What is it?
Knee arthroscopy is “Key-Hole” surgery in the knee joint. This procedure has been around for the last 30 years or so and is the most common technique used on the knee today.
The arthroscope is essentially a small camera that uses fibre-optic cables to relay a picture to a screen in the operating theatre.
The first priority of the procedure is to make a diagnosis of the condition affecting the knee. This could be a torn cartilage (meniscus), arthritis (articular cartilage damage) or damage to a ligament.
The second priority is to do something about the condition diagnosed. This may involve the use of small instruments such as burrs and shavers to remove damaged areas of the knee.
Whereas in the past open surgery would have meant a stay in hospital, most arthroscopic procedures are carried out as day cases. There is no need for a big scar, so the overall rehabilitation period is significantly shorter.
The Procedure Itself
The procedure usually takes place under a general anaesthetic.
Once the patient is anaesthetized the surgeon makes small incisions around the front of the knee so that the arthroscope can be inserted into the joint. The arthroscope, commonly used for knee procedures, is less than 5mm in diameter which means the incisions, or ‘portals’, are very small. Usually the surgeon uses two portals: one for the arthroscope itself and one for the instruments to deal with the internal problem.
Once the procedure has been completed the portals are sutured, local anaesthetic is put into the knee for pain relief, the wounds dressed with a sticky plaster and then a bulky dressing around the knee.
What arthroscopic procedures can be performed?
1. Meniscal resection, trimming or repair
2. Removal of loose cartilage bodies
3. Removal of rough/damaged articular cartilage
4. Microfracture (drilling) of bare bone cartilage defects to encourage new cartilage growth
5. Lateral release to correct unstable knee caps
6. Debridement of ligament injuries. (I do not perform anterior cruciate reconstructions- if relevant then I would refer to a colleague who does)
What happens after your operation?
You will have a dressing on your knee to decrease the swelling. It is removed 3 days after the operation.
Do not be afraid to bend your knee but do not force the bending, it will improve gradually. You will be advised on the ward by the physiotherapist what to do with the knee when you get home.
You may experience some swelling in your knee after the operation, this may be a sign that you have become too active and need to rest the knee. If it persists, it can be dealt with by elevating your leg (so your foot is higher than your hip) and using ice.
To use an ice pack, place a bag of frozen peas in a damp pillowcase and apply to your knee for 20 minutes two or three times a day until the swelling subsides. Avoid using ice therapy if you have any skin problems, or altered sensation around the knee.
Do not drive or return to sporting activities until you have been reviewed by the doctor.
Scar: You will have 2-3 small scars on the front of the knee. These will be somewhat firm to touch and tender for 6-8 weeks. This can be helped by massaging the area firmly with moisturizing cream.
Nerve damage: Nerves running in the region can be damaged during the surgery. This would cause the formation of a painful spot in the scar (neuroma) or a small area of loss of sensitivity on the front of the knee.
Infection: Superficial infection can occur after any operation and would be treated with antibiotics. Deeper infection, involving the joint is very rare. If this occurs, then further surgery will be needed to remove the infection from the joint.
Stiffness: This problem cannot be predicted, but is often related to the amount of surgery required inside the knee. It will be watched for afterwards and treated with physiotherapy.
Pain: Pain may continue after surgery, especially if significant arthritis is found. A arthroscopy does not cure the arthritis, but aims to reduce pain and increase function