Knee arthroscopy

Knee arthroscopy is commonly known as keyhole surgery. It involves a camera attached to a thin telescope that is inserted into the knee via a small incision. With the camera, the surgeon can look inside the knee itself and identify any problems. If the camera reveals any problems the surgeon can use small instruments that can be inserted via a second incision in the knee.

Common problems that are treated by arthroscopic surgery include meniscal cartilage tears, worn articular cartilage and problems with the soft tissues within the knee joint such as synovial plicas.

In addition, complex surgery such as cruciate ligament reconstruction can be performed using keyhole surgery techniques.

What happens in surgery?

The surgery is usually performed as a day case under a general anaesthetic. It can be done with local anaesthetic also as a day case procedure. The operation usually takes around 30 minutes to perform although the time taken may be longer for more complex procedures.

At the end of the operation your knee is injected with a local anaesthetic to minimise the post-operative pain. No stitches are required and the small wounds are closed with steristrips and splash proof dressings.

What are the benefits?

Establish a diagnosis and cure the pain.

Arthroscopic Meniscectomy:

A torn shock absorber cartilage (meniscus) can be trimmed and the symptoms of locking or giving away can be resolved. In selected cases it can be repaired often in younger patients.

Further information regarding meniscal injuries can be found at http://www.eorthopod.com/public/patient_education/6513/meniscal_injuries.html

Arthroscopic Chondroplasty:

Damage to the surface cartilage lining the joint can lead to unstable flaps, trimming can improve symptoms

Microfracture:

In selected cases there is complete loss of the surface cartilage, stimulation of the underlying bone by micro fractures may result in the formation of resilient cartilage leading to the improvement in symptoms. In these case patients will use crutches for 8 weeks touch weight bearing and will be advised to use a bending machine at home for 6 hours per day. This procedure is not performed as commonly as the others.

Floating loose fragments of cartilage (loose bodies) can be removed

Arthroscopic soft tissue debridement:

Sometimes folds of tissue in the lining of the knee can catch and become inflamed. These tissue folds are called plicae. Not everybody has them and, even if you do, they may not be symptomatic. However, a plica may cause pain on the inside of the knee and around the patella. The initial treatment is to have a course of physiotherapy. The majority of people should have a significant improvement in knee pain after physiotherapy, but if the course makes no difference it may be necessary to perform arthroscopic surgery. The plicae can be trimmed with a small arthroscopic shaver and the symptoms relieved. Link: http://www.eorthopod.com/public/patient_education/6520/plica_syndrome.html

What happens after surgery?

You will be mobilised after surgery by a physiotherapist and will be able to walk out of the hospital 3-4 hours after the surgery. You may need to have outpatient physiotherapy or an exercise programme for a few weeks after your operation to get your knee to settle as quickly as possible.

Your mobility will improve each day after surgery. We expect you will be able to walk without crutches the next day and be comfortable to drive after 3-5 days. The dressing and steristrips need to be kept dry for 10 days and can then be removed.

If you have an office-based job you will need to take at least a week off work and possibly up to two weeks if your job is more physically demanding.

Are there any risks?

Arthroscopy is a very safe procedure. However there are risks involved with any operation. Although it is unusual to suffer serious complications you should be aware of some of the risks involved. The overall complication rate in a large series was less than 1%.

Common complications are listed below. If anything is not clear you need to discuss this further with your surgeon before the planned surgery.

· Effusion (swelling in the knee) usually temporary and settles by 4-6 weeks.

· Flare-up of pain – usually settles by 6 weeks

· Small area sensitivity or numbness around the scar.

· Bleeding in to the joint (1%)

· Deep vein thrombosis (0.1%)

· Infection, rarely, about 1 in 500 (0.2%)

By 8 weeks you should have made a complete recovery following the surgery and most of the symptoms should have settled.