Arthroscopic Knee Surgery

A New Spring in His Step

John alves can climb a later once again after arthroscopic knee surgeryHaving injured his knee scrambling onto rides at Hampton Beach with his granddaughter two summers ago, John Alves was reminded that he’s not getting any younger. But thanks to a minimally invasive repair called arthroscopy at Milford Regional, the 51-year-old town worker’s days of waterslides and amusement parks are not yet behind him. So John's granddaughter still has a partner in fun, since his wife’s fear of heights means she’s unlikely to step in anytime soon. “I do all the rides all the time,” the Milford resident jokes. “But I have to learn I’m not as young as my granddaughter.”

In fairness to his wife, John probably wore his left knee down over the years; if it had not given way in New Hampshire, it would have given out sooner or later.  John assumed it was just an unremarkable, middle-age irritant that would go away on its own. He did not want to miss work. And he had never experienced a serious injury before, so lacked a reference for gauging the extent of the problem. John put off seeing a doctor for months, despite a soreness that left him unable to stroll the boardwalk for the rest of his family’s vacation and that grew worse over the fall and winter. “I can deal with it,” he remembers telling his family. “But I was in pain every day, taking aspirin.”

Eventually, he accepted his wife’s advice to see Dr. David Magit, a local orthopedic surgeon she had heard about through work. But even after a visit to Dr. Magit’s Water Street office in Milford, John put off getting a follow-up MRI. That finally changed when the pain reached a point Alves couldn’t endure — a level he now estimates as nearly reaching the top of the standard 10-point scale. An MRI scan revealed two tears in his meniscus — the cartilage cushion between the shinbone (tibia) and thighbone (femur) that can rip not only from the physical demands of sports, but also from arthritis and normal aging.

After reviewing the results of the imaging test, Dr. Magit told John the damage would not heal on its own. While physical therapy is sometimes an option for meniscal tears, Dr. Magit recommended repairing it with arthroscopy, also called a knee scope. He took the time, Alves says, to thoroughly explain the procedure and ask about John’s work — a physical job with the Milford Sewer Department that would require a healthy knee and a little extra recovery.  “He put me at ease,” John recalls. “After talking to him, I felt really comfortable with it.”

As an assistant professor of orthopedics and rehabilitation at UMass Medical School in Worcester, Dr. Magit says he “not only loves to teach students, I love to teach patients.” He specializes in arthroscopy and completed a fellowship at the Kerlan-Jobe Orthopaedic Clinic under cofounder Dr. Frank Jobe — the famed surgeon who pioneered the Tommy John elbow surgery for baseball pitchers.

To start a knee arthroscopy, the Milford Regional team administers anesthesia. Dr. Magit then makes a series of buttonhole-size incisions around the knee. A pencil-like tube (an arthroscope) with a camera and light is inserted into one of the holes, to display the damaged area on monitors and guide Dr. Magit as he works. Special instruments are placed through the other holes to make the repair.

Dr. Magit says the minimally invasive approach continues to provide evermore alternatives for patients at Milford Regional. “Our techniques are always evolving,” he says.

Conventional knee surgery with larger incisions is still necessary at times when greater access is needed for certain surgical procedures such as ligament repairs, when grafts taken from elsewhere in the knee is required. However, the benefits of arthroscopy over open surgery are notable, including smaller incisions; less bleeding, trauma to surrounding knee tissue and post-surgical pain; reduced need for pain meds afterward; and a faster recovery and rehabilitation.

Besides meniscal repairs, arthroscopy has plenty of other applications. Dr. Magit and the Milford Regional team perform arthroscopy during anterior cruciate ligament (ACL) repairs. They use the procedure to trim torn cartilage, remove loose pieces of bone and cartilage, and take out synovial tissue lining the joint when it becomes inflamed. And they have a proven track record with more complex cases, such as transplanting cartilage from elsewhere in the knee and fixing fractures.  “We can pretty much do anything arthroscopically that’s out there,” he says.

Dr. Magit credits the “incredibly cohesive” team at Milford Regional with providing a top patient experience, and says the hospital’s anesthesiologists are some of the best he’s worked with.  While Milford Regional is a teaching hospital, Dr. Magit performs arthroscopy himself — no handing off patients to fellows or residents. He checks in on patients before surgery and meets with them afterward, to discuss how it went and explain the next steps.

Milford Regional also provides the latest implants, including those designed to provide temporary support and then safely disintegrate over time. The medical center also upgraded its arthroscopic cameras and monitors to high definition within the last several years for improved clarity — a step not all Massachusetts hospitals and surgical centers have taken, Dr. Magit says. “Anything we need to give the patient for the best possible surgery is available at Milford Regional,” says Dr. Magit, who is not employed by the hospital and can choose where to operate. He calls the Milford Regional experience one of the best available to patients, “and I truly believe that.”

John notes the hospital’s cleanliness and the staff’s friendliness, and also commends Dr. Magit’s follow-up care. “Everything worked out great,” he says. “I’m not the kind of person who likes to get operations, but if I had to do it again, I’d go back to them.”

Patients with knee complaints are encouraged to at least come in for a consultation. Dr. Magit says many don’t realize their problems are fixable, and not always just with surgery. “It’s worth the trip to go through your issues and discuss your options,” he says.

John agrees that it’s worth getting checked out — he now acknowledges he was a little stubborn and should not have waited so long. ““I should have listened,” he says.

After his successful outpatient procedure, post-surgical physical therapy and recovery, John is back to work and playing with his granddaughter again. His knee feels good, and he’s looking forward to the next Hampton Beach trip. 

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