What is a Knee Arthroscopy?
Knee arthroscopy, also known as ‘key hole surgery’, is an operation which enables the surgeon to look inside the knee joint and perform surgery on it without making big cuts to expose the joint.
Knee arthroscopy is performed by making small cuts on either side of the knee through which a special camera is inserted into one side whilst specialised tools are inserted into the other side.
Knee arthroscopy can be used to treat a variety of knee problems and is one of the most common knee operations being performed.
Who is this operation for?
Knee arthroscopy can be effective for treating a variety of problems. Common problems treated using this technique include:
- Torn meniscus: A meniscus is a ring of cartilage in your knee that acts as a shock absorber. It can be torn, often during sporting activities, and cause symptoms of clicking or locking of the knee. A torn meniscus can be trimmed or stitched together during an arthroscopy.
- Loose bodies: Small pieces of cartilage can break off from joint surfaces or meniscus. These can float around in the knee and cause pain, locking or clicking. These loose bodies can be removed during an arthroscopy.
- Cartilage repair: Cartilage that lines the joint surfaces may become frayed and worn out. This can be trimmed during an arthroscopy. Unfortunately the worn out cartilage can’t be replaced.
- Investigation of unexplained knee pain: Occasionally knee pain will be persistent in spite of no problem being identified on X-ray or MRI scans. Sometimes the surgeon will decide to investigate the cause of the pain using an arthroscopic procedure.
- Removal of tumours or other tissue: An arthroscopy may be used to remove a small growth or tumour. Sometimes a growth in the lining of the joint (known as the synovium) may be removed during an arthroscopy. These conditions are vary rare and not a common cause for an arthroscopy.
What are the alternatives to surgery
Surgery may be necessary if your symptoms are severe. There are however some alternatives to surgery which may help with the symptoms caused by the knee problem. These include:
Pain relief medications – such as paracetamol.
Anti-inflammatories – these medications can be harmful if used long term and you should discuss the use of these medications with your doctor before starting.
Physiotherapy – exercises to improve muscle strength may help with mobility and reduce pain.
Weight loss – being over weight can make your knee pain worse. Loosing weight can help reduce pain and also lead to better results if you have the operation.
What are the benefits of the operation?
A knee arthroscopy is usually a very successful operation and will help to:
- Reduce pain.
- Decrease locking or catching of the knee.
- Provide a detailed diagnosis of the problem causing your symptoms.
Does arthroscopy work for a worn out knee (also known as osteoarthritis)?
If you have advanced wear and tear of the knee joint, known as osteoarthritis, an arthroscope is probably not for you. The only surgery that will probably help is a knee replacement. If you have a worn out knee but also have a torn meniscus or a loose body, then an arthroscopy may actually be very helpful. You will need to have an appointment with your surgeon during which he will examine your knee, assess any x-rays or other scans that you’ve had and ask questions about your symptoms. Following this, you surgeon will be able to advise you if an arthroscopy would be beneficial.
Complications
The complication rate following knee arthroscopy is very low. However like all surgery, there are risks that need to be considered when deciding to have knee arthroscopy surgery.
Side effects
Side effects are symptoms that occur due to the surgery and are a normal part of the recovery from the operation. The main side effects of knee arthroscopy are:
- Knee pain which may last for several weeks after the operation.
- Swelling of the knee which may last for several days.
Complications
Complications are problems that occur during or after the operation. Most people having knee arthroscopy surgery aren’t affected. There are some complications that may occur for any operation. These include:
- A reaction to the anaesthetic
- Infection of the wound or joint
- Excessive blood loss
- A blood clot, usually in a vein of the leg (known as a deep vein thrombosis or DVT)
Specific complications of knee arthroscopy are very uncommon, but can include the following:
- Bleeding into the knee joint (haemarthrosis): Occasionally a blood vessel may be damaged during the arthroscopy leading to bleeding into the joint after the operation. This will result in swelling of the knee which may be stiff and painful. This is a rare complication, occurring in less than 1% of cases.
- Stiffness: Sometimes you may be left with stiffness of the knee joint following the operation. This is a rare complication, happening in only less than 1% of people having an arthroscopy.
- Accidental damage to structures inside the knee joint: Occasionally cartilage or ligaments of the knee joint may be damaged during an arthroscopy. This is a very rare complication.
- Nerve damage: This is a rare complication. Nerves can be damaged during the operation which can cause numbness or weakness in areas of the leg.
- Infection: This is a rare but serious complication. The wound or knee joint may be infected which may require antibiotics or further surgery.
Before the operation
Preadmission Clinic | Preparing for Surgery
Before your operation, you will be seen at the Preadmission clinic to make sure you are fit for the operation and all the necessary tests are performed in preparation for the operation.
During the visit, you will be seen by a
- doctor
- nurse
- anaesthetist (if necessary)
Tests
Tests that may be ordered for you include:
Preparing Your Skin
Your skin should not have any infections or irritations before surgery. If either is present, contact your orthopaedic surgeon for a program to improve your skin before surgery.
Tip
Carry a list of your medications with you including the name, dosage and how often you take it.
Medications
Our doctors will advise you which medications you should stop or can continue taking before surgery.
Get some help from your friends and family
Most people are usually walking within a day after surgery with crutches. You will need some help for several days with tasks such as cooking, shopping, bathing, and laundry. If you live alone, your orthopaedic surgeon’s office, a social worker, or a discharge planner at the hospital can help you make advance arrangements to have someone assist you at your home.
About the Operation
Admission
Most people are admitted to hospital on the day of their surgery. For a knee arthroscopy you can usually go home on the day of your surgery but some people will need to stay overnight.
Anaesthesia
The anaesthetic team will see you and decide the type of anaesthetic that’s best for you.
The different types of anaesthesia include:
- General Anaesthetic. This type of anaesthetic puts you asleep during the whole procedure and a machine controls your breathing.
- Spinal Anaesthetic. An injection is placed into your back to numb your hip and legs. You will be awake during the procedure, however a sedative can be given to you to help you doze off.
- Nerve Blocks. This special injection is used to help with your pain after the operation and often used in conjunction with a general anaesthetic.
The Operation
You will be lying on your back, with your knee bent – during the procedure your surgeon will need to be able to reposition your knee.
Next the surgeon will make two small cuts around the knee. The cuts are usually roughly 1cm long. The first cut is used to insert a special camera into the knee so the surgeon can see inside the joint. The other cut is used to insert instruments into the knee joint. Occasionally a third cut will be made if necessary to insert other instruments.
Once the camera is inserted into the knee joint, the surgeon will examine all areas of the joint. They will then insert specific instruments to trim or repair cartilage tears, remove loose bodies or other tissue as required. During this time, there will be a flow of sterile water through the joint. Once the structures requiring attention have been addressed, the instruments are removed.
The wounds are then closed with sutures or steri strips which completes the operation. The whole operation usually takes 1 – 2 hours to complete.
Recovery Room
After the operation, you will be resting in the recovery room, where specially trained nurses will closely monitor you. This usually takes 1 to 2 hours. After which, you will be taken to your hospital room.
After the Operation
Most people can go home on the same day of their operation.
You will need to go home with some pain relief to help with the pain for the first few days. Try to keep the leg elevated in the first few days after the operation to help limit swelling.
In the first two weeks, the knee will need to be regularly iced to reduce swelling.
You will need to try to bend your knee and keep your thigh muscles active in the first two weeks after an arthroscopy in order to avoid stiffness.
Wound care
Although the wounds caused by an arthroscopy are small, they still need to be carefully looked after. The dressing over the wound should remain in place for the first two weeks. You will have a wound check 2 weeks after the operation at which time the dressing will be removed and the stitches taken out if present or steri strips removed.
Recovery and Rehabilitation
Rehabilitation
The rehabilitation program varies depending on what was operated on during the arthroscopy.
Your physiotherapist will give you exercises to help to improve the flexibility and strength of the knee. It is important to follow the advise of the physio and make sure that you complete the recommended exercises in order to get the best outcome from the operation.
Back to work / sport
If you work in an office environment your should be able to return to work within a week of the operation. You should be able to return to most physical activities 4 – 6 weeks after the operation.
If you have a heavy manual job, or participate in high impact sports, you may need to wait longer before returning to these activities. Ask you surgeon when it is safe to return to these types of activities.
Driving
Most people are able to drive 1 – 3 weeks after the operation. The length of time it will take to get back to driving depends on which leg was operated on, the problem that was operated on and how much pain you have after the operation. You should ask your surgeon when it will be safe for you to get back to driving.
F.A.Q.s | Frequently Asked Questions
What are the alternative treatments to having a Knee Arthroscopy?
Not all knee pain can be treated by a knee arthroscopy. You should discuss with your GP the alternatives to surgery which include:
- Pain-relief medication
- Physiotherapy
- Gait aids – such as walking sticks
Are there things to watch out for doctors after the operation?
- Redness, swelling or warmth around the cut
- Leakage from the cut
- Fever and chills.
- Severe knee pain that is not relieved by prescribed painkillers.
- Sudden sharp pain and clicking or popping sound in the knee joint
If any of these occur after the operation, be sure to tell your surgeon or GP about them.
What are the bones of the knee?
The knee is a hinge joint, formed by the end of the thighbone (femur) and the end of the shin bone (tibia). The bones are coated in cartilage, which acts as a cushion between the two bones and allows the knee to move. In front of these bones is the kneecap (patella) which glides in a groove on the end of the thigh bone.
Diagram of the bones and ligaments of the knee
References
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- Allum R. Complications of arthroscopy of the knee. J Bone Joint Surg Br. 2002 Sep;84(7):937-45.
- Kirkley A, Birmingham TB, Litchfield RB, Giffin JR, Willits KR, Wong CJ, Feagan BG, Donner A, Griffin SH, D’Ascanio LM, Pope JE, Fowler PJ. A randomized trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med. 2008 Sep 11;359(11):1097-107.
- Turman KA, Diduch DR. Meniscal repair: indications and techniques. J Knee Surg. 2008 Apr;21(2):154-62.
- M. A. Bohensky et al, Adverse Outcomes Associated With Elective Knee Arthroscopy: A Population-Based Cohort Study, Arthroscopy: The Journal of Arthroscopic and Related Surgery, 2013: 1-10, DOI:10.1016/j.arthro.2012.11.020
- Ch. Kieser, A Review of the Complications of Arthroscopic Knee Surgery, Arthroscopy: The Journal of Arthroscopic and Related Surgery, 1992, 8(1):79-83
- Onyema et al, Evidence-based practice in arthroscopic knee surgery, J Perioper Pract, 2011 Apr;21(4):128-34
- Briggs, T, Miles, J., Aston, W., ‘Operative Orthopaedics: The Stanmore Guide’, Edward Arnold Ltd., UK, 2010.