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Knee Arthroscopy

Introduction

Knee arthroscopy is a keyhole surgery technique typically used to diagnose and treat conditions affecting the knee, including cartilage damage, loose bodies and other early-stage arthritic conditions.

Performed through two small incisions in the knee, arthroscopy is allows us to visually inspect and perform minor repairs to the knee without the need for large incisions. However, if larger problems are detected, more extensive surgery may be deemed necessary.

Knee arthroscopy is a relatively low-risk procedure with a high rate of success and fast healing times. It is most commonly performed as a day case, although some patients may need to stay overnight for monitoring.

When is surgery necessary?

Knee arthroscopy is usually recommended when scans and physical examinations fail to offer definitive information on what is affecting the knee. It can also be used as an alternative to open surgery to treat chronic pain or structural damage that has not responded to non-invasive treatments (e.g. physiotherapy, supports and medications).

Conditions that knee arthroscopy can diagnose and treat include:

  • Persistent pain, swelling or catching within the joint
  • Tears in the meniscus (cartilage lining)
  • Damaged or degraded joint surfaces and cartilage
  • Loose bodies in the joint
  • Inflamed synovium (joint lining)
  • Torn ligaments (anterior and posterior cruciate ligaments)

The decision to operate

In order to determine whether or not to operate, Dr. Letchford will conduct a physical examination and refer to your medical history and x-rays.

Helping you understand your options

Before deciding to go ahead with surgery, Dr. Letchford will take the time to talk with you about:

  1. The outcome you want
  2. The risks and benefits of surgery
  3. The results you can expect

Dr. Letchford will only recommend surgery if both you and he are in agreement that it offers the most realistic chance of effectively diagnosing you or improving your symptoms.

About the procedure

What it involves

Knee arthroscopy is employed to treat many different conditions; as such, no two surgeries are the same.

Purposes for performing knee arthroscopy include:

  • Diagnosis of knee conditions (leading to immediate surgical treatment or later reconstructive surgery)
  • Removal of loose bodies (bone and cartilage)
  • Removal or repair of torn or inflamed cartilage and synovial tissue

The general procedure for arthroscopic knee surgery is as follows:

  1. You will be given local anaesthesia to numb the knee.
  2. Your leg will be placed in a stirrup to keep it steady.
  3. Two or three small incisions, no more than 1-2cm wide, will be made to accommodate the microscopic camera and surgical instruments.
  4. The surgery itself is performed. This will vary according to your condition, but being keyhole surgery, this will not be major.
  5. Once the procedure is done, Dr. Letchford will inject anaesthetic into the repaired area and suture your incisions.

Hospital stay and recovery time

In-patient stay:          Day procedure (no overnight stay unless recommended)
Walk (crutches):        Immediately
Walk (unaided):        Within 2-3 weeks (ideally)
Driving:                      2 weeks
Return to work:         1 week (3 weeks for labour-intensive work)

Possible risks and complications

While all surgery has potential risks, knee arthroscopy is a very safe procedure with minimal likelihood of complications.

The most common complication with arthroscopy is that the surgery doesn't completely remove the pain caused by your arthritic knee.

Please note that all surgery, however minor, carries with it inherent risks. These can include allergic reactions to medications, blood clots, infection, wound or scar irritation, nerve damage, increased pain, stroke or death.

Pre-operative checklist

Before you come in for your surgery, there are a number of things that both you and Dr. Letchford will need to do to ensure everything goes smoothly before and after the operation.

  • Existing medications

You should inform Dr. Letchford of any medications you are currently taking, as these can cause conflicts with drugs administered during the procedure. It is sometimes recommended that you take aspirin for a few weeks before the operation to help combat clots. You may also be given preventative antibiotics before your operation. Please ask Dr. Letchford if you have any questions.

  • Medical evaluation

You will undergo a routine medical examination to make sure you are in good enough health for the operation, and to identify any factors that might cause problems down the line, including body weight and existing infections or skin conditions.

  • Dental evaluation

Dental work can introduce bacteria into the bloodstream. To protect against the chance of developing an infection, please have any dental work done well before or after your surgery.

  • Further tests and blood work

You will be sent for routine blood work to confirm you are healthy enough to undergo surgery. We may also perform heart checks or additional scans if the need arises.

  • Home preparation

To help make your return home easier, it's a good idea to make preparations as you may have limited mobility after surgery. You might consider planning for loved ones to help you with daily tasks, and to arrange for furniture to be rearranged to help you get about easier.

  • Smoking

It is recommended that you stop smoking for as long as possible before your surgery, as it can encourage clots while hampering circulation and oxygenation of the blood.

Recovery, rehabilitation and precautions

  • Preventing injury or dislocation

You will generally need to ice the knee for 24 hours following surgery, and to keep it rested and elevated for several days. Light, non-impact exercise is recommended within the first week, such as riding a bike in short spells. You should avoid over-flexing your knee or engaging in any high-impact activity for about 6 weeks. Running is not recommended for the first 4 months.

  • Preventing infection

Keeping your wound dry and well dressed is very important. Make sure you change your dressing as instructed, and keep an eye out for any changes, including fever, chills, tenderness, excessive fluid, or increased pain.

  • Preventing blood clots

You may be given a combination of anti-clotting drugs and a pressure bandage to help prevent clots from forming. If you notice any shortness of breath or unexplained pain, contact a medical professional immediately.

  • Staying nourished

To give yourself the best chance at a speedy recovery, try to eat a healthy, balanced diet and keep your fluid levels up.

Further information

For more information on what to expect from your knee arthroscopy, please take the time to read through the resources available at the American Academy of Orthopaedic Surgeons website.