Knee Arthroscopy

A knee arthroscopy is a minimally invasive surgical procedure in which a small camera (arthroscope) and special surgical instruments are inserted into the knee joint through small (keyhole) incisions. The camera is attached to a light source and monitoring screen. This procedure allows your surgeon to view and access damage within the knee joint and to make repairs as necessary.

Your doctor may recommend that you undergo a knee arthroscopy if you are experiencing knee pain or other symptoms such as locking, catching or giving way of the knee. A knee arthroscopy can also be used to investigate swelling of the knee.

A knee arthroscopy may be performed to diagnose and treat the following conditions:

• Repair or removal of a torn meniscus
  • The meniscus is a soft disc of cushioning cartilage that also helps with stabilising the knee.  There are two menisci (medial and lateral) within each knee joint.  A meniscus can be damaged or torn by injury (especially with twisting or hyper-extension of the knee) and is commonly seen in sports people.   Also as we age, the meniscus can degenerate over time.  Both injury and degeneration can result in pain, instability or locking of the knee.
• Anterior cruciate ligament tears – ACL injuries are common in sports and can be reconstructed with arthroscopic surgery
• Removal of inflamed synovial membrane – this can help manage the symptoms of some inflammatory diseases that affect the joint
• Trimming torn articular cartilage – articular cartilage can degenerate over time from painful osteoarthritis. Removal of the rough or frayed cartilage can increase movement and decrease pain
• Removal of loose bone or cartilage fragments
• Evaluation and treatment of patella-femoral (kneecap) disorders
• To help fixing fractures involving the knee joint
• Helping to diagnose unexplained pain or other symptoms

The benefits of an arthroscopy over a more invasive knee surgery include:

• Small incisions
• Minimal damage to tissues surrounding the knee
• Less pain
• Early mobilisation
• Faster recovery
• Lower infection rate
• Shorter hospital stay – Usually Day Surgery only

As with any surgery there are potential risks to undergoing an arthroscopy.  The complications specific to arthroscopy include:

• Infection – an uncommon complication
• Post operative bleeding – which can lead to swelling and pain and slow your recovery.
• Damage to nerves or blood vessels
• Deep vein thrombosis (blood clot legs) or pulmonary embolus (blood clot lungs)
• Numbness and tenderness around the small incisions.
• Pain on kneeling on the knee
• Stiffness
• Failure to relieve pain and potential for further surgery in the future

General complications of any surgery include:

• Allergic reactions to medications
• Nausea and vomiting
• Blood loss requiring transfusion
• Heart attack, strokes, kidney failure, pneumonia, bladder infections

Preparing for your arthroscopy

Preparation begins prior to your admission to hospital. Your surgeon will discuss your surgery and what to expect.

Arrangements should be made in advance to prepare for your recovery including:

• Ensuring your home is free from tripping hazards, 
• Ensuring regularly used items are easily accessible,
• Arranging to have someone at home with you or to check in on you when you are discharged.

Your surgeon may refer you to have routine blood tests and other investigations prior to your surgery.

You will be given instructions regarding your medications and it is important you follow these. These may include:

• Cease blood thinning medication such as aspirin and anti-inflammatory medications up to 5? days prior to your surgery.  If you are on Warfarin or other similar blood thinners, your surgeon will give you specific instructions about these.
• Cease naturopathic or herbal medications 10 days prior to your surgery.
• It is important to continue with your other usual medications especially those used to treat blood pressure and breathing problems.

Certain lifestyle risk factors can slow your healing following your surgery. In preparation for your recovery aim to:

• Eat healthy
• Quit smoking
• Limit alcohol intake
• Reduce weight if overweight (follow medical advice on safe exercise prior to and following surgery)

Remember to bring your x-rays with you to hospital.

Post surgery

If your surgery is performed as Day Surgery, you will need somebody to drive you home from the hospital and to stay with you the night of your procedure.  If you stay over-night at the hospital following your procedure, your discharge time will be at 10:00 am the following day.

Prior to discharge, you will be given information on post-operative wound care and instructions regarding activity and exercises. You will also be seen by a physiotherapist who will instruct you on important exercises to aid and assist your recovery. 

Your knee will have a bandage over a waterproof dressing.  The bandage can be taken down in 2 days and replaced with a compression bandage.  Your waterproof dressing allows for normal showering.  You should avoid baths, swimming pools, water ways or the beach until you have seen your surgeon for your post operative review. 

Even though it is unusual to have severe pain following a knee arthroscopy, your surgeon will talk to you about how best to manage your post-operative pain.  General measures such as rest, ice to the knee, compression bandaging and elevation will help control your pain in the first week post operatively.  Your surgeon will also prescribe you pain relief medications and give you instructions about how to use them. 

On discharge, you will be given an appointment to see your surgeon as an outpatient.

Following your arthroscopy, you will be up and moving on the same day. Often you will not require any additional supports such as a stick, crutches or frame.  It is important to take things slowly over the first 3-5 days.  It is important to do the exercises recommended by your physiotherapist to prevent blood clots and to strengthen the leg muscles in order to speed up recovery.

You may return to work when your knee is feeling comfortable.  Ask your surgeon for a medical certificate if you need some time off work to recover from your surgery.

Full recovery usually takes around 4-6 weeks but is dependent on what has been done at the time of your surgery. You will often be able to return to usual activities, including sports, around this time.

Your should discuss when you can start driving with your surgeon before you are discharged. 

If you are concerned about your recovery or your dressings please contact your surgeon for a review.