Knee Arthroscopy

If you have persistent pain, catching, or swelling in your knee, a procedure known as arthroscopy may help relieve these problems.

Arthroscopy allows an orthopedic surgeon to diagnose and treat knee disorders by providing a clear view of the inside of the knee with small incisions, utilizing a pencil-sized instrument called an arthroscope. The scope contains optic fibers that transmit an image of your knee through a small camera to a television monitor. The TV image allows the surgeon to thoroughly examine the interior of your knee and determine the source of your problem. During the procedure, the surgeon also can insert surgical instruments through other small incisions in your knee to remove or repair damaged tissues.

The knee is the largest joint in the body, and one of the most easily injured. It is made up of the lower end of the thigh bone (femur), the upper end of the shin bone (tibia), and the knee cap (patella), which slides in a groove on the end of the femur.

Four bands of tissue, the anterior and posterior cruciate ligaments, and the medial and lateral collateral ligaments connect the femur and the tibia and provide joint stability. Strong thigh muscles give the knee strength and mobility.

The surfaces where the femur, tibia and patella touch are covered with articular cartilage, a smooth substance that cushions the bones and enables them to glide freely. Semicircular rings of tough fibrous-cartilage tissue called the lateral and medial menisci act as shock absorbers and stabilizers.

The bones of the knee are surrounded by a thin, smooth tissue capsule lined by a thin synovial membrane.  This membrane releases a special fluid to lubricate the knee, reducing friction to nearly zero in a healthy knee.

Signs that you may be a candidate for this procedure include swelling, persistent pain, catching, giving-way, and loss of confidence in your knee. When other treatments such as the regular use of medications, knee supports, and physical therapy have provided minimal or no improvement, you may benefit from arthroscopy.

Most arthroscopies are performed on patients between the ages of 20 and 60, but patients younger than 10 years and older than 80 years have benefited from the procedure.

• A medical history, in which your orthopedic surgeon gathers information about your general health and asks you about your symptoms.
• A physical examination to assess your knee motion and stability, muscle strength and overall leg alignment.
• X-rays to evaluate the bones of your knee. Your orthopedic surgeon may also arrange for you to have an MRI to provide more information about the soft tissues of your knee. An MRI uses magnetic sound waves to create images. They are not X-rays. Blood tests may be obtained to determine if you have arthritis.

The orthopedic surgeon will make a few small incisions in your knee. A sterile solution will be used to fill the knee joint and rinse away any cloudy fluid, providing a clear view of your knee.

The surgeon will then insert the arthroscope to properly diagnose your problem, using the TV image to guide the arthroscope. If surgical treatment is needed, the surgeon can use a variety of small surgical instruments (e.g., scissors, clamps, motorized shavers, or lasers) through another small incision. This part of the procedure usually lasts 45 minutes to 1 1/2 hours.

Swelling: Keep your leg elevated as much as possible for the first few days after surgery. Apply ice as recommended by your orthopedic surgeon to relieve swelling and pain.

Medications: Your orthopedic surgeon may prescribe antibiotics to help prevent an infection and pain medication to help relieve discomfort following your surgery.

Complications: Potential postoperative problems with knee arthroscopy include infection, blood clots, and an accumulation of blood in the knee. These occur infrequently and are minor and treatable.

Although arthroscopy can be used to treat many problems, you may have some activity limitations even after recovery. The outcome of your surgery will often be determined by the degree of injury or damage found in your knee. For example, if you damage your knee from jogging and the smooth articular cushion of the weight-bearing portion of the knee has worn away completely, full recovery may not be possible. You may be advised to find a low-impact alternative form of exercise.

An intercollegiate or professional athlete often sustains the same injury as a weekend recreational athlete, but the potential for recovery may be improved by the over-development of knee muscles. Physical exercise and rehabilitation will play an important role in your final outcome. A formal physical therapy program also may add something to your final result.

A return to intense physical activity should only be done under the direction of your surgeon.

It is reasonable to expect that by six to eight weeks you should be able to engage in most of your former physical activities as long as they do not involve significant weight-bearing impact. Twisting maneuvers may have to be avoided for a longer time.

If your job involves heavy work, such as a construction laborer, you may require more time to return to your job than if you have a sedentary job.