Minimally invasive knee surgery / knee arthroscopy

Minimally invasive knee surgery / knee arthroscopy

Minimally invasive knee surgery at Beta Klinik is often performed arthroscopically. It is also commonly known as knee arthroscopy, knee endoscopy or keyhole surgery. Knee arthroscopy has revolutionized the treatment of knee injuries because it is gentle since less tissue is damaged, and it has a lower risk of infections in comparison to open surgery. In addition to that, it has shortened recovery periods and the duration of hospitalization, and it makes a quick return to work, sports and daily activities possible.

During knee arthroscopy, an endoscope is inserted through small incisions of about 1 cm length (0.4 inches). Inside the endoscope is a camera that enables us to visualize the inner of the knee as well as damaged structures enlarged at a monitor.

Due to these features, knee arthroscopy is also an effective diagnostic procedure since damaged structures can be directly visualized in opposite to imaging procedures like MRICT or X-raying. This makes a direct evaluation of the extent of the injury possible.

Another advantage of knee arthroscopy is that therapy may directly follow diagnostics during the same procedure because the physician can insert small instruments and operate with them. This way, damaged structures, for example, may be stitched, removed or stabilized.
Normal arthroscopies are outpatient treatments, but it is also possible to have a short hospitalization at Beta Klinik.

In case of complex operations like cruciate ligament reconstruction or tibial osteotomy, a short hospitalization is recommended to ensure optimal pain therapy and physiotherapy.

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General advantages of minimally invasive knee surgery and knee arthroscopy

(in comparison to other surgery methods, extent may vary subject to the surgery type)

  • minimally invasive
  • easy on the body
  • reduced risk of infections
  • short periods of hospitalization and recovery
  • quick return to work, sports and daily activities
  • diagnostics and treatment are possible within the same procedure (arthroscopy)

Aftercare and rehabilitation minimally invasive knee surgery / knee arthroscopy

After knee arthroscopy and other minimally invasive procedures of knee surgery, physiotherapy and rehabilitation measures follow. Aim of physiotherapy and rehabilitation is to improve the mobility, range of motion and strength of the knee in order to make a quick return to normal life possible. Furthermore, it is recommended to improve the condition of the knee also to prevent new knee injuries. Thus, physiotherapy is an important factor of the success of the treatment. Generally, it begins at the ward of Beta Klinik and can be continued at Beta Sport & Reha.

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Return to work after minimally invasive knee surgery / knee arthroscopy

After a short hospitalization of a few days, the inability of work amounts 2-6 weeks. Sitting work postures are possible much earlier than physical labor postures. Physical, knee-intensive labor can be resumed after 12 weeks (tibial osteotomy).

Return to sports activities after minimally invasive knee surgery / knee arthroscopy

Return to sports after cruciate ligament reconstruction is possible after 6 months. Less complex arthroscopic surgeries enable resuming sports activities after 2-4 weeks.

Special fields of application of minimally invasive knee surgery / knee arthroscopy

Meniscus tear / meniscus rupture

Knee arthritis / Knee osteoarthritis

If meniscal tissue is destroyed, a gentle smoothing of the ‘buffer’ is performed. Reconstructible tears are stitched or anchored with modern anchor systems.
In rare cases, a larger part of the meniscus has to be removed. After the removal, we can insert a synthetic meniscus during an additional surgery. The artificial tissue serves the body as anatomic landmark to generate a new scarred meniscus that does not have the quality of a natural meniscus but is an adequate alternative to a missing one.

Cartilage damage is gently stabilized during the same surgical procedure. If there is severe damage, a more complex surgery is performed (see below).

Given partial knee arthritis, tibial osteotomy is an alternative to the artificial knee replacement. During this surgery, the mechanical axis of the legs, leading the body weight through the knee joint, is altered. The strain is redirected away from the defect to the intact cartilage. Main focus of the tibial osteotomy is put on the tibial head (shin near the knee) and the distal femur (thigh bone near the knee). Subject to location and case, a part of the bone is partially sawed, and a small gap created or a small wedge removed. The changed anatomic structures are stabilized by a stable titanium plate and screws. The mechanical axis of the legs is altered, and the destroyed part of the joint does not have any influence on movements anymore.

After this surgery, crutches have to be used for 4-6 weeks. The average inability to work for sitting activities amounts 3-4 weeks, for driving a car or physically challenging work 12 weeks. The advantage of tibial osteotomy is the preservation of the joint and postponing artificial knee replacement surgery in case it is necessary at a later point of time.

Anterior cruciate ligament injury / ACL tear / cruciate ligament rupture

After a cruciate ligament rupture—of the anterior cruciate ligament or, rarely, the posterior cruciate ligament—the quality of life and the ability to perform sports activities are significantly reduced. Pre-existent knee instability can also trigger an early wear and tear (prearthritic deformity).

The specialists of Beta Klinik carry out minimally invasive cruciate ligament reconstruction surgery of the anterior and posterior cruciate ligament in case of cruciate ligament rupture by using a tendon of the own body. The primary implant is the semitendinosus tendon, which is merely missed by patients. The tendon transplant is anchored within the bone with specific medical dowels or bioresorbable screws.

Modern surgery techniques even enable us to reconstruct the anterior cruciate ligament without damaging existent intact ligament structures. This reduces recovery and rehabilitation periods significantly.

As an alternative transplant, we can use the very strong quadriceps tendon (above kneecap) as secondary implant, which happens primarily if the first surgical solution has not yielded the desired result or in case of a recurring anterior ligament rupture. In addition to the reconstruction of the affected cruciate ligaments, we are able to reconstruct the medial collateral ligament with tendons of the own body or so-called allografts (not of the own body) if a combined knee instability persists.

Luxating patella / patella dislocation / kneecap dislocation

In case of a luxating patella, often the inner stabilization system of the kneecap is destroyed, the so-called MPFL complex (medial patellofemoral ligament complex). This anatomic structure was discovered a couple of years ago, and it is the new center of attention of patella stabilization surgery. At Beta Klinik, we perform the modern, minimally invasive MPFL replacement.

During this procedure, we reconstruct both ligaments of the MPFL system. The primary implant is the gracilis tendon, which is extracted during a cosmetically appealing surgery through a small incision of about 2-3 cm (0.8-1.2 inches). The tendon is fixed with bioresorbable screws.

If a malformation of the knee joint tendon at the tibial head has been proven, a tuberosity realignment / tuberosity medialization solely or in combination with MPFL surgery is performed.

Cartilage damage

In case of cartilage damage, Beta Klinik offers the whole range of state-of-the-art medical care.

Given superficial cartilage damage, the broken cartilage surfaces will be smoothened. More effort requires the treatment of deep cartilage damage, which is also more time-consuming for the patients in terms of rehabilitation. If the damage reaches the bone, the goal is to substitute the damaged cartilaginous tissue with high-quality cartilage of the same patient. This necessitates two surgery appointments. During the first brief surgery appointment, the cartilage damage is evaluated and measured, and tissue is extracted. The tissue is then processed by replicating the cartilage-building cells of the patient, the so-called chondrocytes, millions of times. During the second surgery appointment, cell conglomerates are injected into the damaged cartilage six weeks after they have been extracted. Thus, the body´s own cartilaginous cells build a new, healthy cartilage within the damaged areas.

If this very sophisticated surgery method is not possible, the so-called nano-fracturing will be carried out, during which the flow of non-differentiated (mesenchymal) stem cells of the bone marrow is induced.

In both cases, the operated knee joint has to be relieved for at least six weeks.