Arthroscopy or not? Treatment of the knee joint using arthroscopy, recovery after surgery, reviews Possible complications after surgery.

Knee joint it hurts, creaks, aches, prevents you from moving normally, in a word, it became the real reason for going to the doctor. You gather your strength and come to a specialist, honestly answer all the questions, take a bunch of tests, and he, shaking his head, suggests doing an artoscopy knee joint and asks for your permission. And you are asking a logical question: what kind of artoscopy is it, why is it needed, should you give your consent? After reading this article, all your doubts will be dispelled, and making the right decision will not be difficult.

What is arthroscopy? Technique and indications

Arthroscopy is essentially one of the options surgical intervention, only less penetrating, and can be used on most joints. This procedure, an alternative to arthrotomy - completely opening the joint, is used to diagnose and treat diseased internal parts of the joint.

In different areas knee two small incisions are made, one of them is intended for inserting an arthroscope into the joint, the second is for working with surgical instruments. An arthroscope makes it possible to obtain an image of the articular surfaces and ligaments and determine the location and extent of their rupture. The information content of such a study is almost 100%. The instruments that the surgeon uses through the second incision are not ordinary surgical ones, but special, small ones, with their help you can remove inoperative parts and restore damaged parts of the joint and torn ligaments, treat injuries to the meniscus - a cartilage pad that is a shock absorber in the joint.

Thus, indications for the procedure include damage to the ligaments, menisci and synovial (articular) membrane, fat body, rheumatoid arthritis and deforming arthritis. However, in the latter case, the value of arthroscopy is more diagnostic than therapeutic. It allows you to determine how deformed the joint is from the inside, in which specific places. Rheumatoid arthritis is another disease, the diagnosis of which often requires arthroscopy to determine uneven changes in the joint areas, proliferation of the synovial membrane and the degree of narrowing of the joint space. Arthroscopy also makes it possible to remove pathological synovial (joint) fluid, which contains particles of cartilage, films and fibrin threads - a protein that forms adhesions.

Arthroscopy: pros and cons

Arthroscopy has a number of advantages over a more serious surgical intervention - arthrotomy, which is why it has become so widely used. With arthroscopy, the joint is not fully opened, this makes it possible to preserve as much as possible connective tissues, which is the key to successful postoperative rehabilitation, with open joint surgery this possibility is significantly reduced. Another advantage of arthroscopy is quick rehabilitation, because this procedure is not a full-fledged surgical intervention. Slight invasiveness, that is, minimal penetration into the body, is a very important principle of treatment, because the more extensive the damage during surgery, the higher the likelihood of infection in the wound and the development of other complications. Thus, arthroscopy, in which only a few four-millimeter incisions are made, has become a real godsend.

Procedure requires the introduction of an irrigation fluid, which is designed to separate the articular surfaces and improve visibility with the help of an arthroscope, but it also has a therapeutic effect. But there is a pitfall here. If the surgical technique is not performed correctly, the irrigation fluid may penetrate into the areas around the joint. soft fabrics, cause hemorrhages, swelling and hematoma (bruise), so in this matter a lot depends on the professionalism of the doctor himself.

Cosmetic effect This is an important point for many, arthroscopy helps to avoid the need for a large number of stitches, so you will be spared ugly scars.

Procedure has a number of contraindications. For example, when adhesions form between the articular surfaces - adhesions; when a joint contracts, its mobility is limited. Thus, for deforming arthritis, arthroscopy is performed if there are flexion movements in the joint with an amplitude of at least 60 degrees.

Because the arthroscopy is performed under anesthesia; the inability to relieve pain, for example, due to intolerance to the anesthetic, is a contraindication to the procedure.
Another serious one contraindication is a period of exacerbation rheumatoid arthritis, as well as the presence infectious diseases knee joint.

Rehabilitation

Period recovery after knee arthroscopy much less than after surgery and lasts about a week, perhaps a little longer in some cases.

Necessary apply an aseptic dressing with an elastic bandage, while preventing the development of . In this case, drainage remains in the joint for the first two days to remove excess lymphatic fluid. Antibiotic therapy is important. A broad-spectrum antibiotic is injected into the joint during arthroscopy to prevent the development of an infectious process. Sometimes it becomes necessary to apply a posterior plaster splint for a couple of days, all this is done to immobilize the joint.

First day It is important to periodically tense the thigh muscles and carry out movements in the ankle joint. On the second day, the drainage is removed, it is necessary to begin passive movements of the joint, avoiding painful sensations. On the fourth day you need to resort to strictly dosed physical activity, from now on the joint should not remain unclaimed. Movement helps improve blood circulation and relieve congestion. On the sixth day, the range of motion of the joint should already be 150 degrees.

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There are quite a few effective ways diagnosis and treatment of joint pathologies. However, knee arthroscopy is especially popular among both doctors and patients. On such a choice, attitude and positive reviews The operation was reflected not only in the low-traumatic nature of the manipulation, but also in the affordable price.

Benefits of the operation

Thanks to the introduction of arthroscopic surgical methods into joint surgery, doctors have been able to achieve high efficiency in diagnosing and treating knee pathologies.

1. Reliability of results. During an arthroscopic examination, all projections of the internal parts of the joint are displayed on the screen without violating its integrity.
2. Minimal invasiveness. The operation does not require opening the joint. Instruments and video equipment are inserted through microscopic punctures.
3. Short length of hospital stay. After surgery, the patient is discharged literally on the second or third day.
4. Relatively short rehabilitation period. Depending on the type of operation, the patient after arthroscopy returns to work within three weeks, and a return to professional sports is allowed after 4 months.

This ratio of benefits allows you to solve many knee problems without risking long-term immobilization of the limb.

Video

Video - Why arthroscopy is needed

When is arthroscopy performed?

Treatment of any knee pathology begins with diagnosis. Imaging studies are usually necessary to detect internal changes and damage to the joint. Most often, doctors perform x-ray examinations. However, such an examination is not able to reflect the true state of some intra-articular structures. Damage to the meniscus, cartilage and ligaments, especially minor ones, are not recorded on photographs.

Of course, tomographic studies provide a more detailed picture. But they are also unable to show the versatility of the picture.

Therefore, doctors resort to intra-articular examination to find out the origin of some diseases.

The uniqueness of the operation is expressed in the possibility of combining diagnostic measures with therapeutic ones. Therefore, when certain pathologies are detected, measures to eliminate damage and unnatural formations are carried out without delay.

• in case of damage to the menisci for plastic surgery or partial menisectomy;
• to eliminate ligament tears;
• in case of damage to articular cartilage;
• for correction of the surface of cartilage tissue;
• to remove foreign bodies or loose bone and cartilage fragments.

In addition, the operation is prescribed when inflammatory diseases when any effusion is removed and. This method also allows injection into the knee medications, For example Fermatron, allowing to reduce inflammation and speed up regeneration processes.

Preparing for surgery

• in a diagnostic examination, consisting of laboratory tests, x-rays, ECG, examination by an orthopedist and consultation with a therapist;
• in refusing to take medications that affect blood clotting a couple of weeks before the intervention;
• in the complete elimination of bad habits such as smoking and drinking alcoholic beverages.

In addition, in the presence of inflammatory or infectious diseases, surgery is postponed until chronic pathologies enter the remission stage. 12 hours before the intervention you should refuse to eat any food.

Despite being minimally invasive, knee arthroscopy is a surgical procedure. Therefore, it requires anesthesia. The anesthesiologist chooses which anesthesia to use based on the examination results and the patient’s condition.

1. Local anesthesia. This anesthesia is simple to perform, relatively safe, but has a short-term effect. In addition, with this method of pain relief, the presence of a large amount of anesthetic creates certain difficulties for intra-articular manipulation.
2. Conduction anesthesia. This anesthesia is performed by injecting lidocaine to block the nerves of the thigh. The limb loses sensitivity for almost 1.5 hours.
3. Spinal anesthesia. Anesthesia is administered by injecting the medicine into lumbar region spine. The patient remains completely conscious. You can prolong anesthesia using dosed administration of the drug through a catheter.
4. General anesthesia. Such anesthesia, of course, allows you to regulate how long the operation will last, but it has a number of negative aspects and risks.

Arthroscopy technique

At the beginning of the operation, a tourniquet is applied to the patient on the thigh of the operated limb. This method allows you to reduce blood flow into the joint and improve visual control.

To perform arthroscopy, three incisions are made in the joint, which do not exceed 7 mm.

How long the procedure will last will depend on the purpose and complexity of the intervention.

After all manipulations are completed, the instruments are removed from the knee joint, and the previously injected fluid is pumped out.

After operation

Quite often, after the procedure, antibacterial or anti-inflammatory drugs are injected into the knee joint.

• restore the protective properties of the liquid;
• reduce inflammation;
• protect cartilage tissue;
• stimulate the production of hyaluronic fluid.

Besides, Fermatron Should be used to reduce pain and eliminate knee stiffness. For maximum results, 4 injections of the drug are prescribed. Fermatron. The doctor decides how many injections will be given. Medicine Fermatron is available in a disposable syringe, which prevents loss of the drug and the risk of infection. Injections with the remedy Fermatron injected directly into the joint, maintaining an interval of 7 days between injections.

Administer medicine Fermatron only an experienced physician can preliminary preparation joint If fluid accumulation is observed, before administering the product Fermatron a puncture is performed to remove it. Efficacy after intra-articular drug therapy Fermatron persists for six months.

The patient is in the hospital for no more than three days. During this period, painkillers and vascular drugs are prescribed. As preventive measures Antibacterial medications may also be prescribed. The operated limb is provided with temporary immobilization. For this purpose, a plaster splint or special orthoses are used.

Already on the second day, exercise therapy begins. Initially, the load is directed to training the muscle tissue of the limb. It is allowed to load the knee from the sixth day. And a week after arthroscopy, the knee can be bent.

During the rehabilitation period, emphasis is placed on therapeutic exercises. Rehabilitation therapy is supplemented with physiotherapy, massage and alternative methods of developing the knee.

Cost of the operation

Arthroscopy has become a fairly common method of treatment and diagnosis. Therefore, patients do not have questions about where to have surgery. Such services are offered by private clinics and any traumatology or surgical departments of federal clinics. If desired, such an operation can be performed in European or other foreign clinics.

The main question when choosing a location for an operation is its price. The cost may vary significantly depending on the country, the status of the clinic and the scope of services included in the price. Thus, arthroscopy in America can be offered for both 4700 $ dollars and for 30000 $ dollars. Israeli and German clinics perform knee surgeries for 3000-4000 $ dollars.

In Russia, you can perform arthroscopic surgery, the price of which will be from 25 thousand rubles. In municipal clinics it is possible to perform arthroscopy almost free of charge.

Knee arthroscopy is an endoscopic operation used for the purpose of comprehensive diagnosis and surgical treatment of various joint injuries. A highly informative visual technique allows for high-quality examination and treatment of the joint in a closed manner, using puncture portals, which significantly reduces the degree of surgical trauma, minimizes pain and significantly shortens the recovery period.

A visual diagram of the operation.

It began to be used as an operation at the dawn of the 20th century. But until now, the procedure has gone through many stages of improvement. And now it has become a truly indispensable area in orthopedics, thanks to minimal trauma, one hundred percent diagnostic accuracy and high efficiency.

Concept and advantages of the procedure

Surgery is performed using specialized fiber optics modern generation, built into an innovative device called an arthroscope. Thanks to the unique device, the procedure got its name. The process involves an internal study of bone and cartilage tissue, menisci, tendons, muscles, ligaments, connective tissue elements, and synovial fluid.

Image of the joint cavity.

For the purpose of highly informative diagnostics, a specialist, through a microportal, inserts the working tube of the device into the joint, into which a system of ultra-strong lenses, a powerful light source and digital video recording equipment are mounted. All structures that the arthroscope “sees” are visualized on the screen in a “live” form, and the image is received in a many times enlarged format. The doctor can find the exact location of the injury or degenerative changes, determine the nature of the pathology, the severity and take action.

Arthroscopy has been proven to be superior to any existing diagnostic methods. It clearly shows from the inside all the structural units of the bone connection in the smallest detail, allowing you to identify even small hidden damage that cannot be detected using standard fluoroscopy or arthrography, ultrasound, MRI, CT and other popular imaging methods.

The method is used not only as a diagnostic tool, but also as a therapeutic and restorative tactic. Having discovered certain violations of the cartilage surface, the doctor can immediately eliminate them. He will perform surgical manipulations through an additional incision (about 6 mm in size) using microsurgical instruments, and he will perform the entire process while looking at the monitor.

Indications and contraindications

Let us immediately note that treatment extremely rarely leads to negative consequences. However, this cannot be ruled out if it was done despite contraindications. But first we will cover the recommendations, and then the restrictions.

Partial tear of the lateral ligament of the knee joint.

The procedure may be prescribed for:

• an unclear cause of pathological symptoms, when other methods are powerless to establish it;
• ligament ruptures, damaged tendons;
• suspected dislocation of the calyx (patella);
• the presence of free bodies in the cavity;
• inflammation of the synovial membrane of unknown origin;
• aseptic necrosis of the head of the articular bone;
• injuries, degenerative-dystrophic diseases of the meniscus;
• arthritic disease and gonarthrosis;
• intra-articular fractures, etc.

It is contraindicated in the presence of such ailments as:

• hypertension;
• diabetes mellitus in the stage of decompensation;
• disturbed balance of blood clotting;
• severe dysfunction of the pulmonary or cardiac systems;
• local skin inflammation.

Therapeutic and diagnostic arthroscopy is performed with caution; the consequences can be unpredictable if you are allergic to local/general anesthetic. Therefore, be sure to tell your specialist if you have a tendency to allergic reactions for any medications.

Preparing the patient for surgery

Preparation consists of a thorough examination of the patient, collecting anamnesis, and conducting basic instrumental and laboratory tests. Until the doctor is convinced that this is a safe operation and weighs the pros and cons, the operation is impossible. Therefore, at first, a round of some specialists of a narrow profile is always prescribed, for example, in addition to an orthopedist or traumatologist, depending on the situation, also a cardiologist, endocrinologist, pulmonologist, allergist, etc.

It is extremely important to take into account absolutely all the results of the preliminary diagnosis. They will influence the choice of anesthesia; a special role is given to the selection of the optimal type of anesthetic that will not cause harm to the body.

In addition to medical rounds, the patient is given directions for an ECG and fluorography, and for laboratory tests of blood and urine. Having made sure that it is advisable to undertake this operation, they conduct a consultation on preparation. During the consultation, you are warned that you will need to stop eating 12 hours before the procedure, and stop taking anticoagulants (aspirin, heparin and medications based on them) a couple of weeks before the procedure.

Patients who left reviews report cautionary recommendations from doctors regarding smoking and drinking alcohol. You will have to give up bad habits 10-14 days before the intervention and, of course, try not to return to them afterward or at least minimize the dose. If you intend to resort only to diagnosis, preoperative preparation is carried out according to similar rules.

Description of the microsurgical process

In reviews, patients tell how quickly and painlessly they underwent the procedure, without general anesthesia. This is quite likely, but do not forget that clinical cases are not the same for everyone, and the physiological status of each patient is different. Therefore, it would be more correct to say that pain, thanks to strong local anesthesia, is almost impossible. However, post-operative discomfort in the area of ​​the operated area will most likely bother you a little for some time.

Disintegration of ligaments when they rupture.

The video allows you to understand all the intricacies of the process. There are plenty of them on the Internet. But due to the fact that not everyone will be able to watch specific stories to the end, we suggest that you simply and calmly read about the important points.

Positioning of the patient on the operating table.

Based on etiology and degree pathological changes, the patient’s condition and concomitant diseases, the anesthetic agent is selected individually. Most often used local anesthesia, that is, regional anesthesia (epidural or conduction). The regional anesthetic contains lidocaine, ropivacaine or bupivacaine. To enhance the anesthetic effect, a medicine from the opiate category can be added to the main solution in a mini-dose. In some situations, however, general intravenous anesthesia is appropriate.

First, regardless of the surgeon's plans, a diagnostic arthroscopy will be performed. It involves inserting an endoscopic probe in the form of a rod into the cavity of the bone joint. When anesthesia takes effect, then diagnostic surgery begins. To do this, the limb, half bent at the knee, closer to the thigh, is twisted to reduce blood flow, after which a puncture (6 mm) is made, through which a contrast agent is injected to enhance the visibility of the articular and periarticular structures. Next, a tube is inserted through this operating port. The specialist thoroughly examines every millimeter of the problem organ.

The surgical field, you can see a glow inside.

The video is broadcast in real time on the screen and reveals any existing defects in the diseased joint. If the doctor considers it necessary to perform regeneration of pathological elements, he will create an additional incision (6-8 mm), through which he will eliminate the detected defect using the necessary instrument from the microsurgical set. He can perform partial resection of osteochondral tissues, plastic surgery of ligaments and tendons, suturing or removal (partial, complete) of the meniscus, expropriate chondromic bodies, extract effusion and pus, administer anti-inflammatory drugs, take a fragment of tissue or synovium to study their composition, etc.

At the end of the surgery, the surgical field is washed and all instruments are removed. The doctor treats the wound with disinfectant compounds, installs drainage and makes a small suture, which he closes with a sterile adhesive plaster. On the operated knee, in order to give it maximum immobility, a tight fixing bandage is applied from the foot to the middle of the thigh.

The entire session takes an average of 1 hour, in some cases up to 3 hours. Restorative measures are simple, but they must be strictly followed so as not to provoke dangerous complications. Negative phenomena that can develop will be discussed further.

Complications after knee arthroscopy

Like anyone surgical method, this method, even with all its minimal invasiveness, can have an unfavorable outcome. Complications result from non-compliance with rehabilitation standards, violation of the principles of asepsis and antisepsis, and medical errors. An unfavorable picture occurs infrequently, so there is no need to panic. You must initially take full responsibility when choosing a clinic.

ACL reconstruction.

Knee arthroscopy is a minimally invasive surgical intervention into the joint.

It is performed to diagnose or treat a number of orthopedic injuries, injuries of the knee joint and has qualitative advantages over open surgery.

What is the essence of the procedure

In cases where the patient does not help drug treatment– use surgical.

Arthroscopy of the knee joint in today's medicine is the least traumatic surgical treatment of joints.

IN modern medicine Diagnosis of diseases of the knee joints in most cases is carried out using MRI (magnetic resonance imaging), however, this method does not always provide a 100% guarantee of the correct diagnosis.

The video shows the process of diagnosing the knee joint using this technique.

The operation is carried out using specialized arthroscope equipment (a type of endoscope - a device designed for penetration and internal examination of organs) and high-precision optics connected to a high-resolution video camera.

All manipulations performed during joint surgery are visible on a monitor with multiple magnification.

Unlike open surgery, with ACS, the trauma to tissue, cartilage and ligaments is so minimal that the recovery process is reduced significantly, increasing the chance of a successful recovery for the patient.

Indications and contraindications for the procedure

Prolonged or ongoing pain and swelling in the knee joint, difficulty turning, moving or flexing-extension, injury during exercise - all this indicates the need to visit an orthopedic doctor.

Indications for knee arthroscopy are:

• rupture, damage to ligaments or meniscus (one or two);
• ambiguity clinical manifestations illness or injury;
• defeats cartilage tissue, Koening's disease;
• chronic synovitis;
• avascular necrosis of bone tissue of the knee joint, etc.

These could be:

• fusion of bone, cartilage or other joint tissues until the joint is completely immobile;
• systemic chronic diseases(severe stages diabetes mellitus, of cardio-vascular system etc.);
• wounds in the area of ​​the knee joint, complicated by infections or purulent-inflammatory foci;
• severe injuries with large hemorrhages into the joint cavity.

How is the operation performed?

This surgical operation involves anesthesia.

It is selected depending on the patient’s tolerance to a particular type of drug, the time of the operation, or simply the preference of the person being operated on (local, spinal, general anesthesia).

Three incisions (from 4 to 7 mm) are made in the area of ​​the knee joint. An arthroscope is inserted into one, which transmits a clear, multi-magnified image (up to 60 times) to the monitor.

The second and third are for entering tools.

Through the second (inflow and outflow tubes) a special liquid (saline solution) is supplied to enlarge the cavity and improve visibility, and the liquid is also removed, along with fragments of tissue material. Through the third, the appropriate instrument performs the surgical action itself (the one that is indicated for a given type of disease or injury).

After the operation, the wounds are sutured and closed with a gauze bandage. Usually the bandages are removed on the third day and the wounds are covered with a plaster.

Consequences of the procedure

Statistics on knee surgeries show that the consequences of arthroscopy, if performed by a professional, are minimal (up to half a percent).

But they can still arise:

• fever, chills, or fever;
• periodic, constant or increasing pain in the joint, redness of the skin or an increase in its temperature around the joint;
• pain radiating to hip joint or calf muscles;
• progressive swelling.

The causes of this condition may be complications that arise both during the operation and after it.

During the procedure there may be:

• large ones affected blood vessels(artery or vein);
• During the operation, small parts of the instrumentation may break off and remain in the cavity of the joint;
• manipulation of the instrument carried out with the application of force can lead to sprain of the ligaments (lateral internal).

After operation:

• the occurrence of infectious diseases (arthritis, bursitis);
• filling the joint cavity with blood (hemarthrosis);
• inflammatory processes of postoperative scars;
• disruption of the activity of nerve endings in the area of ​​surgical intervention leads to tissue damage and pain syndrome(algodystrophic);
• thromboembolic problems.

With timely consultation with a doctor, all cases are curable. In extreme cases, there is a need for a new surgical intervention - washing the joint and drug treatment.

Rehabilitation and recovery

After arthroscopy, rehabilitation and recovery procedures begin, which can last from 2 days to two weeks.

Dressings, analgesic and anti-inflammatory drug therapy, if necessary - therapeutic or cooling compresses, massage, electrophysiotherapy.

A special exercise therapy complex is also prescribed.

In the first week, do not forget:

• alternating load and rest should be carried out strictly as directed by the doctor;
• several times a day - a cold compress;
• wearing a fixing bandage or bandage made of an elastic bandage;
• V horizontal position The CS should be above chest level.

Reviews from doctors and patients

Let's study reviews from doctors and patients to know what knee arthroscopy actually is.

How much does the procedure cost and where can it be done?

The cost of knee surgery depends on the complexity of the operation and the clinic in which it is performed.

Today, such an operation can cost from 15,000 to 105,000 rubles. Prices for arthroscopy of the knee joint for diagnostic purposes range from 5-6 thousand rubles to 11 thousand.

This operation requires high-precision medical equipment, so it is carried out mainly in large cities of our country, but throughout the entire territory of the Russian Federation.

Treatment can be obtained in the following clinics:

• FGU "CITO im. N.N. Priorova";
• Clinic of Vascular and Joint Surgery;
• Moscow Scientific and Practical Center for Sports Medicine;
• clinic based at City Clinical Hospital No. 59;
• Russian Scientific Research Institute of Orthopedics named after. R.R. Vredena (St. Petersburg);
• CNMT (Novosibirsk);
• MC Mirt;
• SportClinic (St. Petersburg);
• City Clinical Hospital No. 6 (Penza), etc.

Ankle surgery: recovery from ankle surgery

Despite the fact that the bones at the base of the feet are thinned, they account for the entire bulk of a person’s weight. An ankle fracture is considered a rather dangerous injury, since the symptoms of a fracture are often confused with the symptoms of a dislocation.

Due to improper treatment, all sorts of serious complications can arise.

An ankle fracture can be:

• No offsets;
• Combined with dislocation of the bone to the internal, external or anterior side;
• Open form;
• Closed form;
• With offsets.

How does the operation take place?

Most often, the doctor insists on performing surgery on the ankle joint. Thus, after a fracture, the first task is to compare the destroyed fragments of the bones of the joint so that the tibia quickly and effectively heals.

Usually, after surgery, the ankle joints have the opportunity to fully restore their functionality. Special attention Orthopedic doctors pay attention to the selection of the necessary implants that fix damaged bones, preventing them from shifting and moving. They are selected based on the characteristics of the injury.

If there was no displacement during the ankle fracture, the bones will heal faster. It is important that the operation is performed only by experienced doctors to eliminate the risk of complications after surgery.

When it is not possible to compare bone tissue, surgery is performed using metal plates and screws. The remaining bone tissue is fixed onto a plate. The joint remains in this condition for at least twelve months.

All this time, the patient is contraindicated to put any stress on his sore legs. After a year has passed, the plate is unscrewed and a bandage is applied to the operation site. In this case, the patient is allowed to place light loads on the limbs.

Ankle surgery begins with choosing where to place the screw at the base of the bone marrow. All this time the process is monitored using x-rays. In difficult cases, the canal is drilled.

The screw is inserted into the bone marrow without drilling in several main stages:

• A fixator is implanted;
• Posterior blocking is carried out in the direction of the screw from the body;
• The bone fragments are compressed;
• Proximal blocking is carried out in the direction of the screw towards the body;
• With additional comparison of fragments of damaged bones after insertion, the screw is adjusted.

The most common method of performing joint surgery is the reaming option. During surgery, dead cells are eliminated. In general, the screw can act as both an implant and part of the destroyed bones.

Similar methods are used for fractures of the shoulder and other joints, and this operation is also performed for elbow injuries.

Ankle arthroscopy

Modern method surgical treatment and diagnosing diseases of the shoulder, ankle and other joints, arthroscopy is used. It allows operations on the elbow, knee and other joints without cutting tissue.

Treatment with arthroscopy is indicated for:

1. Chronic pain in the ankle, elbow, knee joint that does not respond to conservative therapy.
2. Instability ankle joints after being injured.
3. Synovitis in case of systemic and non-systemic lesions.
4. Damage articular cartilage and chondromic bodies of the ankle joint;
5. Early stage of deforming arthrosis of the shoulder and ankle joint;
6. In advanced stages of arthrosis of the shoulder and ankle joints.

During arthroscopy of the ankle, shoulder, knee, elbow joint The patient is given conduction or spinal anesthesia. An arthroscope is inserted through small incisions in the skin. Next, a special tool allows you to remove bone and tissue growths. The comparison of fragments of destroyed bones is controlled in a similar way.

Due to the low level of trauma after arthroscopic treatment, restoration and fusion of the ankle, shoulder, knee, and elbow joints occurs very quickly, compared to open surgery.

Already five weeks after the intervention, the patient is allowed to walk fully. Any complications in the form of inflammation or septic arthritis usually do not appear during the rehabilitation period.

Also a big plus is the fact that during arthroscopy the nerve endings, blood vessels, tendons. The wound at the incision site heals in no more than three days.

Post-traumatic treatment

Treatment during the rehabilitation period is practically the main and important way to restore the functionality of any joint - ankle, shoulder, knee or elbow. After receiving an injury, the recovery process must be approached with special responsibility.

Many doctors recommend doing physical exercises regularly. At first, therapeutic exercises must be done under the supervision of an instructor who will teach you how to correctly and competently select loads on the injured limb.

It is important to remember that the ankle is a complex joint, so the load must be increased gradually. A therapeutic foot massage will be an excellent addition to the rehabilitation complex.

You can use a special elastic ankle bandage during the recovery period.

In order for the functionality of the joints to be restored faster, their development is required. To do this, the doctor prescribes the following types of exercises:

• Squat with physioball. The large ball is pressed against the wall, the feet are pressed firmly against the floor surface. The patient should try to squat so that the angle at the knees is right.
• Balance training. The healthy leg is bent at the knee, and the big leg is placed on a swinging platform. The patient will have to throw the ball and then catch it. This trains the balancing muscles.
• We jump on the downed leg. A vertical line is drawn on the floor or a long rope is placed. The patient will have to jump on one leg over a line or jump rope, gradually moving forward. This is how limb coordination is processed.

Before performing any exercises, you should consult with your doctor, who will assess the severity of the injury and determine the permissible load.

During the recovery period, it is important to eat increased amounts of foods containing calcium. Replenish strength and restore immune system Vitamins and minerals will help. The daily diet should contain the following products: bread, dishes from cottage cheese, fish, nuts, cauliflower, green beans, persimmons, with the addition of sesame seeds. Such nutrition will help quickly restore bone tissue.

To increase the silicon content in the body, it is recommended that the daily menu include raspberries, turnips, currants, cauliflower, pears and radishes. It is also necessary to consume vitamins C, D, and E.

Complications after injury

If the diagnosis was made incorrectly or treatment was not carried out in a timely manner, all sorts of complications may develop after the operation. If there is an open injury or weak bone tissue, infection may develop at the site of injury.

It is also dangerous for the patient if the ankle heals incorrectly. This can deform the joints and provoke arthrosis of the ankle joints. The patient may also experience chronic lameness and swelling of the feet due to poor circulation. The result of this condition is disability.

For this reason, in order to avoid any consequences after surgery, it is necessary to follow all the rules of rehabilitation in postoperative period. At the first signs of bone tissue damage, you should seek professional medical help.

Reviews of the drug for joints Fermatron

Fermatron is a viscoelastic drug that is administered by injection (injections) into the synovial cavity of the joint.

Most often, this medicine is used if a person has a disease such as arthrosis of large joints, for example, osteoarthritis of the hip joint.

Reviews about the drug:
“My mother is now 72 years old. She has arthrosis of both...”
“The doctors diagnosed me a long time ago...”
“I was previously diagnosed with an ACL injury...”
“My father has been receiving injections for a long time...”
“I gave injections...”
“I have never had any strong complaints about my knees...”
Let's summarize + interesting video!

Doctors note that Fermatron has excellent effectiveness and helps many patients significantly reduce the rate of progression of this disease. What do the patients themselves who have directly encountered this modern drug think about this?

This article will present real reviews about the fermatron. It is worth remembering that independent use medicines, without medical recommendations unacceptable, since this may not only become a direct cause of insufficient therapeutic effect from the introduction of fermatron, but also cause the development of new pathological processes.

Opportunities for receiving medical services under the compulsory medical insurance policy are limited to the basic and regional programs. However, despite this, there are regulatory documents that regulate the need to carry out certain diagnostic studies and procedures for the treatment of a particular disease. Today we will find out whether knee arthroscopy is performed free of charge under compulsory medical insurance or not.

Is it possible to do knee arthroscopy for free under compulsory medical insurance?

Athletes and people who constantly experience severe physical exercise, often encounter various joint injuries. Most often they complain of pain in the knee and a clicking sound in the joint when walking. The largest percentage of visits to traumatologists is observed in connection with meniscus damage.

X-rays and ultrasound do not provide a complete picture of the nature of the damage, so another study is often performed - arthroscopy. It is carried out using a special instrument “arthroscope”, which is inserted into the joint cavity. This study provides an opportunity not only to assess the severity of damage, but also to perform surgery knee joint.

Patients with joint problems are wondering whether it is possible to undergo arthroscopy under the free compulsory medical insurance program? IN state system Medical insurance provides a tariff for arthroscopy. Thus, citizens of the Russian Federation can undergo this surgical procedure free of charge.

Who and where can get a free operation under compulsory medical insurance?

Arthroscopy of the knee joint under the compulsory medical insurance policy is carried out in any specialized clinic that takes part in the state compulsory health insurance program for all citizens of the Russian Federation who own a compulsory medical insurance policy. Typically the procedure looks like this:

• examination, research and diagnosis in a clinic at the place of residence;
• receiving a referral to a hospital for surgery.

In this case, it is the referring physician who decides where the operation will be performed, but the patient can express his wishes regarding this issue. If there is such an opportunity, he is admitted for hospitalization to the clinic that he has chosen independently. In addition, on the Internet you can find many offers from orthopedic surgeons who perform this operation under the compulsory medical insurance program for residents of a certain region.

How to do knee arthroscopy according to compulsory medical insurance step by step

To do endoscopic surgery to restore the knee joint for free, you need to clearly know how to act correctly. Step-by-step instruction:

1. Visiting a trauma surgeon at a clinic at your place of residence, carrying your compulsory medical insurance policy. He will conduct an examination and prescribe the necessary tests and studies.
2. Passing examinations. Typically, surgeons prescribe an ultrasound or x-ray of the joints. However, there is one important point here - the ligaments and meniscus are not always clearly visible on X-ray and ultrasound images, so you should insist on an MRI. If the clinic does not have the appropriate equipment, the patient is given a referral to undergo this procedure at another medical institution.
3. After receiving the MRI results, it is recommended to obtain a report from several traumatologists. Even if you have to go to an appointment with a paid specialist, compared to the cost of the operation, this is nothing. At the moment, the main goal is to collect as much evidence as possible of the need for arthroscopy.
4. Next, you need to go to the clinic to see a traumatologist and get a referral for hospitalization. After this, you will have to run around the offices a little, collecting different signatures.
5. Then you need to meet with the doctor who will perform the operation and receive a list of tests necessary for hospitalization.
6. You need to arrive at the hospital the day before the operation with your passport and compulsory medical insurance policy. Before the procedure, you will have a conversation with an anesthesiologist and surgeon.
7. After the operation, they offer to apply a free cast, but according to reviews, a special orthosis is more comfortable, so you will have to purchase it at your own expense, like a pair of crutches.
8. Discharged two days after arthroscopy.

Good to know! The operation itself must be carried out at the expense of the clinic, and the latter is also obliged to provide the patient with free medicines. However, you have to pay for hospital stay and food in some medical institutions. This also applies to the purchase of a fixing orthosis.

How much will the operation cost at your own expense?

The compulsory medical insurance system provides a single basic tariff for knee arthroscopy. It is 2000 rubles. If we add here the cost of anesthesia and hospitalization, the total comes out to 8-10 thousand rubles. The clinic is financed by the TFOMS.

Private clinics often calculate the cost of surgery on an individual basis. Moreover, during preparation, the patient will have to pay for the examination and for each appointment, the cost of which ranges from 1-2 thousand rubles. The cost of knee arthroscopy in Moscow is about 40,000 rubles.

What to do if surgery is denied

If all the necessary tests and examinations have been carried out, and the diagnosis and the need for surgical intervention are confirmed by a doctor, the patient has the right to receive knee arthroscopy services, both in a private and public medical institution. The grounds for refusal may be the following:

• this service is not provided for by the territorial TFOMS program (which is unlikely);
• the selected clinic is not a participant in the state compulsory medical insurance program.

In all other cases, refusal is regarded as unlawful actions on the part of the institution’s medical workers. Of course, provided that the patient has all the necessary studies and a referral for surgery. In such a situation, you should act in several directions at once:

• write a letter to the head physician of the hospital and receive a justified refusal in writing;
• contact the Federal Compulsory Medical Insurance Fund with a letter, detailing all the circumstances and enclosing copies of studies and referrals for hospitalization;
• if the previous steps did not have an effect, and the patient is confident that he is right, all that remains is to resolve the issue in court - in this case, you will have to carefully prepare, study everything regulations and enlist the help of a competent lawyer.

When a trauma surgeon at a polyclinic refuses to give a referral to a hospital based on the results of research, you should contact another doctor and listen to his opinion on the advisability of arthroscopy. Then receive his conclusion and submit it for consideration by the head of the clinic at the place of residence.

On a note! Usually the issue is resolved at the stage of sending a letter to the TFOMS. If the foundation refuses to conduct such a study, it can hardly be unlawful, so in such a situation it is better to consult a lawyer.

You should also be interested to know after such an operation.

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