November 25, 2022 by John Fernandez
Arthroscopy of Knees and Shoulders: Perfecting Big Repairs Through Tiny Incisions
Knee or shoulder arthroscopy — requiring only very small incisions — is more successful at reducing or eliminating pain from cartilage or soft tissue damage, compared to standard surgery. For most patients, the recovery period of up to six months or so that involves extensive rehabilitation remains the same — but the short-term pain and mobility issues are resolved much quicker following arthroscopy.
Both patients and doctors prefer arthroscopic procedures instead of arthrotomy, which refers to traditional open surgery that requires cutting open a joint and inspecting cartilage, ligaments and other structures.
“I’ve been fortunate enough that I haven’t had to do an open arthrotomy in more than 15 years,” said Fernando A. Moya, M.D., Ph.D., orthopedic surgeon at Baptist Health Orthopedic Care in Plantation, who specializes in knee and shoulder arthroscopic procedures. “For example, you don’t need to have a four- to six-inch incision in your shoulder and you do not need to have your deltoid dismantled. I go in there and then I can fix all of these very difficult issues through little holes.”
An arthroscope is a small tube that is inserted into the joint. It carries a system of lenses, a small video camera, and a light for viewing. The camera is connected to a monitoring system that lets a surgeon view everything. The arthroscope is often used with other tools that are maneuvered through another small incision. These tools are used for grasping, cutting, and probing.
The vast advantages of arthroscopy vs. open surgery are quite evident in the short term.
“If you have a big wound in the knee or in the shoulder from traditional open surgery in the first six weeks, you’re going to have more pain,” explains Dr. Moya. “You’re going to have problems walking and you’re going to have problems doing simple activities with your extremities. However, by doing it the procedure arthroscopically, you’re doing tiny wounds and the short-term recovery is much sooner.
Of course, arthroscopy is just one option for patients with shoulder or knee issues, he adds.
“When you come to me, I’m going to be able to figure out exactly the cause of your pain, and give you the best choice of treatment,” said Dr. Moya. “And that treatment may be medication, physical therapy, rest, or may be injections. And in those patients who have things that are torn that are not getting better, then they get arthroscopic procedures.”
Common Knee and Shoulder Injuries
In the knees, the most common issues are related to the ACL (anterior cruciate ligament) and the meniscus. The ACL runs diagonally in the middle of the knee and helps stabilize it. Symptoms include knee swelling, instability, and pain.
A torn meniscus is one of the most common knee injuries, occurring in the rubbery cartilage that cushions the shinbone from the thighbone. Forcefully twisting or rotating your knee, especially when putting your full weight on it, can lead to a torn meniscus.
“A twisting injury can be someone going from sitting down on the floor to getting up — and you can tear your meniscus like that,” said Dr. Moya. “A common scenario involves hyperflexion (when a joint is flexed beyond its normal range of motion), or a changing-directions injury, like football players do.”
Common shoulder injuries often involve the rotator cuff. The arm is kept in your shoulder socket by the rotator cuff, a group of four muscles that come together as tendons to form a covering around the head of the humerus. Rotator cuff tear is a common cause of pain and disability among adults. You don’t have to be a tennis player to require repairs of rotator cuff tendon tears, sometimes involving the bicep or tricep muscles of the upper arm.
And then there’s arthritis, a common cause of knee pain, discomfort or mobility issues. Patients need to know that arthroscopy does not work for treating arthritis.
“We do treat knee arthritis, and we do give them the non-surgical options to avoid the total knee replacement, but arthroscopic knee surgery does not work for arthritis,” he said.
Overall, when someone makes an appointment to see Dr. Moya, it’s because they’re having shoulder or knee pain or dysfunction. If ligament tears or other injuries can be repaired via arthroscopy, then Dr. Moya does what he’s been practicing for more than 20 years.
“For tears involving the rotator cuff I have not had to do an open procedure for those,” said Dr. Moya. “The same for other issues involving the knees and shoulders. I’ve done so many arthroscopic procedures that I have perfected the art of doing these big repairs through tiny holes.”