MURRAY, Ky. -- All those painful, creaky knees aren't deteriorated equally.

Commensurately, the appropriate fixes for them differ -- great news for owners of the less corroded joints.

"I had a 70-year-old in the other day who was afraid he was going to have to have a knee replacement," said orthopedic surgeon Marty Fulbright. "He was thrilled when I told him he only has a meniscus tear and that it could be fixed with an arthroscopy."

Pioneered as a treatment for sports injuries during the 1970s, arthroscopy surgery or scoping of the knee is a treatment of damage in the joint through small keyhole-size incisions with the insertion of an long, narrow instrument with camera that allows a surgeon to see first-hand what's in there.

Knee scoping has become known through surgical treatments on high profile athletes, but it has flourished through orthopedic practices as a preferred option for knees young and old, athletic or more earthbound, with the appropriate sorts of injury or wear.

"One of the most common injuries that arthroscopy can fix is a tear of the meniscus, the layer of cartilage in the knee between the thigh and shin bones," said Fulbright, who practices through Ascension Orthopaedics at Murray, Ky. "A lot of times, all that has to be done is to remove the damaged tissue, leaving the remaining meniscus intact."

With the surgical work being done through small incisions -- nowadays the openings to be made may be two incisions of only 1 centimeter each -- there is minor disruption of tissue to achieve the necessary repair.

"It's minimally invasive compared to the standard old knee surgeries in which a large incision would have to be made," Fulbright said.

The major reduction in the size of the incisions necessary for arthroscopy, the less disruption of tissue to make working space, translates into less damage necessary to affect repairs. In turn, that means less recovery time and less discomfort.

"Because the scope allows you to leave more intact, most patients are walking on the knee the next day or even the same day as surgery," Fulbright said. "I've had folks walk out of the hospital afterward."

Fulbright said arthroscopy is ideal for treatment of cartilage and ligament damages. Along with meniscal tears, the other most common procedure for scoping is repairs of anterior cruciate ligaments, the two ligaments that cross in the center of the knee joint and control backward and forward motion. ACL injuries should be familiar to sports fans as season-ending and sometimes career-threatening knee problems for athletes in basketball, football and other sports in which tears occur when a player slows down while cutting or sidestepping or if he or she takes a blow directly to a knee.

Yet, while doing scoping surgery on softer tissue, some minor bone work might be done as well.

"If I find some early arthritis when I'm in there, I can makes some improvement by removing some of that -- by smoothing some of the surface of the bone ends," Fulbright said.

While severe bone degeneration may call for total knee replacement if anything, several people with longterm troublesome knees may be dreading the wrong thing by putting off diagnosis and possible surgical repair. Fulbright said it's not uncommon for someone with a cartilage or ligament problems to suffer years of pain avoiding joint replacement when arthroscopy might be the logical course of treatment.

"You think of athletes when you think of these meniscal tears, but lots of regular people get them, too," Fulbright said. "There's lots of ways you can injure the cartilage, and it can just wear down on its own. Even people in the 50s can have the meniscus tear just from heavy wear."

Symptoms of a meniscal tear might be a popping or catching of the knee in association with pain.

"Some people describe a tear as feeling like a toothache in the knee," Fulbright said. "It tends to differ from the pain of arthritis. With arthritis, a joint might be aching when you first get up in the morning, but then it loosens up and doesn't bother you later in the day. With a meniscal tear, it tends not to loosen up and quit hurting."

Source: The Paducah Sun, Ky. Distributed by McClatchy-Tribune Information Services. Powered by Yellowbrix.

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