Knee Arthroscopy

Who is Suitable for Knee Arthroscopy?

Knee arthroscopy suits individuals with knee problems that do not respond to non-surgical treatments. These include

• Meniscus tears: Tears in the rubbery cartilage that cushions the knee joint can cause pain, swelling, and difficulty moving the knee.
• ACL and PCL injuries: A torn anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL)  can cause knee instability, pain, and swelling.
• Synovitis: Inflammation of the lining of the knee joint can cause pain, stiffness, and swelling.
• Loose bodies: Small pieces of bone or cartilage that float in the knee joint can cause pain, locking, and catching.

Why Have An Arthroscopy?

Knee arthroscopy offers several benefits over traditional open surgery, including

• Minimally invasive: Knee arthroscopy involves making only small incisions, which reduces scarring and leads to faster recovery times.
• Accurate diagnosis: The arthroscope provides a clear view of the inside of the knee joint, allowing the surgeon to diagnose and treat the problem accurately.
• Quick procedure: Knee arthroscopy is usually performed on an outpatient basis, meaning that patients can return home the same day.
• Less pain and swelling: Unlike open surgery, knee arthroscopy typically results in less pain, swelling, and stiffness.
• High success rate: Knee arthroscopy has a high success rate and is effective in treating a range of knee conditions.

Preparations Before Knee Arthroscopy

Before a knee arthroscopy, the surgeon will conduct a physical exam and review your medical history to ensure you are a good candidate for the surgery. You may need to stop taking certain medications or supplements in the days leading up to the procedure to reduce the risk of bleeding. You must also arrange for someone to drive you home after the surgery.

During Knee Arthroscopy Procedure

The knee arthroscopy procedure typically takes 30 minutes to an hour. Here are the steps involved:

• Anaesthesia: The anaesthetist will administer general anaesthesia 
• Incision: The surgeon will make small incisions (about ¼ inch) around the knee joint to insert the arthroscope and other surgical instruments.
• Arthroscopy: The surgeon will insert the arthroscope, a small camera, through one of the incisions to view the inside of the knee joint. The images from the arthroscope are displayed on a monitor, allowing the surgeon to see the joint and guide the surgical instruments.
• Repair or Removal: Depending on the condition of the knee joint, the surgeon may use surgical instruments to repair or remove damaged tissue, such as a torn meniscus or damaged cartilage.
• Closure: Once the procedure is complete, the surgeon will remove the arthroscope and other instruments and close the incisions with stitches.

After Knee Arthroscopy Procedure

After the knee arthroscopy, you will be taken to a recovery area to rest and monitor your vital signs. You will likely experience some pain, swelling, and stiffness in the knee joint, which can be managed with pain medications and ice. You may also need crutches or a brace to protect the knee joint as it heals. Your doctor will provide instructions on caring for your knee and when you can return to normal activities.

Post-Op Instructions

What to Expect

The recovery speed after arthroscopy varies and depends on your particular condition and the type of surgery. Every case is different, and hence only general comments are made here. The operation's findings will be discussed in detail at the first follow-up visit rather than immediately after the operation, as you may still be recovering after the anaesthetic.

Pain

You should be pain-free for the first 4-8 hours after the operation. Some discomfort can be expected in the first 24 hours. Ensure you have painkillers (or a prescription for such) to take home on discharge. If you experience pain, take painkillers as prescribed; place an ice pack or frozen peas on the knee (over a layer of the towel) for 10-15 minutes every half hour. Some swelling is also expected. 

Walking / Exercises

You may put full pressure on the leg and walk as is comfortable unless told otherwise. Crutches or a walking stick may be required for a few days. Carry out straight leg raising exercises - clench the quads, lift the leg (with knee straight) six inches off the bed, hold it there for 3 seconds, and lower back into bed. Repeat 20 times or more every waking hour.

Depending on your condition and the type of surgery, you may or may not need physiotherapy.

Driving

You must not drive or operate machinery for the first 24 hours due to the anaesthetic effect. If your left knee is involved and you drive an automatic car, you may drive when able. If your right knee is involved, you may return to driving if you can depress the brake and control the vehicle should an emergency arise. 

Dressings

Remove the outer bandage 24 hours after the operation. Underneath the bandages will be stick-on dressings. Keep these dressings intact and dry until your first follow-up appointment with your surgeon within two weeks. If water does get under the dressing, remove it and replace it with an ordinary water-proof dressing found in any chemistry.

Warning Signs

• Severe pain after the first 24 hours not relieved by painkillers.
• Redness of the wound and feeling feverish.
• Pain in the calf, chest pain or shortness of breath.

If you have any of the above symptoms, immediately contact your doctor or the hospital.

Knee Arthroscopy Prognosis

In general, knee arthroscopy has a high success rate and can effectively relieve pain and improve function in the knee joint. The recovery time varies depending on the extent of the surgery and the individual's healing ability. In most cases, patients can resume normal activities within a few weeks to a few months after the surgery.

Knee Arthroscopy Risks

Like any surgical procedure, knee arthroscopy carries some risks. These include

• Infection at the incision site or in the knee joint.
• Excessive bleeding can occur during the surgery or the days following the procedure.
• Blood clots can form in the deep leg veins, which can be life-threatening if they travel to the lungs.
• Nerves around the knee joint can be damaged during the surgery, resulting in numbness or weakness in the leg.
• There is a risk of anaesthesia-related complications, such as allergic reactions or breathing problems.

What If Knee Arthroscopy is Delayed?

Delaying knee arthroscopy can cause the underlying condition to worsen, potentially leading to more extensive surgery or even joint replacement in severe cases. If you are experiencing knee pain, swelling, or stiffness, it is essential to consult with an orthopaedic surgeon as soon as possible to determine the best course of treatment. In some cases, non-surgical treatments such as physical therapy, medications, or injection therapy may be sufficient to alleviate symptoms and delay or avoid surgery.