Key-hole surgery / Arthroscopy
Knee arthroscopy is a minimally invasive surgical procedure. It provides the operating surgeon with an excellent view of the inside of the knee. It is usually performed through two very small puncture holes either side of the knee-cap tendon. One of the puncture holes is used to pass the surgical instruments into the knee and the other is for the camera which is used to visualise the knee joint.
This is a very safe and straightforward procedure which is most commonly performed under general anaesthetic. In most cases it can be performed as a day case without an overnight stay in hospital.
Examination under Anaesthetic (EUA)
If the knee has been badly injured or is painful, examination may be difficult. Once the general anaesthetic has been administered, the surgeon is then able to thoroughly examine the patients knee. This allows obvious or subtle abnormalities to be detected, such as restriction of knee movement and ligament tears which may be dificult when the patient is awake and in pain.
Manipulation under Anaesthetic (MUA)
Loss of flexion (the ability to bend the knee) can be limiting but not being able to fully straighten (extend) the knee can be particularly troublesome as we need to be able to fully straighten our knee in order to walk. Following injury or surgery, scar tissue may build up inside the knee and limit movement. Initially non-operative measures are employed with appropriate rehabilitation and in particular targeted physiotherapy. If stiffness persists then it may be necessary to manipulate the knee under anaesthetic. An MUA involves gently bending and straightening the knee while the patient is asleep in order to improve the range of movement of the knee.
What to expect pre and post op
Arthroscopic knee surgery is straightforward and low risk. The operation is most commonly carried out under general anaesthetic. Following the procedure you will be taken to the recovery ward and then back to your room. Patients are routinely discharged home the same day.
A bandage is applied in theatre which can be removed the day following the procedure. For the vast majority of procedures crutches are not required following surgery and most patients are able to walk unaided. The small wounds are closed with paper strips or a single stitch which is removed 10 days following the surgery. The surgeon will inspect the knee at approximately 2 weeks following the surgery and discuss the intra-operative findings and procedure in detail using still pictures taken during the procedure or an operative video.
For 48 hours following the surgery patients are encouraged to rest the knee and then gradually commence normal activities including walking and driving. Most patients feel comfortable enough to return to work after a week following surgery. There may be some slight discomfort for 4-6 weeks after surgery. The recovery varies depending of what your arthroscopy involved.
Note: The following video shows graphic surgical scenes, produced for technical training.
Possible Complications following Arthroscopic Knee Surgery
Arthroscopic knee surgery is a safe procedure but every operation carries some risk. The potential risks are: bleeding into the knee, infection, blood clots, anaesthetic complications, numbness and altered sensation around the wound sites. Overall the chance of a major complication is significantly less than 1%.
Inflammation of the lining (synovium) of the joint presents as swelling (an effusion) of the knee with discomfort/pain and a feeling of stiffness. There are many causes and sometimes an arthroscopy is required to take samples of fluid and tissue to make a diagnosis. An uncommon condition of the synovium is synovial chondromatosis when it creates many small loose bodies which then grow causing mechanical symptoms of locking and giving way as well as those associated with an effusionVideo of Synovitis and Synovial Biopsy.
May be single or multiple and usually cause symptoms such as locking, giving way and/or swelling. Surgery is usually indiciated.