Knee arthroscopy is a surgical procedure that allows your surgeon to view the knee joint in great detail without making a large incision (cut) through the skin. Arthroscopy over the last few years has become very popular and is used to diagnose and treat a wide range of knee problems.
During knee arthroscopy, your surgeon inserts a small camera, called an arthroscope, into your knee joint. The images from the camera are transmitted to a video monitor, and the surgeon uses these images to guide miniature surgical instruments.
Because the arthroscope and surgical instruments are thin, your surgeon can use very small incisions, rather than the larger incision needed for open surgery. This results in less pain for patients, less joint stiffness, and often shortens the time it takes to recover and return to favorite activities/ sports.
The knee is the largest and strongest joint in your body. It has three bones: The lower end of the femur (thighbone), the upper end of the tibia (shinbone), and the patella (kneecap). The bones never come in contact with each other. This is due to the presence of a smooth slippery substance on the inside of each bone, which acts like a cushion. It is called cartilage. There are two pieces of shock-absorbers between the thigh bone and the leg bone. These are called meniscus. They are tough and rubbery to help cushion the joint and keep it stable. Bones are connected to one other and held in place by thick, rope like structures called ligaments. There are four primary ligaments in your knee and they are responsible to keep your knee stable.
Collateral Ligaments
These are found on the sides of your knee. The medial collateral ligament is on the inside and the lateral collateral ligament is on the outside. They control the sideways motion of your knee and brace it against unusual movement.
Cruciate Ligaments
These are the ones found inside your knee joint. The ligament in front is the anterior cruciate ligament (ACL) and the one at the back is the posterior cruciate ligament (PCL). They cross each other to form an “X”. The cruciate ligaments control the back and forth motion of your knee.
Your knee surgeon may recommend knee arthroscopy if you have a painful condition that does not respond to nonsurgical treatment. Nonsurgical treatment includes rest, physical therapy, and medications or injections that can reduce inflammation.
Knee arthroscopy may relieve symptoms of many problems in and around the knee joint
Common arthroscopic procedures for the knee include:
Removal or repair of a torn meniscus
- Reconstruction of a torn anterior cruciate ligament
- Removal of inflamed synovial tissue
- Trimming of damaged articular cartilage
- Removal of loose fragments of bone or cartilage
- Treatment of patella (kneecap) problems
- Treatment of knee sepsis (infection)
Advantages of knee arthroscopy:
- Smaller incisions
- Shorter hospital stay
- Reduced blood loss
- Quicker recovery
- Less pain
Knee arthroscopies are usually performed as day care procedures, however your surgeon may advice admission for a day or two. Before admission your surgeon may recommend certain blood investigations to assess your fitness for surgery. He may even recommend you to consult a physician/ anaesthetist to optimise any health conditions you may be suffering from.
Anaesthesia:
Your anaesthesist may use general/ spinal anaesthesia after discussing with you.
Surgical procedure:
Your knee is initially cleansed with antiseptic solution and draped in sterile linen/ drapes. Two puncture holes are made in front of the knee. One of the hole is used to insert the camera (arthroscope) and the other is used to insert thin instruments into the knee. Specialized instruments are used for tasks like shaving, cutting, grasping, and meniscal repair. In many cases, special devices are used to anchor stitches into bone.
Most knee arthroscopy procedures last less than an hour. The length of the surgery will depend upon the findings and the treatment necessary.
Many times you may not have a stitch and your surgeon may use steri-strips (small bandaids), and then cover your knee with a soft bandage.
Recovery
After surgery, you will be moved to the recovery room and should be able to go home the same evening. Be sure to have someone with you to drive you home and check on you that first evening. While recovery from knee arthroscopy is faster than recovery from traditional open knee surgery, it is important to follow your doctor’s instructions carefully after you return home.
Pain Management
After surgery, you will feel some pain. This is a natural part of the healing process. You will be prescribed medications to help reduce pain. Your doctor and nurses will work to reduce your pain, which can help you recover from surgery faster.
Dressing Care
Bearing Weight
You will leave the hospital with a dressing covering your knee. Keep your incisions clean and dry. Your surgeon will tell you when you can shower or bathe, and when you should change the dressing.
You may need crutches or other devices to help you walk after arthroscopic surgery. Your surgeon will tell you when it is safe to put weight on your foot and leg.
Rehabilitation Exercise
You should exercise your knee regularly for several weeks after surgery. This will restore motion and strengthen the muscles of your leg and knee. Working with a physical therapist can help you achieve your best recovery. Therapeutic exercise will play an important role in how well you recover. A formal physical therapy program may improve your final result.
Driving
Your doctor will discuss with you when you may drive. Typically, patients are able to drive from 1 to 3 weeks after the procedure.
Outcome
Most people return to full, unrestricted activities after arthroscopy. Your progress will depend on the type of damage that was present in your knee. Please discuss with your surgeon as to when you can go back to unrestricted physical activities. Unless you have had a ligament reconstruction, you should be able to return to most physical activities after 6 to 8 weeks, or sometimes much sooner. Higher impact activities may need to be avoided for a longer time.
Complications
The complication rate after arthroscopic surgery is very low. If complications occur, they are usually minor and are treated easily. Possible postoperative problems with knee arthroscopy include:
- Infection
- Blood clots
- Knee stiffness
- Accumulation of blood in the knee