Types of arthroscopic interventions
Meniscus seam
- Cost: 80,000 - 115,000 rubles.
- Duration: 30-60 minutes
- Hospitalization: 1 day in hospital
More details
The CELT clinic performs arthroscopy of any large joints: knees, elbows, shoulders, hips, ankles, wrists. At the same time, the types of interventions are very diverse.
When pathology is detected in the ankle, wrist, elbow and hip joints, the following operations are performed:
- resection of adhesions;
- joint release;
- resection of exostoses;
- removal of chondromic bodies;
- treatment of intra-articular injuries;
- chondroplasty.
In the knee joints , in addition to the above, the following are also performed:
- resection of the damaged part of the meniscus;
- meniscal suture;
- plastic surgery of cruciate ligaments (anterior, posterior cruciate ligaments);
- plasty of the patellar retinaculum;
- mosaic chondroplasty.
Shoulder joint and types of arthroscopy
Arthroscopy of the shoulder joint is considered a technically difficult intervention among orthopedic traumatologists. Not all surgeons and clinics undertake it, even in Moscow, but we have extensive experience in this area, so patients with similar pathologies often come to us. Based on the results of diagnostic arthroscopy, we determine the exact location of the pathological focus, determine what treatment tactics the disease requires, and, if necessary, take biological material for laboratory testing.
Currently, we work with almost the full range of arthroscopic surgeries for a wide variety of pathologies of the shoulder joint:
- plastic surgery for injuries localized in the area of attachment of the tendon of the long head of the biceps;
- plastic surgery of various types of tendon ruptures, including chronic rupture injuries;
- removal of calcifications;
- dissection of adhesions;
- decompression of the suprascapular nerve;
- chondroplasty;
- elimination of joint instability/hypermobility;
- plastic labrum;
- osteoplastic surgery.
There are certain indications for arthroscopic interventions on the shoulder joint. To fully diagnose shoulder joint damage, an MRI examination is performed. It is important that the radiology specialists conducting the examination have sufficient experience in conducting examinations for such pathologies. The following are the main pathologies for which surgery is indicated:
- labrum injuries: Bankart injury, slap injury;
- damage or rupture of the rotator cuff;
- impingement syndrome, subacromial bursitis, supraspinatus tendonitis;
- limited mobility of the shoulder joint for no apparent reason;
- various shoulder injuries that are accompanied by tendon rupture.
Labrum injuries: Bankart injury, SLAP injury
Treatment of shoulder instability, Bankart injury
- Cost: 120,000 - 160,000 rubles.
- Duration: 30-90 minutes
- Hospitalization: 1-2 days in hospital
More details
Firm fixation of the labrum and joint capsule to the socket (glenoid) plays a key role in stabilizing the shoulder joint. A tear of the labrum in the anterior region is called a Bankart injury, and a tear in the area of the biceps tendon insertion is called a SLAP injury. There are several types of such damage. These pathologies often cause chronic pain and lead to instability of the shoulder joint or the formation of habitual shoulder dislocation. Only surgery can correct the situation.
The most effective treatment methods:
Arthroscopic refixation of the labrum (in case of Bankart injury, slap injury), tenodesis. The torn section of the articular labrum is fixed to the edge of the glenoid cavity using special anchors - absorbable or titanium.
Habitual shoulder dislocation, shoulder instability
habitual shoulder dislocation , can form . This is a condition in which joint dislocations occur with any minor injury or even sudden movement. The cause may be damage to the capsule and labrum of the joint, or defects in the articular surface of the scapula. Very often, a bone defect known as a Hill-Sachs lesion forms on the back of the humeral head.
The most effective treatment methods:
Arthroscopic stabilization of the shoulder joint. The torn parts of the labrum are fixed using anchors, and the joint capsule is additionally tightened.
Bone grafting (Latarjet operation). A part of the coracoid process, with the muscles attached to it, is transplanted into the defect area on the anterior surface of the glenoid cavity; the displaced fragment is fixed with screws.
Combined operations. Sometimes combined operations are used, when additional fixation of the joint capsule (reimplisage) in the area of the bone defect can be performed (Hill-Sachs).
Damage to the rotator cuff
Around the head of the humerus are several tendons that form the rotator cuff or rotator cuff. The cuff consists of the tendons of the supraspinatus, infraspinatus, teres minor and subscapularis muscles of the shoulder. These muscles provide both stability of the humeral head, pressing it against the glenoid cavity during abduction of the arm (initial phase) and rotation of the shoulder inward and outward. If the rotator cuff tendons (one or more) are damaged, the mechanics of the shoulder joint are disrupted, mobility restrictions occur, and pain occurs. abduction of the hand.
In case of complete tendon rupture, surgical treatment is performed - arthroscopically or minimally invasively.
The most effective treatment methods:
Rotator cuff repair
- Cost: 130,000 - 170,000 rubles.
- Duration: 30-90 minutes
- Hospitalization: 1-2 days in hospital
More details
Plasty of the rotator cuff . Arthroscopic suture or refixation of the rotator cuff tendons . The damaged tendon is isolated, stitched and fixed (refixed) to the attachment point on the head of the humerus using special anchors with a diameter of 2.5-5.5 mm and high-strength threads.
Impingement syndrome, subacromial bursitis, supraspinatus tendonitis
Part of the rotator cuff tendons passes through a narrow space formed by the head of the humerus, the tuberosities of the humerus, the inferior surface of the acromial process of the scapula, the coracoid process and the coracoacromial ligament. This space is called subacromial. This area plays an important role in arm movement, as a decrease in this space causes compression when the arm is abducted, pain and limited mobility. A typical symptom is pain when the arm is abducted 60-120 degrees.
The narrowing of the space may be a consequence of deformation of bone structures, the formation of calcifications, scarring or degenerative changes in the tendons, or bursitis.
The most effective treatment methods:
Subacromial decompression. Using special arthroscopic equipment, altered soft tissues and bursa in the subacromial space are removed; if necessary, marginal resection of the lower surface of the acromial process or the edge of the clavicle is performed.
How is shoulder arthroscopy performed?
We perform each intervention on the shoulder joint only according to a specific scheme, which is considered the best option for the patient not only in terms of efficiency, but also comfort. But before the patient receives an appointment for such an intervention, we must study all the examination results available to him and collect the necessary preoperative set of tests.
Arthroscopy is performed under general endotracheal anesthesia.
The following positions are possible for the patient on the operating table:
- Side position. The arm is fixed to the shoulder axis through a special block at an angle with a load of 3-4 kg. The patient himself at this moment is located, lying on his healthy side.
- Beach chair position. The patient is positioned on the operating table in a “semi-sitting” position, while the arm is fixed with a special device that allows the limb to be fixed in any given position.
Once the shoulder joint is fixed in the desired position, the operation begins:
- the skin is treated with a disinfectant;
- Through an incision 5-7 mm long, an arthroscope with a video camera with a diameter of 4.2 mm is inserted into the joint cavity. The joint cavity is filled with saline solution supplied by a pump (for better visualization);
- a second incision is made, and a cannula for a surgical instrument is inserted into it if medical procedures are necessary. If necessary, 1-2 additional arthroscopic ports are installed.
And then everything depends on what results will be obtained during the examination of the joint. Thanks to modern equipment, the surgeon can see the image of the joint on the monitor, assess the condition of tissues, tendons, cartilage and bones and immediately carry out the necessary treatment.
How is the operation performed?
Typically, this type of intervention is performed under general mask or endotracheal anesthesia. Therefore, the question “whether it hurts or not” disappears here by itself, as does the fear of seeing what is happening.
The operated area is treated with an antiseptic and marks are made on the position of the joint and puncture sites for insertion of the arthroscope. Using a puncture needle, the joint capsule is punctured and synovial fluid is removed from it. The synovial fluid is quite thick, as it serves to lubricate the joint, and the arthroscope - the main instrument of this operation - is equipped with a small video camera through which the image is transmitted to a large screen. To ensure good visibility inside the joint, the liquid is replaced with saline solution.
After the examination, the surgeon takes material for further research and, depending on what problem is found inside the joint, decides its fate:
- strengthens the joint capsule;
- removes inflamed areas;
- fixes ligaments;
- strengthens the labrum, etc.
The operation can last from one to three hours. When the procedure is completed, the instruments are removed and the incisions are covered with sutures and a sterile dressing. Using a shoulder brace, the joint is fixed in the desired position.
Regarding stitches, it’s worth saying right away that arthroscopy is a minimally invasive operation and leaves no scars. In the first days, the puncture sites will have slight swelling and possibly hematomas. The shoulder joint itself will feel painful, since the tissues need time to recover. During this period, the patient is required to be hospitalized: several days under the supervision of a doctor to exclude any complications.
Benefits of Shoulder Arthroscopy
Here are the main advantages of arthroscopy over traditional “open” surgery that patients usually pay attention to:
- the patient is in the inpatient department of a medical institution for a short period of time: a maximum of 3 days, but most often the period is limited to 24 hours;
- During the operation, soft tissues are minimally injured, since incisions only 5-7 mm long are used;
- The cost of arthroscopy is quite adequate and affordable for absolutely all patients.
A more accurate diagnostic examination of the joint simply does not exist in medicine today! Arthroscopy does not allow errors, and at the same time it is possible to immediately carry out the necessary medical manipulations.
Postoperative treatment.
If you do not require any special post-operative care, you will be introduced to the physical therapy plan and treatments will begin the day after surgery. For patients with adhesive capsulitis, physical therapy is the cornerstone of postoperative treatment. This means that each patient with a certain picture of the disease receives his own postoperative treatment program, which contains accurate information about the necessary measures for certain periods of rehabilitation. Of course, the doctor who will see you on an outpatient basis will receive all the necessary information for the best postoperative management. This is how the success of your postoperative treatment is achieved outside the walls of the clinic.
Possible contraindications and complications
It is important to note that arthroscopy is not performed for the following concomitant pathologies:
- skin rashes of the pustular type in the shoulder area;
- infectious diseases with localization of the focus in the shoulder joint;
- elevated body temperature, regardless of cause;
- previously diagnosed ankylosis;
- intolerance to painkillers/anesthetics.
Any surgical intervention comes with a risk of complications. But the degree of this risk is important. With the artoscopy method, these are minor complications that can only cause some discomfort to the patient. After joint arthroscopy, swelling and redness of the soft tissues may be observed in the areas where punctures and incisions were made. However, they disappear literally after 3-5 days.
It is extremely rare that deep veins may be damaged during surgery, but this is not dangerous for the patient. We are always able to quickly provide the necessary assistance.
Prices and manufacturers
Postoperative bandages have a wide range of prices. Depending on the manufacturer and material of manufacture, the cost varies from 1,500 to 10,000 rubles. Today the most popular manufacturers: Otto Bock. They make inexpensive products, but the quality is at the highest level. Comfortable to wear, easy to use and maintain. Trives. They produce a wide range of braces for the shoulder joint, from economy to premium class. The manufacturer is known not only in the Russian Federation, but also abroad. Medi. Bandages made in Germany have a very high price. But they occupy a leading position in the market. This brand also produces various types of orthoses. Orlett. They produce several types of fixation products for children and adults. After arthroscopy of the shoulder joint, the doctor will advise which type of brace is best to choose in your case. The duration of wearing is determined individually. Before purchasing a fixation product, be sure to consult your doctor.
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— Arthroscopy in Moscow at the Garant Clinic.
The leading clinic on the basis of the Sechenov First Moscow State Medical University is GarantClinic.
Recovery period
In the first days after arthroscopy on the shoulder joint, symptomatic therapy and dressings are carried out under the supervision of the attending physician. The limb is fixed using a special orthotic bandage for 3-4 weeks after surgery. At the same time, rehabilitation treatment begins.
The rehabilitation course consists of carrying out a set of rehabilitation measures developed by specialists:
- specialized course of physical therapy for up to 3-4 months;
- use of devices for passive development of movements in the shoulder joint (“Artromot”);
- limiting sports and heavy physical activity for up to 4-6 months.
We perform all the joint manipulations listed in the article in the operating room of the CELT clinic, specially equipped for arthroscopic operations. Arthroscopy is often the only real opportunity to restore joint health, and, therefore, restore quality of life. If problems with the shoulder joints are relevant for you, come for a consultation with the author of the article, an orthopedic traumatologist with extensive experience in arthroscopic operations.
Of course, the best operation is the one that does not need to be done, but even in difficult cases we will try to help you!
Diagnosis and preparation for surgery
To make an appointment for surgical treatment, you need to consult a doctor at our department (contact number 8 812 559 97 83).
You will be examined and examined, high-quality radiography, ECG registration, and blood tests. If you have ready-made examination results (X-ray, MRI, etc.), bring them with you to the consultation. After the examination, you will receive final answers to your questions about the surgical plan and postoperative treatment.