post-surgical changes.

MRI of both knees. Right — a repeat injury to the anterior cruciate ligament graft along with associated meniscal injuries after previous surgical treatment; left — a comparative scan of the other knee.

Even findings this pronounced on MRI do not, by themselves, determine the final treatment strategy. The imaging results must be weighed together with the patient's complaints, the clinical stability of the knee, level of physical activity, the outcome of the previous surgery, and functional needs.

Only after this comprehensive assessment can it be determined whether repeat surgery is needed, which structures require repair, and what scope of surgery would be appropriate.

MRI shows the structure of the injury. The surgeon's task is to determine its clinical significance and choose the right treatment strategy.

If the surgery is elective and the clinical situation allows time for a decision, you can get a second opinion on the proposed treatment.

This can be especially useful if:

• surgery was recommended based on the MRI alone
• it is unclear whether conservative treatment could be tried first
• removal of part of the meniscus has been proposed
• there is uncertainty about whether ligament reconstruction is needed
• rotator cuff surgery has been recommended
• the symptoms and MRI findings do not seem fully clear to you

During the consultation, the MRI results can be weighed against your symptoms and clinical picture to determine whether surgery is really needed and what problem it should solve.