ARTHROSCOPIC KNEE SURGERY

What is arthroscopic knee surgery?

Arthroscopic knee surgery is a minimally invasive method of examining and treating problems of the knees that previously involved large incisions and prolonged rehabilitation.  The procedure uses very small incisions through which specialized instruments, including a 4mm arthroscopic camera, are inserted. The camera allows the surgeon to view the insides of the knee on a video monitor.

What are the advantages of arthroscopic knee surgery?

In the past knee surgery involved a large open incision to gain access to the injured area.  Arthroscopic surgery is much less invasive, using only very small incisions. As a result, there is less blood loss, less scarring, and less post-operative pain. The recovery time is significantly shorter than after traditional knee surgery. The arthroscopic method also allows the surgeon to see the anatomy of the knee better than with an open incision.

Who should have arthroscopic knee surgery?

Symptoms of swelling, locking or giving way or persistent pain after an injury are often indications for arthroscopic knee surgery.  If other treatments such as rest, medications and physical therapy have failed to improve these symptoms, arthroscopic knee surgery may be considered.

Some common arthroscopic knee surgery procedures include the treatment of: torn anterior or posterior cruciate ligaments, meniscus tears, removal of loose pieces of bone or cartilage, smoothing out damaged joint surfaces, repairing a cartilage defect or correcting an abnormally aligned kneecap. Arthroscopic knee surgery has not been found to be very helpful in alleviating pain in cases of advanced arthritis.

The first step is to consult with the primary care physician who will, if necessary, refer the patient to an orthopedic surgeon for an evaluation.  This consultation will consist of a general medical history as well a history of the particular knee problem.  The specialist will examine the knee for any swelling; determine its stability, flexibility, and any areas of tenderness.  Any misalignment or mechanical locking will be noted.  X-rays may also be ordered to evaluate the bones of the knee. The surgeon will discuss the results of the consultation to determine if arthroscopic surgery is appropriate. If so, the surgeon will discuss any potential risks or complications associated with the procedure.

What preparations will be needed prior to surgery?

The surgeon may have the patient see a primary care doctor before the surgery to make sure there are no medical conditions that may cause a problem with the surgery.  There will be a pre-op appointment prior to the day of surgery that will include a history and physical examination, possible blood samples, possible EKG, and a possible visit with a member of the anesthesia department.  Patients should not eat or drink anything after midnight on the night before surgery.  The knee should be cleaned using soap and water on the morning of surgery.

What type of anesthesia will be required?

Often, arthroscopic knee surgery can be done under a local anesthetic with sedation. 

Is there a hospital stay after surgery?

Most arthroscopic knee surgery is performed on an outpatient basis. The patient will arrive about 2 hours prior to surgery and usually leaves 1-2 hours after the surgery is finished.

What kind of a recovery can be expected?

After most arthroscopic knee surgeries, patients will be able to walk without support. Some patients may wish to use crutches or a cane for a short while until they are comfortable putting full weight on the leg.  Most patients will be able to drive in about one week.  If a major reconstructive surgery is performed the surgeon may require crutches for a longer period of time and possibly order a brace.

The surgeon will give the patient a list of exercises to perform after surgery.  Often these can be done at home or in a gym.  For larger procedures the patient will probably require physical therapy to regain range of motion and strength. 

The speed of recovery will depend on many factors including the extent of injury and the treatment performed.  With many injuries it is simply not possible to expect a full recovery.  Patients may be advised to switch to alternative lower impact activities.   Often patients are able to return to many activities by 6-8 weeks after surgery.  Some reconstructive procedure may require 6-10 months to fully recover.