Knee Arthroscopy

Arthroscopy is a minimally invasive operation that involves the inspection and surgical treatment of the knee joint with a small fibre optic telescope. The arthroscope contains a camera that allows direct visualization of all the structures in the knee joint. The image is projected onto a television monitor via a fibreoptic cable. Small operating instruments can be inserted into the knee through a second small incision

The benefits of arthroscopy include

• Smaller incisions
• Faster healing
• More rapid recovery, and
• Less scarring

Arthroscopic surgical procedures are usually performed on an outpatient basis. This means patients can return home on the same.

How the Knee Works

To understand the functions, conditions, surgeries and procedures of the knee I have included an interactive video

Conditions treated by Arthroscopy

• Meniscal injury or tear is the most common. The meniscus is very important to the normal function of the knee. Meniscal tears cause pain, swelling and sometimes catching and locking in the knee. The torn, non functioning meniscal fragment is resected or in some cases repaired using a suture to restore normal function. Every effort is made to preserve as much of the meniscus as possible.
• Articular cartilage is the smooth lining of the joint. Damage to the articular cartilage by injury or wear and tear can cause pain and swelling and sometimes loose bodies in the knee. Acute cartilage injuries can be debrided and stabilised and loose bodies removed, but arthroscopy cannot cure arthritis.
• Assessment for suitability for other surgical procedures e.g. partial knee replacement or cartilage transplantation.
• Arthritic knees can occasionally be helped by arthroscopy, especially if there are symptomatic meniscal tears or recent mechanical symptoms caused by loose bodies. Discomfort and pain caused by these can be helped but any arthritis and its symptoms will remain.
• Cruciate ligament or MPFL [Patellar] reconstruction. Arthroscopy is an integral part of these procedures.
• Cartilage biopsy if you are a candidate for cartilage transplant. Or tissue biopsy to diagnose conditions, such as PVNS.

Preparing for Your Surgery

1. Exercise
   It is useful to do some quadriceps exercises (up to the point of mild discomfort) prior to your operation. These exercises are designed to maintain muscle strength to the quadriceps group, which is on the front of your thigh. It is very important to also continue these exercises post-operatively.

   Many patients do benefit from pre operative consultation with their threating physiotherapist who will see them after the surgery.

2. Medications
   Anticoagulant medication such as Plavix, NOACS, warfarin or aspirin may need to be ceased 7 days prior to surgery. Anticoagulants should never be ceased without the advice from your treating general practitioner or specialist .

   All vitamins and supplements should be ceased 10 days prior to surgery. All regular prescribed medication should be continued.

3. Anaesthetic
   Arthroscopic surgery is performed under general anaesthetic. You will be able to discuss this with your anaesthetist on the day of your surgery. If you have any regular medications please bring them with you to hospital to assist the anaethetist

4. Skin preparation
   Your knee and leg should be free of any skin infection or irritation.

   Please contact my office if you have any cuts , scratches , insect or animal bites or sores on your knee or anywhere else on your body. Use an antibacterial wash on your knee and leg daily for a week prior to surgery if possible, (e.g. Phisohex or chlorhexidine ). Please avoid at risk activities such as lawn mowing in the weeks before surgery.

   Please do not shave the knee or leg or use hair removal creams in the weeks before surgery.

5. Smoking should ideally be stopped before surgery. Smoking increases risk of wound problems , infection .less satisfactory outcome and may increase risk of Deep Vein Thrombosis

See Surgery and Smoking, Smoking and Musculoskeletal health and Deep Vein Thrombosis AAOS Orthoinfo links for further information

Your Surgery

You will be admitted to hospital on the day of your operation.

The hospital will call you in the afternoon prior to your procedure with your fasting details and admission time.

The anaesthetist will see you before your operation to discuss your anaesthetic. You will be given some advice regarding post operative medication and pain management.

Wounds are covered with small waterproof dressings and the leg bandaged with a compression bandage.

You will be taken to the recovery ward where you are monitored prior to being returned to the day surgery ward.

You will be fitted and instructed on use of crutches before discharge . Crutches may not be needed for very long although this is variable.

Day surgery staff will allow you to leave the hospital when you are comfortable and mobile.

You should be accompanied home by a relative or friend. You may not drive yourself for at least 24 hours.

If you do not have any one to be with you after discharge or if home has lots of steps please let Dr Berton know .

Early Recovery

Recovery from this operation involves reducing the swelling, strengthening the muscles and reducing pain.

Please read and follow the Post-Operative instructions that will be given to you after surgery.

1. Please note that it is normal for the knee to be sore and swollen following arthroscopy. Activity should be increased gradually. Avoid prolonged walking or standing for the first few days. You should avoid squatting or kneeling or attempting to bend your knee beyond 90 degrees if the knee is painful or swollen. It is safe to walk but do not spend too much time on your feet.

2. You may remove the bandage at home on the day following surgery.

3. Leave the waterproof dressings which are under the bandage intact until your post-operative review. These dressings usually allow for showering. Do not soak in a bath or swim. Remove and replace dressings only if they become wet or lift off. It is normal for some blood to collect under these dressings. This is safe. There may also be some bruising around the knee.

4. It is really important not to allow water to collect under the dressings since this can lead to skin maceration and infection. If the dressing lifts and water gets under dressing please contact either my office during work hours or the Hospital after hours and ask to speak to the after hours nursing supervisor.

5. The anaethetist will provide a script for pain killers. Over activity or standing for long periods can increase the swelling and pain in the knee. Try and rest as much as possible in the first few days.

6. Keep the leg elevated as much as possible after the operation. Apply an ice pack to the knee for 20 minutes at a time to reduce swelling and pain. When applying ice packs, ensure that you place a wet cloth between your skin and the ice pack to prevent an ice burn. Do not fall asleep with an ice pack in place.

7. Strengthening your quadriceps is important in restoring function to the knee. Do the straight leg raising exercises as shown on the post operative exercise sheet. Do 10 straight leg raises every hour whilst awake. It is safe to bend the knee up to the point of mild discomfort. Avoid deep squats.

8. I will see you in my rooms in the first few weeks following your surgery.

Report any unusual or worrying symptoms, e.g. excessive swelling, calf pain, redness or persistent elevated temperature. This could be a sign of infection or a deep vein thrombosis

Please contact my office or the hospital where you had your surgery if you are concerned.

General Advice Following Surgery

Driving

You can resume driving only when your knee is comfortable and you have no restrictions in operating your vehicle. Driving a car is discouraged for 48 hours after an anaesthetic. After 48 hours, your ability to drive will depend on the side you had your operation, left or right, and the type of vehicle you drive, manual or automatic. You can drive whenever you feel comfortable and are walking well with good control over your legs and reflexes. You should not drive under the influence of strong pain killers, e.g. Endone or Codeine.

Travel

Long distance travel for long by plane should be avoided if possible for 2 weeks. This decreases any risk of Deep Vein Thrombosis.

Post-operative Appointment

I will see you in the office following surgery. Please make an appointment with my secretary 49 525 001.

Return to work

I will provide you with a medical certificate at your first post-operative visit if required.

You may return to work as your knee function improves well enough for you to do your particular job.

Return to work will vary depending on the procedure performed and type of work you do. Most patients can return to office work within a few days. Labour intensive work however, may require up to 6-8 weeks or longer before returning to full duties.

During this period you should try to avoid the following activities:

• Prolonged standing
• Heavy lifting
• Bending or
• Excessive stair climbing

There can be risks of stress responses or even stress fractures if too much activity takes place following the arthroscopy

It is normal for there to be some discomfort in the knee for several weeks after arthroscopic surgery.

Results

The results from arthroscopic surgery depend on the arthroscopic findings and the underlying condition. In cases of a torn meniscus with no other damage to the joint, the results are usually excellent.

Patients who are found to have damage to the articular cartilage , that is osteoarthritis, which lines the joint, are likely to continue to experience some symptoms. This is due to the underlying nature of the condition. The results in this situation may be less favourable than when arthroscopic surgery is done for an isolated meniscal tear.

Arthroscopic surgery in the presence of osteoarthritis can give good results if there are meniscal tears or unstable joint linings with pieces of articular cartilage breaking off into the joint, but the results are less predictable than in non-arthritic patients. Patients with osteoarthritis are unlikely to gain full relief of symptoms following arthroscopic surgery, as the underlying condition is not changed, although many patients gain enough benefit to enable them to put off further interventions such as knee replacement. Arthroscopy can occasionally cause a temporary increase in the symptoms of arthritis.

Risks and Complications

Complications following knee arthroscopy are unusual, but surgical and medical complications can occur and may prolong or limit your recovery. The decision to proceed with surgery is made because the advantages outweigh the disadvantages.

Complications can include :

• Allergic reactions to medications.
• Haemarthrosis or bleeding into the joint. Treated with rest, elevation of the leg and ice and occasionally sterile aspiration.
• Infection superficial or deep requiring antibiotics. Infection is rare.
• Blood Clots (DVT). Uncommon due to early mobilisation.
• Damage to nerves or blood vessels. Wound or scar irritation. Some sensitivity or small areas of numbness may occur at the wound site. This usually decreases over time and will not affect the function of your knee.
• Muscle weakness following your injury and surgery. This should improve over time with physiotherapy and exercise.
• Ongoing pain can occur, especially in an arthritic knee. Some knees may require further investigation.

Please feel free to discuss any queries with me .

Summary

Arthroscopy of the knee is a safe and effective procedure. The results of arthroscopic surgery are usually better than open forms of surgery. Complications are uncommon. Remember that every knee is unique, and recovery time and the results of the procedure reflect that uniqueness. Not all knees can be made better as there may be some damage that cannot be reversed

If you have any questions regarding your proposed operation, please call me or make an appointment to see me at my office.