What is Knee Arthroscopy?

Knee arthroscopy, often referred to as “keyhole surgery,” is a minimally invasive surgical procedure that allows orthopaedic surgeons to diagnose and treat problems inside the knee joint with very small incisions. It’s called “keyhole” surgery because it uses a tiny camera (arthroscope) that is inserted into the knee to provide clear, detailed images of the joint on a screen.

This procedure offers significant benefits, including:

• Minimized trauma: Only small incisions are needed, which reduces the impact on surrounding tissues.
• Faster recovery: Due to the smaller incisions, recovery times are generally shorter compared to traditional open surgery.
• Less pain: Patients typically experience less pain following arthroscopy, allowing for quicker mobilisation.
• Lower risk of complications: Smaller incisions mean a lower chance of infection and other complications.

When is Knee Arthroscopy Used?

Knee arthroscopy can be used to treat a variety of knee conditions, including:

• Meniscus tears
• Ligament injuries (e.g., ACL)
• Removal of loose bodies (fragments of bone or cartilage)
• Cartilage repair
• Treatment of knee osteoarthritis
• Diagnosis of unexplained knee pain

Why Do People Have Knee Arthroscopy?

For the majority of people who have knee arthroscopy surgery, the procedure results in:

• Relief of Pain: By addressing underlying issues such as torn menisci, cartilage damage, or loose bodies, knee arthroscopy often provides significant pain relief and improved knee function.
• Restoration of Mobility: For individuals with knee locking, instability, or difficulty bending/straightening the knee, arthroscopy can help restore normal movement and mobility, allowing patients to return to daily activities with fewer restrictions.
• Improved Functionality: Patients who undergo ACL reconstruction, patellofemoral stabilisation, or meniscal repair frequently experience a noticeable improvement in knee function, helping them return to sports or physical activity sooner.
• Reduced Risk of Further Damage: By addressing conditions such as loose bodies or meniscal tears, arthroscopy can prevent further joint damage, which could lead to more serious problems like osteoarthritis down the road.

Conditions Treated with Knee Arthroscopy

Knee arthroscopy can be used to treat a wide range of knee conditions, including:

• Meniscal Tears: The meniscus is the cartilage in the knee that acts as a cushion between the thigh bone and shin bone. Tears can occur due to injury or age-related wear and tear.
• Loose Bodies: Fragments of bone or cartilage that have broken off and are floating in the joint can cause pain, swelling, and locking sensations.
• ACL Reconstruction: Arthroscopy is often used in ACL (anterior cruciate ligament) reconstruction, which is commonly performed to repair a torn ACL.
• Cartilage Damage: Damaged cartilage can be repaired or smoothed out through arthroscopy, preventing further degeneration and improving knee stability.
• Patellofemoral Stabilisation: Procedures like patella realignment or stabilisation are performed to address issues with the kneecap (patella) that may be causing pain or instability.
• Septic Arthritis: In cases of infection within the joint, arthroscopy may be used to irrigate and remove infected tissue, aiding in treatment.

The Knee Arthroscopy Procedure

Although knee arthroscopy is minimally invasive, it still requires general or local anaesthesia. The procedure typically involves:

• Small Incisions: Two to three tiny incisions are made around the knee to allow the insertion of the arthroscope (camera) and surgical instruments.
• Camera Insertion: The arthroscope is inserted to visualise the inside of the knee joint, sending real-time images to a monitor for the surgeon to assess the knee’s condition.
• Treatment or Repair: Based on the diagnosis, the surgeon will perform necessary repairs, such as trimming damaged cartilage, repairing or removing the meniscus, or reconstructing ligaments.
• Closing the Incisions: Once the procedure is complete, the incisions are closed with small sutures or steri-strips, and a dressing is applied.

What Are Alternatives to Knee Arthroscopy?

Before considering knee arthroscopy, there are several alternative treatment options that Mr Richardson may recommend, depending on your symptoms and diagnosis. These conservative approaches include:

• Exercise and Physical Therapy: Strengthening the muscles around the knee can help improve stability and reduce pain. Stretching and strengthening exercises can also enhance mobility.
• Walking Aids: Crutches, knee braces, or a cane can be used to reduce pressure on the knee and aid in mobility during recovery.
• Medications: Anti-inflammatory medications, pain relievers, or corticosteroid injections may help alleviate pain and reduce inflammation.
• Time: Many knee conditions, especially those caused by minor injuries, may resolve on their own with rest and time. It’s important to monitor symptoms to see if they improve without surgical intervention.

In cases where symptoms are persistent, recurrent, or extremely severe, and conservative treatments are ineffective, surgery such as knee arthroscopy may be considered.

What Are Possible Complications of Knee Arthroscopy Surgery?

While knee arthroscopy is considered a minimally invasive procedure with fewer risks than traditional surgery, it is still not risk-free. The most common complications include:

• Prolonged Swelling and Pain: This is a normal part of the healing process and usually resolves with time and anti-inflammatory medications.
• Infection: Although rare due to the small incisions used in arthroscopy, infection can still occur. Symptoms of infection include fever, chills, increased tenderness, redness, and drainage from the wound.
• Blood Clots: Whilst uncommon, blood clots (deep vein thrombosis or DVT) can occur after surgery. Warning signs include tenderness, redness, or swelling in the calf, thigh, ankle, or foot. Occasionally blood clots can break off and travel to the lungs. This is called a pulmonary embolism, or PE. If at any stage in you recovery you develop shortness of breath, pain in the chest, or difficulty breathing you should call an ambulance and travel to the nearest emergency department.

To minimise the risk of complications, it is important to recognise potential issues early. If you experience any of the following, contact your doctor immediately:

• Signs of a blood clot: Tenderness, redness, swelling in the calf, thigh, ankle, or foot.
• Signs of infection: Fever, chills, increased tenderness or swelling around the surgical site, or drainage from the wound.

By following your post-operative instructions and attending follow-up appointments, you can help reduce the risk of complications.

What Types of Exercise Are Most Suitable Following a Knee Arthroscopy?

Post-operative care and appropriate exercise are crucial for a successful recovery. Here’s an outline of what to expect in terms of physical activity following your knee arthroscopy:

• First 2 Weeks: During the initial recovery phase, you are encouraged to rest, elevate, and ice your knee as much as possible. Avoid strenuous activity, as overexertion could lead to increased pain and swelling. Short walking distances are permitted, but be sure to follow the guidelines from your surgeon.
• After the 2-Week Review: At your follow-up appointment, Mr Richardson will assess your progress and determine whether you are ready to begin more active rehabilitation. Common activities that are generally safe to resume include:
  • Walking: Gradually increasing your walking distance as tolerated.
  • Swimming: Gentle swimming can improve mobility without putting too much strain on the knee joint.
  • Cycling: Stationary biking can help strengthen the knee without high-impact stress.

• Avoid High-Impact Activities: For at least 4 weeks, or until all swelling (effusion) has resolved, contact sports and running should be avoided to ensure proper healing.

It’s essential to follow these guidelines carefully to prevent re-injury and ensure the best possible recovery outcome.