Knee arthroscopy

Introduction

Arthroscopy is a surgical procedure in which an arthroscope is inserted into a joint. Arthroscopy is a term that comes from two Greek words, arthro- (meaning joint), and -skopein, meaning to examine.

The benefits of arthroscopy include smaller incisions, faster healing, a more rapid recovery, and less scarring. Most arthroscopic surgical procedures are often performed on a day-case basis under general anaesthetic and the patient is usually able to return home on the same day.

The arthroscope is a small fibre-optic telescope that can be inserted into a joint (commonly the knee, shoulder and ankle) to evaluate and treat a number of conditions. A camera is attached to the arthroscope and the picture is visualized on a TV monitor.

Indications

• Torn meniscus (cartilage) - The menisci are half-moon shaped pieces of "gristle" which act as "shock absorbers" between the bones in the knee. A meniscal tear can lead to pain, swelling locking and a sensation of instability. The arthrosope can often be used to enable the torn part of the meniscus to be trimmed away, leaving the remaining healthy cartilage to minimise the risk of arthritis later on. Occasionally it is possible to repair a torn meniscus using during a knee arthroscopy.
• Torn ligaments - There are two strong crossed ("cruciate") ligaments within the knee joint, which connect the femur and tibia bones. If one or other of these is torn it can lead to instability. The arthroscope can be used to assess damage to these ligaments and sometimes to assist in repairing them.
• Loose bodies - Sometimes, a loose piece of bone or cartilage breaks free and floats around within the knee joint. This can cause pain, and episodic locking of the knee as well as a sensation of instability. Such loose bodies are amenable to removal via the arthroscope.
• Arthritis - Particularly in its early stages, symptoms from knee arthritis may be alleviated by debridement via the arthroscope.

Before the operation

• Depending on your age and your general medical health, you may be asked to attend for pre-operative blood tests or other investigations before coming in for your surgery.
• You will be admitted on the day of your operation.
• You should have nothing to eat for at least six hours before your operation. Clear fluids are generally allowed up to four hours beforehand.
• The anaesthetist will assess you on the day of surgery - If there are any concerns regarding your general medical health it may be suggested that you stay overnight afterwards, but this is unlikely.

The surgical procedure

• The operation will take takes between 20 minutes and one hour.
• Surgery is performed under sterile conditions in the operating theatre usually under a general anaesthetic (with you asleep).
• For some patients a spinal anaesthetic is more appropriate.
• Each knee is different, and the exact procedure performed will depend upon the pathology within your knee joint.
• At the end of the operation the knee joint is injected with a long-acting local anaesthetic which will help provide pain relief after you wake up.

Post-operative recovery

• You will wake up in the recovery room and then be transferred back to the day-case ward.
• A bandage will be around the operated knee - Before you go home this will be reduced in size.
• You will be visited by the Physiotherapist - an ice-cold "compress" may be applied to your knee to minimise post-operative swelling. The Physiotherapist will advise you on a number some exercises to do.
• You are able to drive and return to work when comfortable unless otherwise instructed. Taking ten working days off after the operation is commonly recommended.
• An appointment will be made for you 10 - 14 days after surgery to monitor your progress and remove the stitches from your knee.
• Depending upon the findings during your knee arthroscopy, further surgery may be necessary at a later date.

Risks and complications

As with any surgery, there are potential risks involved. Your decision to proceed with the surgery should be made when you feel that the advantages of surgery outweigh the potential disadvantages.

It is important that you are informed of these risks before the surgery takes place. Complications can be medical (general) or local complications specific to the knee arthroscopy.

Medical complications include those of the anaesthetic and your general well being.

Local complications following arthroscopic knee surgery are very rare indeed - They include:

• Infection - Infection can occur with any operation. In the knee this can be superficial or deep. If it occurs it can be treated with antibiotics but may require further surgery.
• Blood clots (Deep Venous Thrombosis - DVT) - These can form in the calf muscles and can travel to the lung (Pulmonary embolism - PE). These can occasionally be serious and even life threatening. If you get calf pain or shortness of breath at any stage, you should notify your doctor. After an arthroscopy it is extremely unlikely that you will suffer this complication.
• Damage to nerves and Blood vessels - Rarely these can be damaged at the time of surgery. If recognised they are repaired but a second operation may be required. Nerve damage can cause a loss of feeling or movement below the knee and can be permanent. This complication is extremely rare.
• Incomplete resolution of symptoms - It is possible that you will have some residual symptoms after an arthroscopy on your knee.

Summary

An arthroscopic operation can be used to treat a variety of problems within the knee joint. - These operations are usually successful and the risk associated is very low.

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