What is knee arthroscopy

Knee arthroscopy is surgery that uses a tiny camera (arthroscope) to look inside your knee to check for problems inside your knee joint. The camera displays pictures on a video monitor, and your surgeon uses these images to guide miniature surgical instruments. Other medical instruments may also be inserted to repair your knee. 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.

During a knee arthroscopy small cuts are made to insert the camera and small surgical tools into your knee for the procedure.

Three different types of pain relief (anesthesia) may be used for knee arthroscopy surgery:

1. Local anesthesia. Your knee may be numbed with pain medicine. You may also be given medicines that relax you. You will stay awake.
2. Spinal anesthesia. This is also called regional anesthesia. The pain medicine is injected into a space in your spine. You will be awake but will not be able to feel anything below your waist.
3. General anesthesia. You will be asleep and pain-free.
4. Regional nerve block (femoral or adductor canal block). This is another type of regional anesthesia. The pain medicine is injected around the nerve in your groin. You will be asleep during the operation. This type of anesthesia will block out pain so that you need less general anesthesia.

A cuff-like device may be put around your thigh to help control bleeding during the knee arthroscopy procedure.

The surgeon will make 2 or 3 small cuts around your knee. Salt water (saline) will be pumped into your knee to inflate the knee.

A narrow tube with a tiny camera on the end will be inserted through one of the cuts. The camera is attached to a video monitor that lets the surgeon see inside the knee.

The surgeon may put other small surgery tools inside your knee through the other cuts. The surgeon will then fix or remove the problem in your knee.

At the end of your knee arthroscopy, the saline will be drained from your knee. The surgeon will close your cuts with sutures (stitches) and cover them with a dressing. Many surgeons take pictures of the procedure from the video monitor. You may be able to view these pictures after the operation so that you can see what was done.

Knee anatomy

Your knee is the largest joint in your body and one of the most complex. The bones that make up the knee include the lower end of the femur (femoral condyles), the upper end of the tibia (tibial plateau), and the patella (kneecap). A number of ligaments run between the femur and the tibia in the knee joint. The anterior cruciate ligament, the posterior cruciate ligament, and the meniscal ligaments are among the ligaments of the knee joint.

Other important structures that make up the knee joint include:

• Articular cartilage. The ends of the femur and tibia, and the back of the patella are covered with articular cartilage. This slippery substance helps your knee bones glide smoothly across each other as you bend or straighten your leg.
• Synovium. The knee joint is surrounded by a thin lining called synovium. This lining releases a fluid that lubricates the cartilage and reduces friction during movement.
• Meniscus. Two wedge-shaped pieces of meniscal cartilage act as “shock absorbers” between your femur and tibia. Different from articular cartilage, the meniscus is tough and rubbery to help cushion and stabilize the joint.
• Ligaments. Bones are connected to other bones by ligaments. The four main ligaments in your knee act like strong ropes to hold the bones together and keep your knee stable.
  • The two collateral ligaments are found on either side of your knee.
  • The two cruciate ligaments are found inside your knee joint. They cross each other to form an “X” with the anterior cruciate ligament in front and the posterior cruciate ligament in back.

Figure 1. Knee anatomy

Knee arthroscopy indications

Your doctor 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 painful symptoms of many problems that damage the cartilage surfaces and other soft tissues surrounding the joint.

Knee arthroscopy may be recommended for these knee problems:

• Removal or repair of a torn meniscus. Meniscus is cartilage that cushions the space between the bones in the knee. Surgery is done to repair or remove it.
• Torn or damaged anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL). Reconstruction of a torn anterior cruciate ligament or posterior cruciate ligament.
• Torn or damaged collateral ligament.
• Swollen (inflamed) or damaged lining of the joint. This lining is called the synovium. Removal of inflamed synovial tissue
• Kneecap (patella) that is out of position (misalignment).
• Small pieces of broken cartilage in the knee joint. Trimming of damaged articular cartilage
• Removal of a Baker cyst. This is a swelling behind the knee that is filled with fluid. Sometimes the problem occurs when there is swelling and pain (inflammation) from other causes, like arthritis.
• Repair of defect in cartilage.
• Some fractures of the bones of the knee.
• Removal of loose fragments of bone or cartilage
• Treatment of patella (kneecap) problems
• Treatment of knee sepsis (infection)

Before the knee arthroscopy procedure

Always tell your health care provider what medicines you are taking, even drugs, supplements, or herbs you bought without a prescription.

During the 2 weeks before your knee arthroscopy surgery:

• You may be told to stop taking medicines that make it harder for your blood to clot. These include aspirin, ibuprofen (Advil, Motrin), naproxen (Naprosyn, Aleve), and other blood thinners.
• Ask which medicines you should still take on the day of your surgery.
• Tell your provider if you have been drinking a lot of alcohol (more than 1 or 2 drinks a day).
• If you smoke, try to stop. Ask your provider for help. Smoking can slow down wound and bone healing. It also leads to a higher rate of surgical complications.
• Always let your provider know about any cold, flu, fever, herpes breakout, or other illness you have before your surgery.

On the day of your knee arthroscopy surgery:

• You will most often be asked not to drink or eat anything for 6 to 12 hours before the procedure.
• Take the medicines you have been told to take with a small sip of water.
• You will be told when to arrive at the hospital.

If you are generally healthy, your knee arthroscopy will most likely be performed as an outpatient. This means you will not need to stay overnight at the hospital.

Be sure to inform your orthopaedic surgeon of any medications or supplements that you take. You may need to stop taking some of these before surgery.

The hospital or surgery center will contact you ahead of time to provide specific details of your procedure. Make sure to follow the instructions on when to arrive and especially on when to stop eating or drinking prior to your procedure.

Knee arthroscopy procedure

Positioning

Once you are moved into the operating room, you will be given anesthesia. To help prevent surgical site infection, the skin on your knee will be cleaned. Your leg will be covered with surgical draping that exposes the prepared incision site.

At this point, a positioning device is sometimes placed on the leg to help stabilize the knee while the arthroscopic procedure takes place.

Procedure

To begin the procedure, the surgeon will make a few small incisions, called “portals,” in your knee. A sterile solution will be used to fill the knee joint and rinse away any cloudy fluid. This helps your orthopaedic surgeon see the structures inside your knee clearly and in great detail.

Your surgeon’s first task is to properly diagnose your problem. He or she will insert the arthroscope and use the image projected on the screen to guide it. If surgical treatment is needed, your surgeon will insert tiny instruments through other small incisions.

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.

Closure

Most knee arthroscopy procedures last less than an hour. The length of the surgery will depend upon the findings and the treatment necessary.

Your surgeon may close each incision with a stitch or steri-strips (small bandaids), and then cover your knee with a soft bandage. A soft bandage will protect your incisions while they heal.

Knee arthroscopy complications

The complication rate after arthroscopic surgery is very low. If complications occur, they are usually minor and are treated easily.

The risks for anesthesia and surgery are:

• Allergic reactions to medicines
• Breathing problems
• Bleeding
• Infection

Additional risks for knee arthroscopy surgery include:

• Bleeding into the knee joint
• Damage to the cartilage, meniscus, or ligaments in the knee
• Blood clot in the leg
• Injury to a blood vessel or nerve
• Infection in the knee joint
• Knee stiffness

Knee arthroscopy recovery

After knee arthroscopy, you will be moved to the recovery room and should be able to go home within 1 or 2 hours. Be sure to have someone with you to drive you home and check on you that first evening.

You will have an ace bandage on your knee over the dressing. Most people go home the same day they have surgery. Your surgeon will give you exercises to do.

Full recovery after knee arthroscopy will depend on what type of problem was treated.

Problems such as a torn meniscus, broken cartilage, Baker cyst, and problems with the synovium are often easily fixed. Many people stay active after these surgeries.

Recovery from simple procedures is fast in most cases. You may need to use crutches for a while after some types of surgery. Your provider may also prescribe pain medicine.

Recovery will take longer if you have had a more complex procedure. If parts of your knee have been repaired or rebuilt, you may not be able to walk without crutches or a knee brace for several weeks. Full recovery may take several months to a year.

If you also have arthritis in your knee, you will still have arthritis symptoms after surgery to repair other damage to your knee.

Pain Management

After surgery, you will feel some pain. This is a natural part of the healing process. Your doctor and nurses will work to reduce your pain, which can help you recover from surgery faster.

Medications are often prescribed for short-term pain relief after surgery. Many types of medicines are available to help manage pain, including opioids, non-steroidal anti-inflammatory drugs (NSAIDs), and local anesthetics. Your doctor may use a combination of these medications to improve pain relief, as well as minimize the need for opioids.

Be aware that although opioids help relieve pain after surgery, they are a narcotic and can be addictive. Opioid dependency and overdose has become a critical public health issue in the U.S. It is important to use opioids only as directed by your doctor. As soon as your pain begins to improve, stop taking opioids. Talk to your doctor if your pain has not begun to improve within a few days of your surgery.

Medications

• In addition to medicines for pain relief, your doctor may also recommend medication such as aspirin to lessen the risk of blood clots.

Swelling

• Keep your leg elevated as much as possible for the first few days after surgery. Apply ice as recommended by your doctor to relieve swelling and pain.

Wound Care

You will have a dressing and an ace bandage around your knee when you go home. DO NOT remove these until your provider says it is OK. Keep the dressing and bandage clean and dry.

Place an ice pack on your knee 4 to 6 times a day for the first 2 or 3 days. Be careful not to get the dressing wet. DO NOT use a heating pad.

Keep the ace bandage on until your provider tells you it is OK to remove it.

• If you need to change your dressing for any reason, put the ace bandage back on over the new dressing.
• Wrap the ace bandage loosely around your knee. Start from the calf and wrap it around your leg and knee.
• DO NOT wrap it too tightly.

When you shower, wrap your leg in plastic to keep it from getting wet until your stitches or tape have been removed. Please check with your surgeon to see whether that is OK. After that, you may get the incisions wet when you shower. Be sure to dry the area well.

• Your surgeon will see you in the office a few days after surgery to check your progress, review the surgical findings, and begin your postoperative treatment program.

Bearing Weight

• Most patients need crutches or other assistance after arthroscopic surgery. Your surgeon will tell you when it is safe to put weight on your foot and leg. If you have any questions about bearing weight, call your surgeon.

Activity

Your surgeon will ask you to rest when you first go home. Keep your leg propped up on 1 or 2 pillows. Place the pillows under your foot or calf muscle. This helps control swelling in your knee.

For most procedures, you may start to put weight on your leg soon after surgery, unless your provider tells you not to. You should:

• Start slowly by walking around the house. You may need to use crutches at first to help you keep from putting too much weight on your knee.
• Try not to stand for long periods.
• Do any exercises your provider taught you.
• DO NOT jog, swim, do aerobics, or ride a bicycle until your doctor tells you it is OK.

Ask your surgeon when you can return to work or drive again.

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.

Knee arthroscopy recovery time

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.

Many people return to full, unrestricted activities after arthroscopy. Your recovery will depend on the type of damage that was present in your knee.

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.

If your job involves heavy work, it may be longer before you can return to your job. Discuss when you can safely return to work with your doctor.

For some people, lifestyle changes are necessary to protect the joint. An example might be changing from high impact exercise (such as running) to lower impact activities (such as swimming or cycling). These are decisions you will make with the guidance of your surgeon.

Sometimes, the damage to your knee can be severe enough that it cannot be completely reversed with surgery.

Knee arthroscopy recovery exercises

You should exercise your knee regularly for several weeks after surgery. This will restore motion and strengthen the muscles of your leg and knee.

Therapeutic exercise will play an important role in how well you recover. A formal physical therapy program may improve your final result.