Knee Arthroscopy – Keyhole Surgery
What Is Knee Arthroscopy?
Arthroscopy is probably better known as keyhole surgery, a technique used to inspect the inside of the joint cavity to diagnose and assess damage and, where possible, to treat this damage.
Arthroscopic knee surgery involves putting a small telescope and special instruments into the knee, giving your surgeon the ability to photograph and video the operation.
Arthroscopic knee surgery is used to treat any number of conditions that occur within the knee from simple cartilage tears to removal of loose bodies and anterior cruciate ligament reconstruction. At the same time, your knee surgeon will be able to clearly view and probe all the other structures within the knee.
Arthroscopic Knee Surgery – Will I Need An Overnight Stay In Hospital?
Not usually. Arthroscopic knee surgery is generally performed as day case surgery, so you’ll be in and out same day.
The operation is most often performed under a general anaesthetic but may also be done under epidural, spinal or occasionally a local anaesthetic if necessary. Typically you will come into hospital shortly before the operation, having been pre-assessed as fit for surgery and having fasted for at least 6 hours.
What Happens During An Arthroscopy?
A knee arthroscopy requires two, sometimes three, small incisions (5-7mm) in the knee joint to allow insertion of the arthroscope [attached to a camera] and instruments.
The knee is filled with clear fluid to allow better visualisation. Occasionally your surgeon will need to enlarge the incision to remove a fragment from the knee.
The length of the operation depends on the procedure which is being performed. Simple arthroscopic knee surgery usually takes between 10 and 30 minutes. Afterwards, you are likely to have a local anaesthetic injected into the joint and around the little incisions to assist with pain relief.
The incisions rarely require stitches.
A simple dressing applied with a bandage wrapped around the knee is usually sufficient.
Once you have recovered from the anaesthetic and started to mobilise, you are normally safe to be discharged from hospital. Typically this may be 2 or 3 hours after arthroscopic knee surgery, but some patients take longer to recover.
What Happens Immediately After A Knee Arthroscopy?
You may not need crutches after simple procedures, but your surgeon might advise their use after specific procedures or the physiotherapist may recommend them for a few days depending on how you feel when you are ready to go home.
It is essential that you have somebody to drive you home – you must not attempt it yourself.
For the first two to three days you should undertake essential walking only. This relative rest will give the knee a chance to settle down, and for the swelling to reduce. It is not a very painful operation but inevitably there is some aching which improves over the first week or two.
Managing Your Recovery
For the first couple of days, you should rest and elevate the leg as much as possible. This will help the swelling and pain settle down.
You can use simple painkillers and cold packs as required. Once swelling subsides and it feels comfortable, you can increase activity.
Dressings
The large bandage around the knee is normally removed 24-48 hours after arthroscopic knee surgery.
There are usually no stitches to be removed and you should keep the wounds clean and dry until they have completely healed.
You will be given a small dressing or plaster to place on the wounds for a few days following surgery.
Bathing & Showering
You should keep the wounds clean and dry until at least four days following arthroscopic knee surgery when, providing the wound has sealed, bathing or showering is permitted.
Wounds
The small wounds can remain tender and thickened for a few weeks following arthroscopic knee surgery.
Occasionally, a lump remains under one or other of the puncture holes for several weeks – this will slowly resolve and is nothing to worry about.
Rehabilitation
You should make sure the first few days following surgery are relatively restful.
Your knee surgeon or physiotherapist will recommend simple rehabilitation exercises including straight leg raising, knee and ankle movements and tensioning of the quadriceps [thigh] muscles. You should ensure you perform these as instructed.
Physiotherapy
Some patients require physiotherapy following arthroscopic knee surgery. This may take place either before or after the first post-operative check-up depending on your needs.
It is not essential but can improve the speed of recovery.
Return To Activity
Generally, a return to activities takes between two and six weeks following keyhole knee surgery.
Recovery, however, depends on the extent of damage found within the knee, the treatment performed, the type of activities to which you wish to return and your general level of fitness. Approximate recovery times following simple arthroscopic surgery are:
- Sedentary (office type) work: 2-5 days
- Physical work: 1-3 weeks
- Light training: 3 weeks
- Return to full impact activities: 4-6 weeks
- Driving: 2-4 days
Some procedures, such as meniscal repair or microfracture, entail the need for crutches and a slower recovery. We will discuss this with you.
Risks
Arthroscopy has a very low complication rate. However, complications such as infection, excessive swelling and pain can occur along with rare general complications such as blood clots and anaesthetic risks. In general, the risk of major problems is much less than 1%.
Ongoing Problems
Knee arthroscopy is not in itself damaging to the knee joint. Any ongoing symptoms following surgery are usually the result of the problem within the knee joint for which the surgery was recommended and not as a result of the arthroscopy itself.
An arthroscopy carried out to remove loose fragments caused by osteoarthritis, for example, will remove the fragments but will not be a solution for the underlying osteoarthritis.
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