Walk Through Of A Knee Arthroscopy

We're going to have a look inside this young lady's knee. We know that her kneecap doesn't track very nicely.

Make two little incisions either side of the knee to put the instruments in.

This is called an arthroscopy, which just means keyhole procedure of the knee.

This is the sheath for the telescope.

It also allows fluid to go in. So, what we're going to do is, we're going to fill this knee up with fluid first.

Okay, so I'm in the knee, I'm under the kneecap.

So now, this has been introduced underneath the kneecap.

When we do an arthroscopy, we look at all aspects of the joint. We start off at the front of the joint.

So, let's turn the fluid on.

So now, fluid filling up the knee, and let's have a little look inside the knee.

I'm doing this without a tourniquet, so it's less painful.

Could I have the screen pointing at me, please?

A little bit murky. Let's wash that out a bit.

Just the screen different.

That's right. Yeah, just point it over there.

So, towards you and then facing me would be great. Thank you.

So, that's the groove at the end of her thigh bone.

Her head's in the distance, and her feet are coming out towards us.

The kneecap is above us, and she's obviously out straight,

and that's the damage that we're going to be tidying up.

That's catching, and clicking, and causing the problems.

So, we're going to come back to that in a second.

As I go down the end of that thigh bone and come into the inside of her knee, we can see above the end of her thigh bone, the top of her shin, and we can see the meniscus, which is this structure here on the inside.

So, we're now going to make a second keyhole into the knee so we can probe and we can work inside the knee.

Just going to make one more tiny little incision here on the inside.

There we go.

Just check my height. My height's nice.

So, let's have a probe.

So, this is the end of the thigh bone, and that's this cartilage covering, which is four millimeters deep. Can you see that, Sam?

Mm-hmm.

You got that? And that's the top of the shin bone.

This is the anterior cruciate ligament, the footballer's ligament, here.

That looks great.

I'm just going to look on the outside here.

We're not expecting any damage in this young lady's knee on the outside. Let's go over.

So, there's the outer meniscus, and we can put the probe underneath.

Top of the shin, end of the thigh bone.

Just dim the lights very slightly.

So, lights down, guys, just so we can see a little bit more clearly.

Yep, lights down.

So again, the covering on the end of the thigh bone, the meniscus, the top of the shin bone, and there's the ACL.

That's the outer compartment of the knee, which looks great.

Oh, that's lovely. Thank you.

No worries.

Great mood lighting. I love it. Great, Gisele.

If we come over, we can do the same on the inside now.

Probe again.

We'll have a little look here. We're not anticipating any issues here at all.

So, she's just turning in slightly.

Mark, can you come here and hold the foot for me next time I rotation?

I just want to have a quick look at her meniscus. Just like that. Sounds good.

So, let's just focus a little bit here, and let's empty the knee so we can see a bit more what we're doing.

End of the thigh bone, top of the shin bone. That all looks great.

We can even go into the back of the knee here if you want. Relax that off.

We can actually drive into the back of the knee, and we can look in the back of the knee at the back of the meniscus there, right in the back.

So, I'll just take a photo for the Kodak moment.

That all looks great. Now, I'm going to come back, and we're going to treat what needs to be treated, which is this area of damage.

So, we'll have a probe again, and let's quantify this a little bit. So, this is the loose area that's catching and causing the problems.

You can see how that might be doing that. The actual kneecap sits a little bit bad.

She's sitting a little bit more here, so she's slightly this way, but the rest of the kneecap looks nice.

There's a little bit of overhang here on the outside. So, if we go around... Actually, no, that's good.

That's good. There's just a medial beset inner area.

Let's have the shaver first, the nice, clean, new shaver you know is-

Yep, you want the shaver into the room. Yeah, all right.

Perfect. The gentle one.

Wow.

There's a tiny little shaver.

If we put that into the knee, we can very gently take off this area of damage.

The big man is already flying.

Flying.

Do I hear the dulcet tones of the Red Baron?

No. It's more of a werewolf.

See how soft this is?

I'm just going to get this back to stable, nice cartilage.

This is about eight millimeters across.

Small area.

I just want it to be stable.

Just turn the anesthetic machine down.

Don't turn it off, but just turn it down slightly.

That's safe. What we're going to do is we're going to empty out all the fluid in the knee.

We're sucking the fluid out. All the lights on there, dear today.

All right. And then we're just going to close the two little wounds.

Just have a swab so we don't frighten the audience.

It was just the medial facet, nothing in the propial.

Just the medial facet.

So we've got these two tiny wounds, and we're just going to close those with two stitches.

All right. Don't want to- Stitches, thanks. Nylon, thanks.

So nylon stitch. So one on one side.

These come out at around about 10 days.

Small plates, Mark.

Swab again, please.

That's it. Perfect.

Can you just go down and disconnect me, and you can print the picture.

I'll keep all the photos to give to her.

See the front compartment, the inner compartment, the outer compartment.

The only thing that was problematic here was a little tiny bit of damage

to the inner aspect of the kneecap. And she should do really well with her knee.

Nylon is 3.0?

Nylon 3.0.

At the end, we put local anesthetic in.

So we put it- There you go ... in where we made the little incision.

And into the knee itself.

It's just long-acting. This will last her tomorrow.

Full weight bearing.

Full weight bearing. TED stocking, Flowtron boots. Steri-Strips, thanks.

One more dry swab.

Thank you.

That's it.

Thank you.

That's proper music.

That's proper music, buddy.

Finally.

You're welcome.

No medication for her.

Just not problematic, I guess.

Just TED stocking, Flowtron boots, early mobilization. Full weight bearing.

So this young lady will go home in an hour or two.

She'll take it easy for 48 hours, and then she'll be able to resume normal activities.

She'll be able to go back to work. Actually, she's at university.

She'll be able to go back to university on Wednesday, in four or five days' time.

And we would say back in the gym in sort of two or three weeks.

It's very important to do a nice, pretty bandage.

Sticky tape, thanks. It's here as well. Perfect.

No worries.

We're in a plastic surgery hospital, and they're the best at bandaging.

Perfect.

Well done. Thank you