Knee Arthroscopy
What is knee arthroscopy?
Arthroscopic surgery is commonly called keyhole surgery. A camera (arthroscope) is used to look inside the knee, then specially designed instruments are used to carry out the surgery.
Which conditions can be treated with arthroscopic knee surgery?
Arthroscopic knee surgery is generally performed to remove or repair damaged cartilage inside your knee. It allows the entire inside of the joint to be checked. Procedures such as removal of scar tissue, loose bodies, treatment of early arthritis or even ligament reconstruction may also be possible during the arthroscopy.
Can my knee be treated without surgery?
Many knee conditions can improve with time and rehabilitation. These include meniscal tears, cartilage damage and early arthritis. Surgery may make some conditions worse, such as mild arthritis. Before any surgery is recommended you may be referred for physiotherapy, or asked to follow a specific exercise programme. Using a stationary cycle (exercycle) at low resistance can help to improve the strength and control of the supporting muscles and will not cause any further damage to your knee.
What is cartilage?
There are two types of cartilage inside your knee.
1. The articular cartilage is the smooth glistening lining on the inside surface of your knee. This allows the knee to move freely. When this is damaged or worn away the result is arthritis.
2. The meniscus is the C-shaped disc of cartilage which sits inside the knee joint. You have one on each side of your joint. This acts as a natural shock-absorber, protecting the rest of your knee from damage during normal activity.
Different treatments are available for various types of cartilage injury.
What treatments can be performed during knee arthroscopy?
A number of different procedures can be performed during knee arthroscopy surgery. The most common procedures include:
Meniscectomy
Removal of a damaged section of meniscus is called a meniscectomy. The remaining healthy section is left intact.
Meniscal repair
This is when a torn meniscus is sutured together or repaired onto the bone using specialised arthroscopic instruments.
Chondroplasty
The smooth cartilage covering the bone surfaces in the knee (articular cartilage) may be damaged by trauma or early arthritis. If a rough area is reshaped or smoothed during surgery this is called a chondroplasty.
Microfracture procedure
This may be indicated for more significant articular cartilage damage. Microfracture involves drilling small holes in the bone underneath the area of missing cartilage. This releases your body’s natural stem cells and stimulates the growth of new cartilage.
How is the surgery done?
You will need a general anaesthetic. Your operation is done through 2-3 small (1cm) incisions on the front of the knee. These allow a tiny camera to be inserted into the knee and special instruments are used to complete the operation. At the end of the operation, a stitch is placed into each small wound which are then covered by waterproof dressings. A large bandage will be applied over these to help reduce swelling.
What is the recovery process after surgery?
You should be able to get up and use your leg freely once you are awake and comfortable. You will be able to go home the same day as your operation. There are specific circumstances where some restrictions may apply, such as after meniscal repair or cartilage repair surgery.
Most people are able to walk without crutches. If you need them, crutches will be available but should be used only until you are confident walking without support. This is usually only for a few days. Unless advised otherwise, you can take your full weight on the operated leg.
The large crepe bandage can be removed on the first day after surgery and replaced with a tubigrip bandage. The waterproof dressing should be left intact until your first review with Mr Gormack. If they start to peel off or are stained with blood they can be changed by your local nurse, or by yourself with similar dressings provided or available from a pharmacy.
You should make an appointment to have the stitches removed by a nurse at Mr Gormack’s clinic (or at your GP) approximately 10 days after surgery.
You can drive once you are no longer taking morphine-based pain relief and if you are safe to use the brake pedal in an emergency. This normally takes 1-2 weeks.
You can return to work as soon as you are comfortable. For an office job this can be as soon as 1-3 days after surgery. Returning to work will take longer if you have a heavy physical job that requires a lot of standing, walking or lifting.
Swelling
Knee swelling is normal in the first 6-8 weeks after keyhole surgery. You will be given some tubigrip (elastic knee support) to take home with you. This will help to reduce swelling and should be used for the first few weeks after surgery. Other ways to reduce swelling include:
Resting your leg elevated in front of you when not standing or walking, and avoiding too much exercise in the early post-operative period.
Icing your knee for 20 minutes, three times a day or after exercise. Gel packs, frozen peas or ice wrapped in a moist towel all work well.
Using anti-inflammatories such as ibuprofen, Voltaren or Celebrex. These will be prescribed for you on discharge from the hospital.
Exercises
You can start doing straight leg raises immediately. To do these, lie on your back with your knee locked straight and lift your leg 10cm off the bed. Hold this position for 2-3 seconds and then lower your leg slowly onto the bed. Repeat this 10 times to make one set of exercises. Repeat 10 sets, three times per day.
After two weeks you can start to use a stationary bike (exercycle) at low resistance for 10 minutes at a time. Slowly increase duration and resistance.
After 3-4 weeks some patients may benefit from physiotherapy input.
Meniscal Surgery
If a meniscectomy has been performed, then rehabilitation can proceed as described above (see “Exercises”). If the meniscus has been repaired with sutures then it needs to be protected as it heals. Specific restrictions may mean:
That you use crutches and/or a hinged knee brace for 2-6 weeks
Avoiding bending your knee more than 90 degrees for the first six weeks
Some people are restricted in the amount of weight they can put on their leg while healing. You may need to remain non weight-bearing or touch weight bear for six weeks.
Cartilage repair
If you have had chondroplasty surgery then normal rehabilitation can be followed (“see Exercises”). If you have had microfracture surgery then you will need to remain touch or non-weight bearing for 6-8 weeks to protect the healing area. You will still be able to perform normal range of motion and strengthening exercises.
What are the risks of surgery?
There are risks with any operation. In keyhole knee surgery the chance of a significant complication is very unlikely. The main potential risks include bleeding, infection, post-operative stiffness, blood clots (DVT) and ongoing pain.