Knee Arthroscopy

What is Knee Arthroscopy?

Knee Arthroscopy is a minimally invasive procedure performed to examine the knee joint and perform surgery with the help of a small fiber-optic video camera called an arthroscope. This procedure avoids making large cuts on the knee to go through with a surgical procedure. The arthroscope allows visualization of the inside of the joint on a video monitor screen, which aids in the passage of small surgical instruments into the knee to correct the knee deformity. Knee arthroscopy is more beneficial than open knee surgery, resulting in less pain, less joint stiffness, and shorter recovery time.

Is a Knee Arthroscopy procedure an elective or an emergency procedure?

Knee Arthroscopy is done as an elective procedure.

Indications

Knee arthroscopy is indicated to diagnose knee joint deformity and ailments and may be advised to diagnose the cause of knee pain for individuals suffering from the condition. It is also used to treat other knee joint ailments.
Knee arthroscopy can treat and diagnose the following conditions:

• Removing or repairing the torn meniscus of the knee (the meniscus is the cartilage between the bones in the knee)
• Reconstruction of the torn anterior cruciate ligament or posterior cruciate ligaments. Torn cruciate ligaments are repaired with graft tissues
• Removing inflamed synovial tissue (synovium is the lining of the knee joint)
• Trimming of damaged articular cartilage
• Removing loose fragments of bone or torn cartilage in the knee joint
• Correcting patella or kneecap deformities such as out of positioning of the kneecap
• Removing Baker’s cyst
• Treating fractures of the knee bones
• Treating infection in the knee joint or knee sepsis
• Excising or releasing tight structures in the knee to improve movement and relieve pain
• Performing chondroplasty, which means to smooth out or remove torn pieces of cartilage
• Diagnosis of pain, stiffness, and limited mobility of the knee joint

Contraindications and Risk Factors

Conditions at which a knee arthroscopy is not performed include:

• Presence of active local soft-tissue infection at the knee
• Severe degenerative joint disease
• The poor blood supply in the leg

Investigations before the procedure

Investigations that are done before the procedure include:

• Complete blood count
• Electrocardiogram (EKG)

Preoperative advice

Preoperatively before undergoing a knee arthroscopic surgery:

• Risks, benefits, and alternative methods of procedure are discussed with the patient and the family members
• All current medications of the patient are reviewed
• Certain medications like aspirin or ibuprofen are discontinued a few weeks before the procedure
• Oral intake should be avoided at least 8 to 12 hours before the procedure

Intraoperative details

• Duration: Knee Arthroscopy takes 30 minutes to 45 minutes.
• Anesthesia: General anesthesia is administrated, and in some cases, spinal anesthesia is also used.

Description of the procedure

After the administration of anesthesia, either general or spinal, the surgical area is prepped and draped in a sterile manner. Three to four small incisions are made around the knee to allow surgical instruments to be introduced into the knee. A fiber-optic camera is also introduced into the knee. Sterile saline water is used to flush the knee joint. The knee joint is then filled with clean saline water. This provides the surgeon with a clear view of the structures inside the knee during the surgery. An arthroscope with an attached camera at its end is inserted into the knee through one of the incisions. This helps to visualize the knee joint.

The torn parts of the meniscus and damaged parts of the cartilage are identified. Special arthroscopic instruments are passed through other incisions into the knee to dissect the torn meniscus or damaged parts of the cartilage carefully. After the procedure, the saline water is drained from the knee. The knee is lined with stable tissues, smoothing the rough edges. The incisions are closed with Steri-strips, and sometimes they are left to heal on their own. Some absorbable stitches are also used. If nylon stitches are used, they are generally removed 10 to 14 days after the surgery. Dry sterile gauze pads and an Ace wrap are used over the incision to protect the surgical site. After the incision is dry and healed, the bandage is removed.

Postoperative details

Postoperatively after performing the surgery:

• Ice packs are used to reduce swelling and minimize pain
• Dressings over the incision site should be changed regularly
• The incision site is to be observed for any signs of infection
• Fever greater than 101 degrees Fahrenheit should be reported immediately to the physician
• The knee is to be observed for any rapidly increasing pain and swelling around the surgical area, redness around the incision site, drainage from the surgical wound site, or swelling and pain of the calf associated with ankle swelling and painful ankle motion.
• The shower should be avoided until the incision site is clean and dry
• Scrubbing should be avoided over the incisions after a shower and should be only patted dry
• Pain medications are provided for 2 to 3 weeks after the surgery. In some cases, pain medications are given only for a week after the surgery
• Apart from pain medications, other medications are prescribed to avoid blood clot formation in the knee.
• Follow up is done as scheduled by the physician

A knee can take up to six weeks to be re-established as a normal joint after the surgery. The recovery pace is different for each individual. Some may recover within 2 weeks and resume normal activities, while others may need four to six weeks to heal and resume full activities. The benefits of knee arthroscopy surgery do not usually appear immediately after the surgery but can take almost 6 weeks to be realized. After the surgery, individuals are advised to use crutches or a walker for a few days to reduce pain and weight-bearing on the knee, and the use of these is gradually done away with. A limp may be noticed initially, but it gradually improves.

Role of Diet/ Exercise/ Lifestyle changes

Nonsurgical knee pain treatment includes rest, medications, injections to reduce pain, and physical therapy. Other lifestyle changes after the surgery are described below:

• Physical therapy after Knee Arthroscopy is essential to improve strength and resume the knee's normal functioning. Some individuals may have minimal swelling with activity; however, it could gradually resolve
• Straight leg raises are very essential after the surgery. The quadriceps muscle right after the surgery would become tightened. Straight leg raises help these muscles loosen
• Massaging the kneecap while straightening the leg is also beneficial.
• Other exercises like walking, bike riding, and treadmill should be followed gradually to improve knee motion and function.
• It is common for the knee to swell after any exercise or physical activity. The swelling can be reduced with ice and elevation.
• Driving should be avoided as long as pain medications are taken. Once the pain medications are stopped, driving can be resumed.
• Driving long distances or sitting for too long is not good for the knees. Frequent breaks with standing up, stretching, and walking are essential to decrease the risk of blood clot formation.

Complications

Complications that are associated with knee arthroscopy include:

• Excessive bleeding during the procedure
• Infection at the surgical site or infection inside the joint
• Bleeding inside the knee joint after the procedure
• Formation of any blood clot in the leg
• Knee joint stiffness
• Injury or damage to the surrounding cartilage, ligaments, meniscus, blood vessels, and nerves during the procedure
• Side effects from anaesthesia such as breathing difficulties. Other allergic reactions to anesthesia or other medications used during the procedure

Prognosis

The overall prognosis of knee arthroscopic procedures depends upon the condition's severity and the required procedure's complexity. Most individuals resume normal activities within 6 to 8 weeks after the surgery. However, higher impact activities may need to be avoided for a longer period. Pain and swelling improved within a couple of weeks after the surgery. Nevertheless, knee strength, motion, and coordination may take 3 to 4 months to be restored completely. In a few cases, if the knee damage is very severe, it may not be completely reversed, even with surgery.

Indications for hospitalization if required

Knee Arthroscopy can be performed on an outpatient basis without hospitalization; however, in some cases, brief hospitalization is required.

Suggested clinical specialist/ Department to consult for the procedure

Orthopedics