Knee and shoulder arthroscopy in Kyiv

Arthroscopy is an endoscopic method of joints investigation and treatment. This is a surgical intervention of less invasiveness carrying out in sterile conditions under general or conductive anesthesia. Arthroscope is a videocamera with optic devises and light conductor. Arthroscope and instruments are introduced through small punctures (some mm in diameter), the joint is filled in with a fluid and the image is transmitted to the screen. This method allows to peep into the joint, diagnose the damage or disease and to eliminate the problem. For example, if there is a knee joint meniscus damaged, the broken area closure or meniscus resection is carried out. In chondromatosis bone and chondral fragments are elimenated, in synovitis synovectomy is performed. Arthroscopic technique also makes it possible to carry out the cartilage defects forage, an articular lip anchoring in a shoulder-slip (Bankhart’s operation), retinaculums release and duplication in patellar dislocation. In knee joint instability anterior and posterior crucial ligaments plastics is performed under an arthroscopic control. Quite often joint diseases are far consequences of traumatizing as for instance cases of arthrosis or meniscus problems in anterior crucial ligament long-standing damage. Therefore, arthroscopy is a method of great diagnostic value as well.

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Anterior instability of knee joint is pathological condition caused by affection of cruciate ligament of knee joint

It is the one of the most wide spread types of intraarticular ligaments damages. Ptella and muscles with tendons are main and first (during movments) stabilizers of a joint. Ligaments, including intraarticular ones (anterior and posterior cruciate) are additive stabilizers. However, cruciate ligaments fulfil a necessary work especially in time of running on uneven surface (as far as muscles are not ready for stabilizing) or sufficient loads on knee joints. Majority of patients with anterior cruciate ligament affection develop arthrosis and damage of menisks resulted by instability of joint and violation of its congruence. Therefore operative intervention  - anterior cruciate ligament reconstruction is performed in case of anterior cruciate ligament affection. Arthroscopic method is used in time of operations on knee joints especially in damages of meniscs and anterior cruciate ligament. Fragments of tendons of adducent group of muscles are used as autotransplant. Channels are drilled in bones and new ligament is installed inside. New ligament is fixed with titanium or bioabsorptive implants. Cruciate ligaments accrue within 3 - 4 weeks, during this period patient should limit movements and loads but can walk. It is allowed to run and jump 2 months after operation. Anterior cruciate ligament reconstruction details and main stages are presented in video. 

Knee joint meniscus damages

As a rule, meniscus traumas occur in rotation, knee joint excess adduction or abduction in half-bent position. They manifest in pain syndrome in joint fissures region, blockage of a joint and hemarthrosis. Joint blockage is resulted by meniscus damaged part entrapment between two joint surfaces. Magnetic resonance imaging may be used in order to confirm the diagnosis. Arthroscopy is carried out in meniscus damages. Meniscus suturing or resection is a method of choice in dependence of zone of the damage. Meniscus suture is performed when “alive” zone capable of jointing is damaged.

Luxation of a shoulder joint and Bankart repair

The frequency of this trauma makes a half of total number of all luxations. This is connected with uneven correlation between joints working surfaces square from one side and great volume of movements from another. It usually occurs in falling on abducted hand. Luxation of a shoulder joint is accompanied with damage of joint capsule and joint lip and is sometimes combined with a fracture of greater tubercle or rotating cuff. Dependently on dislocation direction a shoulder joint frontal, back and lower fractures are marked. Jenelidze, Cocher, Hippocrate and Mot methods are used to obviate luxations. Desault's bandage is applied for 3 weeks after removing of luxation and control X-ray carrying out. In case of insufficient fusion of joint capsule repeated fallings out of shoulder are possible and luxation becomes habitual one. Habitual dislocation should be treated operatively. Suturing of capsule defects and sewing of a joint lip underneath joint surface of a blade bone, the so called Bankart’s operation, is performed. This operation may be carried out in arthroscopy or opened way. Laterge intervention – plastics of joint surface with an autograft – is performed in defects of joint surfaces.