Knee Arthroscopy

What is an arthroscopy?

An arthroscopy is where the surgeon performs a small cut in the skin and inserts a special telescope, attached to a video camera, into your knee joint (key-hole surgery). This gives a clear image of what is happening inside the joint.

The surgery is performed by two or three small incisions on the front or sides of the knee:

• The arthroscope (camera) is inserted into one portal
• A second portal can be used for saline solution through the knee joint to improve visibility and manoeuvrability of the instruments. 
• A third portal to allow the instrument tool to be inserted to carry out any treatment.

What is this operation for?

Arthroscopic surgery can be used for various procedures, which include:

• Trimming or removing any loose fragments or cartilage that have broken off into the joint space (loose bodies)
• Repairing torn ligaments
• Micro fracture procedure

What are the benefits of the procedure?

Arthroscopy allows a surgeon to look inside a joint place that would otherwise only be reachable by opening up the joint using traditional surgery.

The keyhole technique of arthroscopy has a lower risk of complications than traditional surgery and usually results in less pain after the procedure, a shorter hospital stay and a quicker recovery.

Common types of procedures:

Loose body removal

Loose bodies are fragments of bone or cartilage that may be floating freely or lodged in the knee joint fluid or synovium. Loose bodies may causing locking symptoms of the knee. An arthroscopic instrument is used to reduce to a suitable size and remove it through the portal.

Meniscectomy

Meniscus tears may be confirmed on MRI and can be surgically managed if you have persistent symptoms, restriction in function and any mechanical symptoms of locking or giving way. A meniscectomy involves a small cutting instrument being used to trim away any loose or torn meniscus.

Meniscus repair

Some tears are not repairable, which will be determined by your consultant. The repair is dependent on the blood supply of the meniscus. Good blood supply allows for meniscal healing. To be repaired, the torn edges are stitched back into place. Meniscus repairs take longer to heal and you may have restrictions to your ability to bear weight and bend your knee after surgery. This will depend on your consultant’s decision on an individual basis and may not be decided on until after surgery.

Microfracture

This can be carried out if there is an area of articular cartilage damage or there is an area of bone damage below the cartilage (osteochondral defect). This involves smoothing over the loose articular cartilage flaps from the surface of the bone. This area of bone is drilled to create a microfracture, which allows more blood supply to stimulate fibrous cartilage growth.

You may be required to be protected weight bearing for 6 weeks if this is carried out.

Ligament reconstructive surgery

Ligament reconstructive surgery may be indicated following trauma to the knee, symptoms may include instability and locking which may interfere with your every day or sporting activities. The aims of surgical intervention is to stabilise the knee. A harvesting tendon from one of the leg muscles may be used as the graft and secured in place of the damaged ligament. Ligament reconstructions will follow different post-operative rehabilitation protocols guided by your surgeon and physiotherapist.

How long will I be in hospital?

The operation is usually carried out as a day case. This means that you will usually be in hospital a day.

Before you are admitted to hospital

Before you are admitted to hospital, you may need to have a pre-operative assessment. This is an assessment of your health to make sure you are fully prepared for your admission, treatment and discharge. The pre-operative assessment nurses will help you with any worries or concerns that you have and will give you advice on any preparation needed for your surgery.

Before the date of your admission please read, very carefully, the instructions given to you. If you are undergoing a general anaesthetic you will be given specific instructions about when to stop eating and drinking, please follow these carefully as otherwise this may pose a risk and we may have to cancel your surgery. You should bath or shower before coming to hospital.

On admission a member of the nursing staff will welcome you. The nurses will look after you and answer any questions you may have. You will be asked to change into a theatre gown.

The surgeon and anaesthetist will visit you and answer any questions that you have. You will be asked to sign a consent form. A nurse will go with you to the anaesthetic room and stay with you until you are asleep.

A cuff will be put on your arm, some leads placed on your chest, and a clip attached to your finger. This will allow the anaesthetist to check your heart rate, blood pressure and oxygen levels during the operation. A needle may be put into the back of your hand to give you the drugs to send you to sleep.

What happens after the operation?

A nurse will check your blood pressure, pulse and the area where the operation has been done. You will normally be able to have a drink shortly after the procedure and eat as soon as you feel hungry.

You can usually get out of bed an hour or so after you wake up and you should wait for the nurses to help you as you may feel a little dizzy at first. It is likely to be a bit painful where the operation has been carried out, but if you move carefully, the pain is usually limited. The nurses will monitor your pain and give you painkillers, if necessary. It is quite normal for a small amount of blood to soak through the dressing and this can easily be changed. Sometimes the staff will need to press gently on the dressing for a while to prevent this happening again.

Recovery after surgery

Your knee will feel painful and swollen after arthroscopy, this is normal. It is important to be aware of your pain level. Take your pain relief regularly, as prescribed by the hospital. An appointment will be made for you to see a member of the lower limb orthopaedic team in three-six weeks time.

What complications can occur?

All surgeries have potential complications. Arthroscopy risks are lower than traditional surgery. Some pain and stiffness around the joint are common after surgery, but complications are rare. Whilst this section is not intended to scare you as a patient, it provides information to help you make an informed decision in the consent process.

Complications from arthroscopy can include:

• Accidental damage to the joint
• Damage to the structures inside or near to the joint such blood vessels or nerves
• Infection of the joint
• Bleeding into the joint
• Blood clot
• Unexpected reaction to anaesthetic
• Loss of feeling in the skin around the joint
• Failure to improve symptoms.

Walking

Unless you have any restrictions you must try to walk normally as soon as you can. You may need to use a stick or crutches for a few days to help you walk without a limp. Please remember to return the walking aids when you no longer need them.

If it has been necessary to perform a microfracture or meniscus repair during your operation your post-operative instructions to be able to bear weight may be restricted. This will be explained to you by the physiotherapist on the day unit following your surgery.

Swelling

Swelling and inflammation is a normal part of the healing process. Dependant on your surgery this can last up to a few months. Swelling of the leg is different for everyone and may cause the leg to ache and feel very heavy.  

Following your discharge from hospital; you need to apply the ice pack three to four times daily for 15-20 minutes. You will be able to reduce the frequency after this time, but will find that you will benefit from ice therapy for up to three months to help manage the swelling.  

Elevating your leg on a stool or on the bed will also help manage the swelling. Do not rest a pillow underneath your knee in a semi bent position. Although this may feel comfortable, it may cause problems with your movement and walking pattern.  

Physiotherapy

Not everyone needs a course of physiotherapy after surgery. An appointment will be arranged if necessary or the appropriate contact details will be provided for your local physiotherapy team if you have any problems.

Work

You should return when you feel able to cope with the physical demands of your job. You can discuss this with your GP or Consultant if you are not sure.

Driving

Unless you have any restrictions you can drive when you feel safe to do an emergency stop and safely control the car. You must tell your insurance company that you have had a knee arthroscopy. If in doubt, contact your consultant or GP.

Telephone Numbers

If you are at all worried by your knee please contact us: