What is Knee Arthroscopy?
Arthroscopy is keyhole surgery of the knee joint. It allows the diagnoses and treatment of knee disorders by providing a clear view of the inside of the knee with small incisions, utilizing a pencil-sized fibre-optic camera called an arthroscope. The arthroscope contains optic fibers that transmit an image of the knee through a small camera to a television monitor.
Modern or contemporary arthroscopy of the knee was first performed in the late 1960s. Improvements in the instruments and cameras has seen the procedure become highly effective for both the accurate diagnosis and proper treatment of knee problems. Today, arthroscopy is one of the most common orthopaedic procedures in Australia.
A few small incisions will be made around the knee. A sterile solution will be used to fill the knee joint and rinse away any cloudy fluid, providing a clear view of the knee.
The arthroscope will then be introduced into the knee. If surgical treatment is needed, a variety of small surgical instruments (e.g., scissors, clamps, motorized shavers) are inserted through another small incision. This part of the procedure usually lasts 45 minutes to 1 1/2 hours. At the end of the surgery, incisions will be closed with a suture or paper tape and covered with a bandage.
How can knee arthroscopy help?
Arthroscopy can be used to diagnose many problems:
- Torn meniscal cartilage.
- Loose fragments of bone or cartilage.
- Inflammation of the synovial membrane, such as rheumatoid or gouty arthritis.
- Abnormal alignment or instability of the kneecap.
- Torn ligaments including the anterior and posterior cruciate ligaments.
Arthroscopy can be used to treat many specific conditions:
- Removal or repair of torn meniscal cartilage.
- Reconstruction of a torn cruciate ligament.
- Trimming of torn pieces of articular cartilage.
- Removal of loose fragments of bone or cartilage.
- Removal of inflamed synovial tissue.
What sort of anaesthetic is used?
Almost all arthroscopic knee surgery is done on an outpatient basis. Usually patients arrive at the hospital an hour or two prior to surgery, having fasted as per instructions given. Arthroscopy can be performed under regional or general anesthesia. Regional anesthesia numbs from below the waist, and general anesthesia puts the patient to sleep. The anesthetist will determine which is the most suitable.
What to expect after the knee arthroscopy?
Most patients experience only mild discomfort when they wake up after a knee arthroscopy.
Recovery from knee arthroscopy is much faster than recovery from traditional open knee surgery. Still, it is important to follow the instructions carefully after returning home and have someone to check on you that evening.
Wounds will be dressed with waterproof dressings under the outer bandage. The outer bandage may be removed 24hrs after surgery. The smaller dressing is to remain intact for 7-10 days.
Bearing Weight Generally, patients can walk unassisted immediately after arthroscopy unless instructed otherwise. As discomfort subsides and strength returns in the leg, more weight can be taken on the leg.
Exercises to Strengthen the Knee It is important to exercise the knee regularly for several weeks following surgery to strengthen the muscles of the leg and knee. A physiotherapist may help with an exercise program.
How Long will it take to recover?
Most patients will be walking normally 7 days following surgery although there is considerable patient to patient variation. It is reasonable to expect a return to most former physical activities by six to eight weeks. A return to intense physical activity should only be done after the post-operative review.
Time off work will vary depending on occupation. Sedentary and office workers may return to work approximately 2-3 days following surgery. Occupations that involve heavy work, such as a construction labourer usually require more time to recover. This will be discussed at the post operative review.
The outcome of the surgery will often be determined by the degree of injury or damage found in the knee. There may be some limitation in activities even after recovery. For example, if the knee is damaged from jogging and the smooth articular cushion of the weight-bearing portion of the knee has worn away completely, then full recovery may not be possible.
Is physiotherapy required after knee arthroscopy?
Yes. Physiotherapy is commenced immediately post operatively. A physiotherapist will supervise muscle contractions, walking and weight bearing. Physiotherapy will continue on a daily basis following surgery until the dressings are removed 7-10 days following surgery.
What are the risks?
Knee arthroscopy is a very safe procedure. The most common side effect is temporary discomfort or slight bruising. Other complications include infection, blood clots, and an accumulation of blood in the knee. These occur infrequently and are minor and treatable.