Arthroscopy of the Knee
Arthroscopy is a surgical technique that allows your surgeon to examine, diagnose, and treat many of the common joint problems of the knee without making a large incision. The arthroscope is a small video camera with a light source, which allows the surgeon to look into the knee through a very small opening.
The knee is a hinge joint connecting the thigh bone (femur) to the lower leg bone (tibia). The kneecap (patella) gives the knee additional motion and strength. Cartilage covers the ends of all of the bones of the knee and allows for smooth joint motion. It is wear and loss of this cartilage that causes pain, restriction of motion and, eventually, arthritis. Additionally, pads of moving cartilage each called a meniscus protect the knee inside. Your knee has two of these pads, a medial and a lateral meniscus. The bones of the knee are bound together and supported by ligaments, one on each side of the knee and two in the middle of the knee. Finally, muscles move the joint, reduce stress on the cartilage, and provide additional support.
Common Knee Problems
The most common injury to the knee treated with the arthroscope is a tear in the meniscus. This occurs when the pads of cartilage tear, split or fray. This can result from an injury or from the day-to-day wear of walking, climbing stairs, bending, etc. The torn meniscus can cause painful catching, locking, and swelling and can significantly reduce motion in the joint. The torn meniscus can be treated by trimming, suturing, or removing the tear. It is better to keep as much of the protective meniscus as possible. With the arthroscope, your surgeon can remove or repair only what is necessary to treat your knee problem.
Techniques for repairing meniscal injuries via the arthroscope
The next most common knee problem is worn cartilage on the end of the bone. This can also result from an impacting injury (like a fall) or, more commonly, from daily wear and tear of the knee.
Generally, wear occurs first on only one side of the joint. Wear of any type can cause pain, swelling, stiffness, and significant loss of motion in the joint. The arthroscope can then be used to smooth the worn surface by shaving and sanding. The arthroscope can also be used to inspect for complete cartilage loss. Complete cartilage loss cannot be effectively treated with the arthroscope. Other techniques, such as cartilage transfer or joint replacement (see knee replacement) are required in those more severe situations.
Thirdly, problems with abnormal alignment of the patella can be treated with the arthroscope. When the patella pulls to one side or the other, excess wear can occur. This wear causes pain, swelling, stiffness and difficulty walking up/down stairs. The arthroscope can be used to change the alignment of the patella. From inside the knee, some of the muscles pulling the patella to one side are released (using an electric knife) allowing the patella to be more centered. This centering decreases wear and relieves pain.
Finally, the supporting ligaments around and inside the knee can be damage from injury. The arthroscope can be used to repair, shrink, or replace the damaged ligaments on the inside of the knee (cruciate ligaments). These procedures are much more involved than those listed above and are covered on our ACL page.
The problem in your knee will be diagnosed primarily by examination of your surgeon. To confirm the diagnosis, or in cases where the exact diagnosis may not be clear, additional testing may be done. Commonly, standing x-rays are done to rule out any bony cause of your pain and symptoms. Additionally, an MRI (magnetic resonance imaging) scan may be done to confirm what your surgeon’s exam already suspects. X-rays and scans allow your surgeon to better plan the procedure for your particular problem.
Arthroscopy of the knee is an outpatient procedure. Your surgeon or family doctor will check to see if you are healthy enough to have surgery and spinal block is generally recommended. You should NOT eat or drink anything after midnight the night before your procedure. When you arrive at the outpatient surgery area, you will meet the anesthesiologist who will do your block. The spinal block is a very safe and effective procedure that can be done on most patients. Advise the anesthesiologist if you have had spinal surgery, any problems with a previous block, are on blood thinners, or have any bleeding problems.
Once your block is in you will be taken to the operating room where all of the arthroscopic equipment is set up. You will be put on a special table and a pressure cuff placed on your thigh. This cuff decreases bleeding and enables your surgeon to better see inside you knee joint. Your surgeon will then test your knee to make sure you cannot feel any pain and then will make two small incisions and insert the arthroscope into the knee. If you would like, you can watch the TV screen and see what the surgeon sees or you can take a nap until the procedure is over.
Immediately following surgery, your knee will be bandaged and elevated. Ice will be used to reduce swelling and pain. You will be taught how to use crutches to walk and exercises to do to help in the recovery process. You will be given pain medication to help with the pain of moving the knee. It is normal to experience some pain and swelling in the few days up to two weeks following arthroscopic surgery. Rest and elevation are very important during this time. Icing should be done several times during the day for 20-30 minutes at a time. The bandage should be left in place and not removed until instructed to do so by your surgeon. Do not allow the bandage to get wet. You will be given a date and time for your after surgery office visit with your surgeon.
Generally, recovery time form arthroscopic surgery is about 1 month. Most patients can walk without crutches in 7-10 days and swelling is significantly reduced by 2 weeks. Most can return to work at that time when authorized by your surgeon, but contact sports and heavy manual labor is restricted for at least 1 month.