The arthroscope is a fibre-optic telescope that can be inserted into a joint (commonly the knee, shoulder, hip and ankle) to evaluate and treat a number of conditions. A camera is attached to the arthroscope and the picture is displayed on a TV monitor.

Normal lateral meniscus (Click to Enlarge)

The arthroscope is an excellent means of examining the whole of the knee and most conditions can be treated at the same time. Knee arthroscopy is one of the most common orthopaedic operations performed worldwide.

Indications for Knee Arthroscopy

There are many indications for undertaking arthroscopy of the knee:

• General diagnostic purposes
• Torn meniscal (‘sports’) cartilage; the cartilage is trimmed to a stable rim or occasionally repaired
• Damaged articular (surface) cartilage; the damaged area is trimmed so that it has a stable margin. Large areas of damage are usually treated by microfracture (see Cartilage Injuries)
• Removal of loose bodies (cartilage or bone that has broken off)
• Resection of inflamed lining tissue (synovectomy)
• Reconstruction of the anterior cruciate ligament (see Cruciate Ligament Reconstruction)
• Patellofemoral (kneecap) disorders (see Patellar Realignment)

Intraoperative photos of damaged lateral meniscus pre & post resection (Click to Enlarge)

The Operation

Most arthroscopic surgery is undertaken as a day-case procedure and is usually performed under general anaesthesia. Patients are admitted on the day of surgery and need to remain fasted for 6 hours prior to the procedure. The knee undergoing the procedure will be identified and marked prior to the anaesthetic.

Intraoperative photo showing chondral damage on femur (Click to Enlarge)

During the operation a tourniquet is placed around the thigh to permit better visualisation of the knee. The arthroscope is introduced through a small (approximately 0.5-1.0cm) 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

Local anaesthetic is administered into the knee by the surgeon at the end of the procedure. This usually provides 8-12 hours of pain relief. A bandage is wound around the knee.

Post-operative Recovery

• Once the patient has recovered their intravenous drip is removed and they are shown a number of exercises to complete
• The surgeon sees the patient prior to discharge and explains the findings of the operation and what was undertaken during surgery
• Pain medication will be provided and should be taken as directed
• Bandages can be removed after 24 hours and waterproof dressings applied over the wounds
• It is NORMAL for the knee to swell after the surgery; elevating the leg when seated and placing an ice-pack on the knee will help to reduce swelling

Intraoperative photo showing large synovial plica (Click to Enlarge)

Rehabilitation

Following surgery patients are given an instruction sheet showing exercises that are helpful in speeding up recovery.

Strengthening the thigh muscles (quadriceps and hamstrings) is very important; cycling (stationary or road) and swimming are excellent ways to build these muscles up and improve movement.

Return to driving and work is variable and usually at the patient’s discretion.

Complications

General Anaesthetic risks are extremely rare. Occasionally patients have some discomfort in the throat as a result of the tube that supplies oxygen and other gases.

The risk of complication from arthroscopic knee surgery is extremely low. However complications specific to Knee Arthroscopy can include:

• Postoperative bleeding
• Deep Vein Thrombosis
• Infection
• Stiffness
• Numbness to part of the skin near the incisions
• Injury to vessels, nerves or a chronic pain syndrome
• Progression of the disease process

View of normal PCL (ACL absent) (Click to Enlarge)

Outcome

Occasionally there is more damage in the knee than was initially thought; this can affect the recovery time.

If the cartilage in the knee is significantly worn out then arthroscopic surgery has only about a 75% chance of improving symptoms in the short to medium term; more definitive surgery (e.g. knee replacement) may be required in the future.

In general arthroscopic surgery does not improve knees that have well established osteoarthritis but may give symptom relief for a period of time. This is useful in young patients who are not keen on joint replacement.

Summary

• Keyhole surgery where a camera is inserted into the knee
• Indicated for a wide variety of conditions
• Day case procedure
• Recovery and rehabilitation usually fairly rapid
• Very low risk of complication