Arthroscopy

Arthroscopy or keyhole procedure is a surgical operation for inspecting and treating problems in a joint. The joint is visualised via a narrow tube that is attached to a light source and a special camera. This is connected to a TV monitor and one can capture pictures or videos. A second keyhole is used to pass fine instruments to probe and treat various conditions in the joint.
The keyholes are tine stab incisions on either side of the knee cap tendon. In general most arthroscopies are done via these two cuts. Occasionally a third keyhole may be required.

There are two menisci in your knee- Medial and lateral meniscus. These are C shaped fibro-cartilaginous cushions that have important load transmitting functions. They can tear with acute twisting injuries or sometimes with no trauma when they are a bit degenerate. They case pain, stiffness, locking or swelling. They are diagnosed clinically and sometimes with MRI scans. Meniscus tears seldom heal on their own and usually require arthroscopic repair with sutures or trimming with fine instruments and/or shavers (Partial meniscectomy).

Articular cartilage is the lining of your joint surface in your knee and is made of hyaline cartilage. This is different from menisci described above. Please see picture to the right. Cartilage damage can be due to trauma or due to repetitive impact or be a localised component of early arthritis.

Cartilage damage is usually localised to a small part of your knee whilst osteoarthritis is generalised degenerative wearing of your joint surface. This infact may be a spectrum of the same problem. Rheumatoid arthritis is a different inflammatory type of arthritis.

Cartilage damage presents with pain, swelling, locking or giving way. They are commonly found at arthroscopy. MRI scans are somewhat less sensitive in picking early cartilage damage. Once damaged, cartilage has poor potency to heal. Activity modification, exercise and medicines like Glucosamine and anti-inflammatories can help. With arthroscopy there are a variety of special techniques to improve symptoms depending on individual situations. Some of these are Chondroplasty, Microfracture, Cartilage transplant or Mosaicplasty. None of these would recreate normal cartilage.

On the day of surgery you would see your surgeon and physiotherapist who would explain the procedure and its risks and also place a mark on your leg that needs the operation.

Most of arthroscopic knee surgery is done as a day case and under general anaesthesia. It is a quick procedure that usually takes 30 minutes or less. A local anaesthetic agent is injected in to the knee for pain relief.

The surgeon examines the entire joint via the arthroscope and probes the cartilage, menisci and ligaments to establish the reason for your problems. The common problems are meniscus tears, articular cartilage (joint surface) damage or early arthritis, loose fragments and ligament tears. Most of the knee problems would be dealt with using fine instruments or shavers via the key hole. Occasionally you may have more than two keyhole scars. Ligament surgery would be done via the keyhole but you would have a small scar through which your new graft would have been harvested.

Most arthroscopic operations last for about 30 minutes. Ligament reconstructions would take about an hour. They are done under general anaesthesia.

After the operation you would arrive in a recovery ward. You would have a bulky bandage around your knee. Once the anaesthetic has worn off your surgeon and physiotherapist would explain what problems were identified and the treatment done. You would have local anaesthetic pain relieving injections in your knee during your operation but occasionally you may require additional tablets for pain relief. The physiotherapists would then commence mobilisation.

For most arthroscopic meniscus surgery and articular cartilage and arthritis surgery, you should be able to start full weight bearing mobilisation with the help and guidance of the physiotherapists. Meniscus repairs and microfracture are two relatively common operations where your rehabilitation would change.

You should be able to go home the same day in most situations. A responsible adult should take you home in a car or taxi and stay with you for 24 hours.

You can remove the buky bandage at 48 hours. There would be light sticky dressings underneath that could be left alone or replaced. Your arthroscopy scars would either be closed using sticky tapes or fine sutures. Keep the knee dry until the portals have healed and when you shower the knee, blot the knee dry.

There is likelihood that the knee may remain swollen for a few weeks depending on the type of surgery performed. Rest the knee and also ice the knee intermittently (15-20 minutes once every 2-4 hours with ice or bag of peas wrapped in a towel). Donot leave ice on the skin for too long especially if the skin feels numb as this can cause skin damage.

Following routine arthroscopies you can anticipate return to simple activities by 1 week. Return to work depends on your job. Your Surgeon and Physiotherapist would give you further advice depending on the extent of the surgery. Should the knee feel comfortable with good movements, you can commence driving at that stage. Assess individual circumstances. Avoid long travel for 2-4 weeks after simple arthroscopic procedures.

Risks from arthroscopic surgery are rare. The more common ones are residual pain, stiffness and swelling and these can be more significant after certain procedures like microfracture, lateral release or multiple procedures in your knee. Persistent pain can often be due to cartilage damage. Sometimes your arthroscopy portals look swollen and painful and they have to be treated by massage and would resolve.

Bleeding, infection, thrombosis or reactions from anaesthesia are less common risks. Damage to nerves or blood vessels is extremely rare and has been more reported after meniscus repair.

• Have pain, swelling or tenderness in the joint which is getting worse,
• Develop a high temperature,
• See fluid, pus or blood coming from the incisions, or
• Develop numbness or tingling near to the joint
  

Contact your hospital ward nurse or your physiotherapist who would liaise with your Surgeon. If it is at late hours in the night, you may have to attend the emergency department and see the on call Orthopaedic Doctor who would assess your knee and speak to your surgeon.