Arthroscopy in Children and Teenagers (Ages 8 to 18)
Edited By: Gregory A. Schmale, M.D.
Last updated Friday, July 22, 2005
About the procedureTechnical details On the day of the surgery, the patient checks into the surgery center
and meets the anesthesiologist, the doctor who is in charge of keeping
the patient comfortable and medically stable during the procedure.
After general anesthesia is administered, the surgeon performs an exam
of the knee as a means to thoroughly assess the injury. The limb is
then washed, drapes are placed, and the arthroscopy is performed.
“Arthroscopy” means that the joint is examined and probed using small
instruments through small incisions or portals, while the action inside
the knee is viewed on a large monitor like a TV screen. The surgeon
decides where to place and move the instruments in the knee depending
on what is seen on the viewing monitor. Ultimately, three or more small
incisions are made around the knee, of a size just big enough to accept
instruments the diameter of a pencil. The instruments are then inserted
into the knee – a tube to collect the overflow of fluid, a tube for the
camera and a magnifying lens, and an incision for probes, shavers and
suturing or sewing needles or other instruments (Figure 5). The probes
are small hooked devices that help the surgeon tug on the meniscus to
see where it may be torn; shavers come in different sizes and help trim
the edges of torn a torn meniscus, and a variety of different small
scissor type instruments may be used to trim the edges of meniscal
tears.
There are numerous ways to repair a torn meniscus. The
meniscus may be sewn with absorbable or non-absorbable suture or
thread, it may be hooked together with a small device with barbs or
small hooks that either absorb over time or stay permanently within the
knee, or the sides of the tear may be pinched together with a pair of
special winged washers pushed out through the tear and the back of the
meniscus, onto which suture material is attached to allow for knot
tying on the front of the meniscus.
When the meniscus is sewn
using an “inside-out” technique, long sewing –type needles are
introduced through the small incisions or portals in the front of the
knee to stitch together a repairable meniscal tear (Figure 6). These
needles are usually pulled out of the knee through larger incisions,
4-6 centimeters in length on the inner or outer back side of the knee,
and the thread on the ends of the needles is then tied over the capsule
or joint covering. When the repair is completed, the knots from the
stitches of the repaired meniscus are covered as these larger wounds in
the back of the knee are closed. All sutures in the skin are
absorbable, so no stitches need to be removed at future clinic visits.
The stitches holding the sides of the torn meniscus together can be
seen on the surface of the inner edge of the meniscus (Figure 7). In
this particular case, the suture or thread used was non-absorbable, to
protect the repair in case of slow healing.
Trimming of a
meniscus is the preferred treatment when the torn piece is not
repairable, either because the tear is more central with a poor blood
supply, or the pieces of meniscus are deformed and unable to be
returned to their normal position and function. Instruments used in
trimming include, small scissors, shavers, and special large biting
clippers that can cut-off large chunks of meniscus with each bite.
Anesthetic
Most patients undergo arthroscopy for meniscal tears under general
anesthesia, though sedation with a local or regional anesthetic are
both possible alternatives.
Length of minimally-invasive surgery for a torn meniscus in athletic children
Time for this procedure depends on the size and location of the tear,
as well as the tightness of the knee. These procedures may take
anywhere from one to three hours.
Surgery for Meniscal tears in the knee of adolescents and children at the University of Washington If you are interested in making an appointment to discuss this procedure, you can request an appointment using our online referrals website. To request a referral online, please click here. You can also call 206-987-3700 to make an appointment.
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