Knee Arthroscopy

Knee arthroscopy is normally performed under a short general anaesthetic, lasting usually somewhere between 30 to 45 minutes. Two small (1cm) incisions ('portals') are made at the front of the knee (either side of the patellar tendon). Sometimes it is necessary to create additional incisions if better visualisation inside the knee is necessary.

The knee is filled with pressurized fluid, to help give a good view of the interior of the joint. A 3.5mm diameter telescope is inserted into the knee with a digital camera attached to the end, giving a high quality image on a monitor, viewed by the operating surgeon. Special probes and other tools can be inserted through the second portal, enabling minimally invasive interventional surgery to be performed.

Intra-articular view of a knee through an arthroscope:
top = femoral condyle,
bottom = tibial plateau,
back = meniscus,
front = arthroscopy probe.

What arthroscopic procedures can be performed?

The range of procedures that can be performed at the time of standard knee arthroscopy include:-

• Meniscal resection / trimming / repair (as appropriate) for meniscal tears
• Abrasion chondroplasty (shaving of rough damaged cartilage for articular cartilage damage )
• Radiofrequency ablation chondroplasty (welding-over of cracks / fissures in the articular cartilage)
• Removal of cartilage loose bodies

Loose bodies in synovial chondromatosis

• Microfracture for treatment of bare bone cartilage defects
• Medial plica excision
• Excision of scarring of the fat pad
• Lateral release to correct patellar tilting / maltracking
• Debridement of ragged ligament tissue from ACL ruptures

What should I expect post-operatively?

At the end of the procedure the knee is filled with local anaesthetic. In addition, painkillers are normally administered by the anaesthetist. It is normal to have some discomfort in the knee initially on waking up from the anaesthetic. However, if the knee is significantly painful then it is important for you to indicate this to the nursing staff in the recovery section of the theatres department or back on the ward, as they have ready access to whatever additional strong painkillers might be necessary.

How one feels in the early post-op period depends on the length of the anaesthetic given, the patient's reaction to the anaesthetic, the pathology found within the knee and the amount and magnitude of the surgical procedures undertaken arthroscopically.

If only relatively minor surgery has been performed inside the knee, then most patients can fully weight bear pretty much straight away post-operatively, often without any aids but sometimes with the temporary help of a crutch. However, if more major surgery (such as articular cartilage repair or meniscal repair) has been performed, then a slower, more careful rehab regime will be needed in order to protect the knee and the surgical repairs. This can involve the use of a hinged knee brace plus crutches for up to 6 weeks, with regular intensive physiotherapy treatments.

Article written by
Mr Ian McDermott
Consultant Knee Surgeon and Hip Surgeon, London & Northwood
Last updated 13/01/10

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