› Arthroscopy of the Knee Joint
The arthroscope is a fiber-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. Most arthroscopic surgery is performed as day surgery and is usually done under general anesthesia. Knee arthroscopy is common, and millions of procedures are performed each year around the world.
Arthroscopy is useful in evaluating and treating the following conditions:
- Torn floating cartilage (meniscus): The cartilage is trimmed to a stable rim or occasionally repaired
- Torn surface (articular) cartilage
- Removal of loose bodies (cartilage or bone that has broken off) and cysts
- Reconstruction of the Anterior Cruciate ligament
- Patello-femoral (knee-cap) disorders
- Washout of infected knees
- General diagnostic purposes
Following a twisting type of injury the medial (or lateral) meniscus can tear. This results either from a sporting injury or may occur from a simple twisting injury when getting out of a chair or standing from a squatting position. Our cartilages become a little brittle as we get older and therefore can tear a little easier. The symptoms of a torn cartilage include:
- Pain over the torn area i.e. inner or outer side of the knee
- Knee swelling
- Reduced motion
- Locking if the cartilage gets caught between the femur a tibia
Torn cartilages in general continue to cause symptoms of discomfort, pain and swelling until the loose, ragged pieces are removed. Only the torn section is removed and the knee should recover and become symptom free. If the entire meniscus is removed, the knee will develop osteoarthritis in 15 to 20 years. It is standard to remove only the torn section of cartilage in the hope that this will delay the onset of long-term wear and tear osteoarthritis.
Occasionally, provided the knee is stable and the tear is a certain type of tear in a young patient (peripheral bucket handle tear), the meniscus may be suitable for repair. If repaired, one has to avoid sports for a minimum of three months.
Isolated areas of articular cartilage loss can be repaired using cartilage transplant technology. This is a new and exciting field that is developing in the treatment of specific isolated cartilage defects in younger patients
The process is called Autologous Chondrocyte Grafting . It involves harvesting cartilage cells from the affected knee, sending these cells to a laboratory and then culturing the cells to multiply into many cells. The large amount of cells produced are then placed back into the affected knee into the defect requiring resurfacing. Results are still short-term follow-up but are looking encouraging.
After a major cartilage or ligament injury has been treated the knee can return to normal function. There is however a small increase in the risk of developing long-term wear and tear (Osteoarthritis) and depending on the degree of injury activity modification may be required. Activities that help prevent knees deteriorating quickly include:
- Low impact sports like swimming, cycling and walking
- Reducing weight and maintaining a healthy diet
You will be admitted on the day of surgery and need to remain fasted for 6 hours prior to the procedure.
The limb undergoing the procedure will be marked and identified prior to the anesthetic being administered.
Once you are under anesthetic, the knee is prepared in a sterile fashion. A tourniquet is placed around the thigh to allow a ‘blood – free’ procedure.
The Arthroscope is introduced through a small (size of a pen) incision on the outer side of the knee. A second incision on the inner side of the knee is made to introduce the instruments that allow examination of the joint and treatment of the problem.
A bandage will be around the operated knee.
Once you are recovered your IV will be removed and you will be shown a number of exercises to do.
Your Surgeon will see you prior to discharge and explain the findings of the operation and what was done during surgery.
Pain medication will be provided and should be taken as directed
You can remove the bandage in 24 hours and place waterproof dressings (provided) over the wounds.
It is NORMAL for the knee to swell after the surgery. Elevating the leg when you are seated and placing ice packs on the knee will help to reduce swelling. (Ice packs on for 20 min 3-4 times a day until swelling has reduced)
You are able to drive and return to work when comfortable unless otherwise instructed.
Please make an appointment 7-10 days after surgery to monitor your progress and remove the 2 stitches in your knee.
- Postoperative bleeding
- Deep Vein Thrombosis
- Numbness to part of the skin near the incisions
- Injury to vessels, nerves and a chronic pain syndrome
- Progression of the disease process
The risks and complications of arthroscopic knee surgery are extremely small. One must however bear in mind that occasionally there is more damage in the knee than was initially thought and that this may affect the recovery time. In addition if the cartilage in the knee is partly worn out then arthroscopic surgery has about a 65% chance of improving symptoms in the short to medium term but more definitive surgery may be required in the future. In general arthroscopic surgery does not improve knees that have well established Osteoarthritis.
A: Approximately 4 hours
Do I need crutches?
A: Usually not required (Unless you are having Anterior Cruciate Ligament Reconstruction)
When can I get the knee wet?
A: After 24 hrs remove the bandage and apply a waterproof dressing.
When can I drive?
A: After 24 hrs if the knee is comfortable.
When can I return to work?
A: When the knee feels reasonably comfortable.
When can I swim?
A: After removal of the stitches.
How long will my knee take to recover?
A: Depending on the findings and surgery, usually 4 to 6 weeks following the surgery.
When Can I return to Sports?
A: Depending on the findings, 4-6 weeks after surgery.
Scott W. Trenhaile, M.D.
346 Roxbury Rd
Rockford, IL 61107