Knee arthroscopy

Knee scope - arthroscopic lateral retinacular release; Synovectomy; Patellar debridement

Arthroscopic surgery on the knee involves inserting a small camera, less than 1/4 inch in diameter, into the knee joint through a small incision. The camera is attached to a video monitor, which the surgeon uses to see inside the knee. In some facilities, the patient can choose to watch the surgery on the monitor as well.

For a simple surgical procedure, a local or regional pain-killing medicine (anesthetic) is given to numb the affected area. You will remain awake and able to respond. For more extensive surgery, general anesthesia may be used. In this case you will be unconscious and pain-free.

After the camera is inserted, salt water (saline) is pumped in under pressure to expand the joint and help control bleeding. Some surgeons also use a tourniquet to prevent bleeding.

After looking around the entire knee for problem areas, the surgeon will usually make 1-4 additional small surgical cuts to insert other instruments. Commonly used instruments include:

• A blunt hook to pull on various tissues
• A burr to remove bone
• A shaver to remove damaged or unwanted soft tissues

A heat probe may also be used to remove inflammation (synovitis) in the joint.

At the end of the surgery, the saline is drained from the knee. The incisions are closed, and a dressing is applied. Many surgeons take pictures of the procedure from the video monitor to allow the patient to see what was done.

Arthroscopy may be recommended for knee problems, such as:

• A torn meniscus (either repair or remove)
• A torn or damaged anterior cruciate or posterior cruciate ligament
• Inflamed or damaged lining of the joint (synovium)
• Mild arthritis
• Misalignment of the kneecap (patella)
• Small pieces of broken cartilage (loose bodies) in the knee joint

The risks for any anesthesia are:

• Allergic reactions to medications
• Problems breathing

The risks for any surgery are:

• Bleeding
• Infection

Additional risks include:

• Bleeding into the joint (hemarthrosis)
• Damage to the cartilage, meniscus, or ligaments in the knee
• Failure of the surgery to relieve symptoms
• Knee stiffness

Use of arthroscopy has reduced the need to surgically open the knee joint. This has resulted in:

• Decreased length (if any) of hospital stay
• Faster recovery time
• Fewer complications
• Less pain and stiffness

Expectations vary depending on the cause for the surgery.

Surgery done for a meniscal tear or loose bodies with no other problems (like arthritis) is usually uncomplicated. Most patients can expect a full recovery.

Having arthritis dramatically reduces the effectiveness of arthroscopy. Up to half of patients may not improve after surgery.

Arthroscopic removal of the synovium (arthroscopic synovectomy) can be of great benefit to patients with rheumatoid arthritis. Arthroscopic or arthroscopic-assisted surgery to repair the meniscus or reconstruct ligaments in the knee is much more complicated, with a long recovery and varied results.

For a simple meniscal cleaning (debridement), recovery is usually fast. You may need to use crutches for a while to reduce weight placed on the knee joint and to control pain. You can manage pain with medications.

For more complicated procedures where anything is fixed or reconstructed, you may not be able to walk on the knee for several weeks. Recovery may be anywhere from several months to a year.