About Arthroscopic Surgery

Arthroscopy is a procedure that orthopaedic surgeons perform to evaluate, diagnose, and repair problems inside a joint. The word "arthroscopy" comes from two Greek words: 'arthro', meaning "joint" and 'scope' meaning "look". Arthroscopy is a minimally invasive procedure that allows surgeons to examine the joints. Arthroscopic procedure can be performed on any joint. Common types of arthroscopic procedure include shoulder arthroscopy and knee arthroscopy. In the event you have a painful condition that does not respond to nonsurgical (conservative) treatment, your doctor may recommend knee or shoulder arthroscopy. Nonsurgical (conservative) treatment includes physical therapy, injections or medications that can reduce inflammation. Inflammation is a normal reaction of the body to injury or disease. In an injured knee or shoulder joint inflammation causes swelling, pain, and stiffness. All of arthroscopic knee and shoulder procedures are done on an outpatient basis.

Knee Arthroscopy

Arthroscopy is a common surgical procedure in which a joint is inspected using a tiny camera. Arthroscopy enables doctors to clearly view the inside of the knee. This helps them diagnose and treat knee problems. Knee arthroscopy may relieve painful symptoms associated with torn meniscus, torn or damaged anterior cruciate ligment or posterior cruciate ligament, swollen (inflamed) or damaged lining of the joint (synovium), misalignment of the knee cap (patella), loose bodies in the knee joint, Bakers;s cyst (a swelling behind the knee that is filled with fluid), some fractures of the bones of the knee. Arthroscopy is done through a couple of small incisions.

In the operating room a sterile solution is used to fill the knee joint and rinse away any cloudy fluid. This allows your orthopaedic surgeon clearly see your knee and in great detail. During the procedure, the doctor inserts the arthroscope (a tiny camera instrument approximately the size of a pen) through a small incision into your knee joint. The arthroscope delivers the image to a television monitor. On the monitor, the doctor can see the structures of the knee in great detail. Your surgeon will use arthroscope to evaluate, repair or remove damaged tissue. To do this, small surgical instruments are inserted through other incisions around your knee. Your surgeon will close your incisions with a stitch or steri-strips (small bandaids) and cover them with a soft bandage. Knee arthroscopy usually lasts between 20 minutes to over an hour. How long it takes will depend upon the findings and the treatment necessary.

Common arthroscopic procedures include:

• * Menisectomy
• * Synovectomy
• * Removal of loose bodies
• * Removal of inflamed tissue
• * Meniscal repair
• * ACL repair

Shoulder Arthroscopy

Arthroscopy is a common surgical procedure in which a shoulder joint is evaluated using a tiny camera. Arthroscopy enables doctors to clearly view the inside of the shoulder. This helps them diagnose and treat shoulder problems. Because the arthroscope and surgical instruments are thin, your surgeon can use very small incisions, compared to the larger incision needed for standard, open surgery. This results in less pain for patients, and lessens the time it takes to recover and return to activities of daily living. Shoulder arthroscopy has been performed since the 1970s. Injury, overuse, and age-related wear and tear are responsible for most shoulder problems. Shoulder arthroscopy may relieve painful symptoms associated with damage of the rotator cuff tendons, labrum, articular cartilage, and other soft tissues surrounding the joint.

In the operating room the doctor will first inject fluid into the shoulder to inflate the joint. This will make it easier to see all the structures of your shoulder through the arthroscope. Then the doctor will make a small incision in your shoulder (about the size of a buttonhole) for the arthroscope. Fluid will flow through the arthroscope to keep the view clear and control any bleeding. Images from the arthroscope are delivered to a television monitor showing your doctor the inside of the shoulder and any damage. Once the problem is detected, the doctor will insert small instruments through separate incisions to repair it. Specialized instruments are used for shaving, cutting, suture passing, grasping and knot tying. In some cases, special devices are used to apply anchor into bone. Your doctor will close your incisions with stitches or steri-strips and cover them with a bandage. Shoulder arthroscopy usually lasts between 30 minutes to over an hour. How long it takes will depend upon the findings and the treatment necessary.

Common arthroscopic procedures include:

• * Rotator cuff repair
• * Bone spur removal
• * Removal or repair of the labrum
• * Repair of ligaments
• * Removal of inflamed tissue or loose cartilage
• * Repair for recurrent shoulder dislocation

Surgery Center Locations

To schedule an appointment please call: (718) 575-5454

Journal Square Surgery Center
550 Newark Ave #5
Jersey City, NJ 07306
(718) 575-5454 ext. 121

Manalapan Surgery Center
50 Franklyn Lane
Manalapan, NJ 07726

AFHC Ambulatory Surgery Center
3632 Nostrand Avenue
Brooklyn, NY 11229

Fifth Avenue Surgery Center
1049 5th Avenue
New York, NY 10028

Pre-Operative Instructions

When booking your surgery, our surgical coordinator will provide you with the date of surgery, pretesting date and location of the surgery center. Pretesting is done 2-10 days prior to surgery. Pretesting is done in the same surgery center or hospital where your surgery is booked. Blood tests, an electrocardiogram, or chest x-ray may be needed as part of pretesting. If your surgery is booked in Excel Surgery Center located in NJ, you do not need to have pretesting.

Your orthopaedic surgeon may ask you to see your primary doctor to get a medical clearance if you have any medical problems that need to be addressed before your surgery. Make sure to inform your surgeon of any health issues that you may have or if you think that you may be pregnant. If you have certain health risks, a more extensive evaluation may be necessary before your surgery. Be sure to inform your orthopaedic surgeon of any medications or supplements that you take. You may need to stop taking some of these prior to surgery. Before the operation, a member of the anesthesia staff will talk with you about anesthesia options.

The hospital or surgery center will contact you a day before your surgery to provide specific details about your procedure. Make sure to follow the instructions on when to arrive and especially on when to stop eating or drinking prior to your surgery. Please, remember that you should not be eating (no food, no gum, no candy) or drinking (including clear fluids) after midnight the day before your surgery.

If your surgery is booked in Excel Surgery Center or Manalapan Surgery Center in NJ, the centers will provide you with the transportation. Excel Surgery or Manalapan Surgery Center will contact you a day before the surgery to arrange for your transportation. Please make sure to provide us with your correct address.

Please, be sure to make appropriate arrangements ahead of time to have someone (a family member or a friend) with you and to accompany you to go home after your surgery. Please, remember that you are not allowed to take public transportation to go home after surgery.

The Date of Surgery

On the date of surgery, please remember that you should not eat (no food, no gum, no candy) or drink (even clear fluids). It is important that you arrive to the surgery center or the hospital that you are booked in at the designated time. When you arrive to the surgery center or the hospital that you are booked in, you will be checked-in by a member of the staff. The admission process is usually very quick. For your comfort, we encourage you to wear clothing that can be easily removed and stored. Please avoid wearing any jewelry, piercings, nail polish and cosmetics, and leave contact lenses at home or bring your lens case with you. Before the surgery you will meet with your surgeon to confirm both the specific type of procedure you are having as well as the surgical site of that procedure. After the surgery you will be moved to the recovery room and should be able to go home within 1 or 2 hours. Before you leave the surgical center or the hospital you will be provided with post-operative instructions. Please, be sure to to have someone (a family member or a friend) with you to accompany you to go home after your surgery. Please, remember that you are not allowed to take public transportation to go home after surgery.

Post-Operative Instructions

After Knee Arthroscopy:

• - It is important to follow your orthopaedic surgeon's instructions carefully after you return home. You should ask someone to check on you the first evening post¬operatively. Keep your leg elevated as much as possible for the first few days after the procedure to avoid swelling.
• - You will leave the hospital with a dressing on your knee. Keep your incisions clean and dry. You may remove the dressing three days after the surgery and put a regular bandaid over the incision site. You can take a shower 3 days after the surgery.
• - It is normal to have some pain and discomfort for at least a week after surgery. If you have had a more extensive surgery, however, it may take several weeks before your pain lessens. Your doctor will prescribe pain medication post-operatively to help relieve discomfort following your procedure. Please do not take any Tylenol in addition to the medication prescribed to you by your doctor post-operatively. Apply ice to relieve swelling and pain.

You should have physical therapy to your knee 2-3 times weekly for 6-8 weeks post-operatively (unless instructed by your doctor otherwise). This will improve motion and strengthen the muscles of your leg and knee. In addition to physical therapy you are recommended to use a CPM machine at home (for 4-6 weeks) post-operatively. A CPM (Continuous Passive Motion) is a machine that will help you significantly accelerate recovery time by improving range of motion, preventing the development of adhesions and decreasing soft tissue stiffness. A company representative will contact you after surgery to deliver the machine to your home. A CPM machine DOES NOT substitute physical therapy. It is crucial to your recovery that you engage in both activities as advised by your surgeon.) These steps will play an important role in how well and fast you recover.

ATTENTION: If you had an ACL Reconstruction, your surgeon will advise you to wear a brace. Please DO NOT use a CPM machine and DO NOT start physical therapy until further notice by your surgeon.

• - Please call our office to schedule you post-operative appointment to remove the sutures within 7-14 days after the surgery.
• - Call our office for any temperature over 101 Fahrenheit, or for any unusual reactions, such excessive bleeding, chills, persistent nausea or vomiting, rash, excessive swelling, excessive redness of the incision site or puss.

After Shoulder Arthroscopy

• - Although recovery from arthroscopic shoulder procedure is usually faster than recovery from open surgery, it may still take weeks for your shoulder joint to completely recover. It is important to follow your doctor's post-operative instructions carefully after you return home. You should ask someone to check on you the first evening post¬operatively. If you had an arthroscopic repair of rotator cuff tearing or repair of labral tearing, your surgeon will advise you to keep you arm immobilized at all times.
• - You will leave the hospital with a dressing covering your shoulder. Keep your incisions clean and dry. You can remove the dressing five days post-operatively and put a regular bandaid over the incision site. You can shower 5 days after the surgery.
• It is normal to have some pain and discomfort for at least a week after surgery. If you have had a more extensive surgery, however, it may take several weeks before your pain lessens. Your doctor will prescribe pain medication post-operatively to help relieve discomfort following your procedure. Please do not take any Tylenol in addition to the medication prescribed to you by your doctor post-operatively. Apply ice to relieve swelling and pain.
• You should have physical therapy to your shoulder 2-3 times weekly for 6-8 weeks post¬operatively (unless instructed by your doctor otherwise). This will improve motion and strengthen the muscles of your arm and shoulder. In addition to physical therapy you are recommended to use a CPM machine at home (for 4-6 weeks) post-operatively. A CPM (Continuous Passive Motion) is a machine that will help you significantly accelerate recovery time by improving range of motion, preventing the development of adhesions and decreasing soft tissue stiffness. A company representative will contact you after surgery to deliver the machine to your home. A CPM machine DOES NOT substitute physical therapy. It is crucial to your recovery that you engage in both activities as advised by your surgeon.) These steps will play an important role in how well and fast you recover.

ATTENTION: If you had an arthroscopic repair of rotator cuff tearing or repair of labral tearing, your surgeon will advise you to keep your arm immobilized at all times and NOT to exercise. Please, DO NOT use a CPM machine and DO NOT start physical therapy until further notice by your doctor. In most of these cases your surgeon will instruct you to start using a CPM machine and physical therapy only 4-6 weeks after the surgery.

• * Please call our office to schedule you post-operative appointment to remove the sutures within 7-14 days after the surgery.
• * Call our office for any temperature over 101 Fahrenheit, or for any unusual reactions, such excessive bleeding, chills, persistent nausea or vomiting, rash, excessive swelling, excessive redness of the incision site or puss.

Dr. Berkowitz is well versed in all areas of orthopaedic medicine, and is a renowned expert in shoulder and knee arthroscopic surgery. Dr. Berkowitz also has expertise in sports medicine as well as hip, knee, and hand osteoarthritis. He operates at top-rated surgical centers and hospitals in the Tristate area, and is backed by a team of dedicated, friendly, and service-oriented professionals. His practice utilizes the most innovative technology in the industry to make procedures as minimally invasive as possible.

Dr. Berkowitz is a member of the Arthroscopy Association of North America, the Medical Society of the State of New York, and the Medical Society of the County of Queens. Dr. Berkowitz often attends orthopaedic and arthroscopic conferences around the country. In September 2016, he participated in a live activity titled “Knee Cartilage,” hosted by the Arthroscopy Association of North America in Rosemont, Illinois. In October 2016, Dr. Berkowitz joined shoulder surgeons from around the world, including world-renowned surgeon Dr. Stephen Burkhart, at an orthopaedic conference in Texas. At the conference, Dr. Berkowitz learned a new advanced procedure for rotator cuff repairs. Outside of healing patients, Dr. Berkowitz is devoted to serving his family, his friends, and his community. He is the founder of the Yeshiva Har Torah School, which started with 25 students, and now has nearly 700 students on its roster. In addition, Dr. Berkowitz actively supports organizations that help Jewish children learn about their backgrounds and the land of Israel.