Knee Arthroscopy - Procedure, Preparation and Recovery

What is knee arthroscopy?

Knee arthroscopy is a minimally invasive procedure that is done by joint and bone specialists. A knee arthroscopy helps the arthroscopy specialist to examine the knee joint, identify the underlying cause of a problem, diagnose the problem, and also treat it.

In this procedure, the surgeon makes a small cut over the knee joint and introduces into the joint an instrument known as an arthroscope. The arthroscope is a small narrow tube that has a fiber optic video camera attached to one end and with the help of this camera, the surgeon is able to look inside and around the knee joint, identify the problem and its location, and perform other actions by introducing various other tools to help treat knee troubles.

When do doctors recommend a knee arthroscopy?

An orthopedic surgeon may recommend a knee arthroscopy when an individual has knee pain, or problems with movement and mobility that have not improved with medications, physiotherapy, or intra-articular (intra-joint) injections. Some conditions for which a knee arthroscopy may be recommended include

• Tear of the Meniscus: This is a common knee injury that causes swelling, pain, and loss of mobility due to the locking of the knee.
• Tear of Ligaments: Ligaments such as the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL), can be subjected to trauma and tear resulting in instability and difficulty with walking or running.
• Damage to the joint cartilage:  Damage to the cartilage within the joint can cause swelling, stiffness in the knee joint, and pain.
• Presence of loose bodies: Loose bodies are small pieces of cartilage or bone that break away and keep floating inside the joint resulting in pain and stiffness.
• Synovitis: An inflammation of the lining of the knee joint that causes pain and swelling.
• Knee fractures: Knee arthroscopy can also be used for the treatment of fractures of the knee bones
• Knee joint infections and sepsis: Infection in the knee joint or sepsis in the knee joint can cause severe swelling, pain, and loss of mobility
• Stiff Knee: When other investigation methods have not provided any conclusive evidence of an underlying cause of a stiff knee, an arthroscopy can help to identify such causes

When should a knee arthroscopy not be done?

There are very few conditions under which a knee arthroscopy is not done, and they include the presence of an active soft tissue infection in and around the knee, the lack of proper blood supply to the knee, and when there is evidence of severe degenerative knee joint disease as seen on other investigations such as an MRI.

What are the advantages of knee arthroscopy over open surgery?

As knee arthroscopy is a minimally invasive surgery it has several advantages over traditional open surgical procedures. Some of these include

• Less tissue damage, less scarring, and a faster recovery compared to open surgery.
• Shorter recovery period - most individuals are returning to normal activities within a few weeks.
• Less pain and bleeding than open surgery.
• Visualization of the inside of the knee joint helps in accurately diagnosing and treating a lot of conditions
• Lower risk of complications such as infection, blood clots, and nerve damage.

What are the risks associated with knee arthroscopy?

A knee arthroscopy like any other surgical procedure comes with inherent risks, but as it is a minimally invasive surgery, the risks are often very less and rare. Some risks associated with this procedure include

• Bleeding: bleeding may occur in the knee joint after the procedure, although, severe bleeding is very rare.
• Blood clots: rarely, there can be a formation of blood clots in the leg after the procedure is done. Postoperative measures such as the use of compression stockings reduce this risk.
• Infection: infection can sometimes occur at the site of the incision and antibiotics are prescribed to reduce this risk.
• Nerve or blood vessel injury: these rare occurrences are sometimes encountered while the procedure is being performed, and surgeons usually take utmost care to avoid such mishaps.
• Problems related to anesthesia such as allergic reactions, breathing problems, and other complications can occur from the use of anesthetic agents.  

How should you prepare for a knee arthroscopy?

• Surgeon Consultation: A consultation with the surgeon is mandatory so as to discuss medical history, medications that are currently being taken, and the presence of any allergies or other medical conditions that could affect the procedure. It is also important to ask the surgeon any questions so as to have all concerns addressed.
• Travel Arrangements: As the procedure requires anesthesia it is essential to make travel arrangements to go back home from the hospital. It is advisable to make travel arrangements to and from the hospital.
• Strictly adhere to any pre-operative instructions given: As specific instructions are likely to be provided before the operation, it is important to follow them in the days before the operation. Preoperative instructions usually include restrictions on eating and drinking such as nothing by mouth for 8-12 hours before the procedures, stopping medications such as blood thinners and painkillers a few days before the procedure, and other such guidelines.
• Home arrangements for postoperative recovery: It is important to arrange your home in such a way so as to make the recovery process more comfortable. This may require shifting to a room that has easy access, and also furniture rearrangement, etc. if required.
• Time off from Work & Duties: The procedure may require a period of rest in which travel to work or performing other duties may not be possible. It is important to make alternate arrangements for the same.
• Advance Physiotherapy appointments: As physiotherapy may be required after the procedure to help with quicker recovery it might be advisable to identify and schedule an appointment with a physiotherapist in advance to avoid last-minute rush or compromise.

What is the procedure of knee arthroscopy?

A knee arthroscopy procedure is done either as an outpatient or inpatient procedure and it can take anywhere between 30-60 minutes or sometimes a little more to be completed. The time taken for the procedure depends on the type of knee arthroscopy and any additional procedures being done. The steps of the procedure will usually be as follows

• Preparation and Anesthesia: usually general anesthesia which puts the individual to sleep or regional anesthesia to only numb the leg and lower body is given at the start of the procedure to ensure no pain or discomfort is experienced when the procedure is being done.
• Surgical Incisions: Next, one or more small incisions (cuts) at the front, side, or back of the knee are done so that the arthroscope and other surgical instruments can be introduced into the knee joint.
• Knee Arthroscopy: The arthroscope is then inserted through one of the incisions, and the images from the camera showing the inside of the knee joint are projected onto a screen within the operating theatre. The surgeon is thus able to see the inside of the knee joint and accurately identify the problems.
• Surgical Treatments: After the problem has been identified other small surgical instruments are then inserted through one of the other incisions to either treat issues such as removing damaged tissue or cartilage, trimming torn cartilage or meniscus, or repairing a ligament or tendon tear, removing floating bone or cartilage pieces, etc.
• Incision closure: After all procedures are completed, the instruments are carefully withdrawn from the joint, and all the incisions are closed with sutures. A sterile dressing is then applied over the surgical site.
• Shift to Postoperative Recovery Room: the individual is shifted to a recovery area where vitals and surgical site are monitored until it is safe to be discharged.
• Discharge Instructions: at the time of discharge, postoperative care instructions are provided including medications, rest, wound care, physiotherapy, etc.

How long does it take to recover from a knee arthroscopy?

The recovery time after a knee arthroscopy can take anywhere between a few weeks to a month or more depending on the type of procedure done, and the overall individual health and recovery status. The first few days after the surgery is when pain, swelling, and stiffness are most experienced, and these will gradually reduce as the knee heels. Most people are able to return to normal activities in a few weeks after the procedure with proper rest, physiotherapy, and postoperative care. Intense physical activity, however, are to be avoided and it might be a few months before heavy physical activity can be attempted.

What precautions need to be taken during the recovery period after knee arthroscopy?

Some precautions that need to be taken during the recovery period are as follows

• Wound care: taking proper care of the surgical site, regularly changing sterile dressing as advised, and keeping the site dry helps to prevent infections.
• Shower & Bathing: The shower should be avoided until the incision site is clean and dry. Scrubbing should be avoided over the surgical site after a shower and the region should be only patted dry.
• Rest and elevation of the operated leg: helps to reduce swelling and promotes healing. It is advisable to keep the leg elevated as much as possible in the first few days after the procedure.
• Applying ice to the knee: ice applications or cold pack application for 20-30 minutes in a session and for several sessions a day helps reduce pain and swelling.
• Medications as prescribed: pain medication and antibiotics that are prescribed need to be taken without fail during the recovery period. It is also important to not take more than the prescribed dose, especially when it comes to pain medications. If the prescribed medications are not providing relief, it is important to speak to the doctor about an alternative.
• Compression stockings: wearing compression stockings helps to prevent blood clot formation in the legs.
• Driving: Driving should only be resumed when advised by the surgeon. It is also important to avoid driving for long distances as well as sitting for a prolonged period at a stretch. It is important to take small breaks to prevent blood clot formation.
• Avoid weight bearing on the operated knee: it is important to use crutches or a walker for as long as advised by the surgeon to avoid putting any weight on the operated knee.
• Physiotherapy: to restore strength and flexibility in the knee it is important to follow the instructions of the physiotherapist and diligently perform the recommended physiotherapy exercises without fail. Some physiotherapy exercises that help include straight leg raises – to strengthen the front thigh muscles gentle massage of the knee cap when straightening the leg, etc.
• Avoid heavy physical activity: it is important to avoid putting any stress on the operated knee and activities such as jumping, running, and lifting heavy weights until advised by the surgeon to ensure a proper recovery.

A knee arthroscopy procedure offers many benefits over open surgery and can help in providing relief from both short-term and long-term knee problems. To get the best results from this procedure it is important to seek advice from qualified orthopedic surgeons and arthroscopy specialists, and to follow their advice on knee care, lifestyle modifications, and overall well-being.