Arthroscopy

Knee arthroscopy is keyhole surgery used for both the diagnosis and treatment of knee conditions.
It allows the inspection and assessment of the cavity of the knee joint and allows treatment, such as removal of meniscal tears, articular cartilage flaps and loose bodies to be performed at the same time.

The Surgery

Arthroscopic knee surgery is performed in an operating theatre and is usually performed as day case operation under general anaesthetic. The operation can be performed under spinal or epidural anaesthesia but is not generally possible under local anaesthetic.

The arthroscopic knee operation requires two small incisions either side of the patella to allow a camera (arthroscope) and operating instruments to be introduced into the knee. The incisions are usually less than 1cm in size but occasionally need to be larger and sometimes additional small incisions have to be made.

At the end of the operation a local anaesthetic solution (to reduce the post-operative pain) combined with adrenaline (to reduce bleeding and bruising around the incisions) is normally injected into the joint.

The incisions are covered with a sterile dressing as they do not normally require any stitches. The knee is then wrapped in a soft compressive bandage to help to reduce any swelling and keep the knee comfortable.

Arthroscopic view of a torn meniscus being removed
Arthroscopic view of a torn meniscus being removed

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Post-operative Management

Most patients are able to return home on the same day as surgery. They can often be discharged several hours after surgery as long as they are sufficiently recovered from the anaesthetic, although some patients take longer to recover. Most patients are pain free when discharged.

All patients will need someone to take them home and be with them on the night following surgery

Dressings

The large bandage around the knee is normally removed 24-48 hours after surgery.

The non-stick sterile dressings on the wound are replaced with clean waterproof dressings and a tubigrip to supply gentle compression to reduce post-operative swelling.

Bathing and Showering

The wounds should be kept clean and dry until the wound has sealed. Showering is fine and the waterproof dressings can be changed afterwards. Bathing is best avoided until the wounds are sealed, typically 4 to 5 days after surgery.

In summary, whilst the wounds are wet – keep them dry and when the wounds are dry, you can get them wet.

Rehabilitation

Patients should and try to minimise their activities as much as possible in the first few days following surgery. The leg should be rested and elevated as much as possible. Painkillers (supplied on discharge from hospital) and cold packs may be used as required.

Simple exercises, including straight leg raises and other exercises as instructed by your physiotherapist prior to discharge should be performed.

Most patients do not require formal physiotherapy following arthroscopy as all patients are seen and assessed by a physiotherapist prior to discharge from hospital.

Some patients might require physiotherapy either before or after the first post-operative check-up.

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Return to Activity

Recovery is a gradual process and whilst most patients bounce back quickly following arthroscopy everyone should assume it will take up to six weeks to make a full recovery and symptoms can often improve for some time beyond this period.

The speed of recovery depends on the surgery performed, the degree of degeneration found and the age of the patient.

In general, the older the patient and the more degeneration a patient has, the slower and less predictable recovery will be. Most patients can perform most tasks around the house and return to driving within a few days.

Sedentary/office workers can often return to work a few days after surgery. Patients performing more physical work might require two to six weeks off work depending on their individual positions.Patients can usually return to sport between three to six weeks following surgery.

The small wounds can remain tender for a few months following surgery. Occasionally patients are advised to be non-weightbearing for a period of up to six weeks, most commonly if a microfracture chondroplasty has to be performed.

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Risks

Arthroscopy is an extremely safe routine operation with a very low complication rate.

Potential complications include infection, injury to blood vessels and nerves and severe pain and swelling in addition to the rare general complications such as blood clots (DVT) and anaesthetic risks.

In general, the risk of sustaining a complication as a consequence of the operation that leaves you worse off in the long term is less than 1%.

The biggest practical risk is the risk of not being able to improve symptoms as much as desired or at all. This occurs most commonly due to the presence of degenerative changes.

Most ongoing symptoms following arthroscopic surgery are usually the result of the underlying problem within the knee joint for which the surgery was undertaken and not as a consequence of the arthroscopy.