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Knee arthroscopy
Definition
Knee arthroscopy is surgery that is done by making small cuts on your knee and looking inside using a tiny camera. Other medical instruments may also be placed inside to fix your knee.
Alternative Names
Knee scope - arthroscopic lateral retinacular release; Synovectomy - knee; Patellar (knee) debridement; Meniscus repair; Lateral release; Knee surgery
Description
Three different types of pain relief (anesthesia) may be used for knee arthroscopy surgery:
- Your knee may be numbed with painkilling medicine. You also may be given medicines that relax you. You will stay awake.
- Spinal anesthesia. This is also called regional anesthesia. The painkilling medicine is injected into a space in your spine. You will be awake but will not be able to feel anything below your waist.
- General anesthesia. You will be asleep and pain-free.
A cuff-like device that blows up (inflates) may be used around your thigh to help control bleeding during knee arthroscopy.
The surgeon will make two or three small cuts around your knee. Salt water (saline) will be pumped into your knee to stretch the knee.
A narrow tube with a tiny camera on the end will be placed inside through one of the cuts. The camera is attached to a video monitor in the operating room. The surgeon looks at the monitor to see the inside of your knee. In some operating rooms, the patient can also watch the surgery on the monitor, if they want to.
The surgeon will look around your knee for problems. The surgeon may put other medical instruments inside your knee through the other small cuts. The surgeon will then fix or remove the problem in your knee.
At the end of your surgery, the saline will be drained from your knee. The surgeon will close your cuts with sutures (stitches) and cover them with a dressing. Many surgeons take pictures of the procedure from the video monitor so that afterward you can see what was done and what was found.
See also: ACL reconstruction
Why the Procedure Is Performed
Arthroscopy may be recommended for these knee problems:
- Torn meniscus. Meniscus is cartilage that cushions the space between the bones in the knee. Surgery is done to repair or remove it.
- Torn or damaged anterior cruciate ligament (ACL) or posterior cruciate ligament (PCL)
- Swollen (inflamed) or damaged lining of the joint. This lining is called the synovium.
- Kneecap (patella) that is out of position (misalignment).
- Small pieces of broken cartilage in the knee joint
- Removal of Baker's cyst -- a swelling behind the knee that is filled with fluid. Sometimes this occurs when there is swelling and pain (inflammation) from other causes, like arthritis.
- Some fractures of the bones of the knee
Risks
The risks for any anesthesia are:
- Allergic reactions to medicines
- Breathing problems
The risks for any surgery are:
- Bleeding
- Infection
Additional risks for this surgery include:
- Bleeding into the knee joint
- Damage to the cartilage, meniscus, or ligaments in the knee
- Blood clot in the leg
- Injury to a blood vessel or nerve
- Infection in the knee joint
- Knee stiffness
Before the Procedure
Always tell your doctor or nurse what drugs you are taking, even drugs, supplements, or herbs you bought without a prescription.
During the 2 weeks before your surgery:
- You may be asked to stop taking drugs that make it harder for your blood to clot. These include aspirin, ibuprofen (Advil, Motrin), naproxen (Naprosyn, Aleve), and other drugs.
- Ask your doctor which drugs you should still take on the day of your surgery.
- Tell your doctor if you have been drinking a lot of alcohol, more than 1 or 2 drinks a day.
- If you smoke, try to stop. Ask your doctor for help. Smoking can slow down wound and bone healing.
- Always let your doctor know about any cold, flu, fever, herpes breakout, or other illness you may have before your surgery.
On the day of your surgery:
- You will usually be asked not to drink or eat anything for 6 to 12 hours before the procedure.
- Take your drugs your doctor told you to take with a small sip of water.
- Your doctor or nurse will tell you when to arrive at the hospital.
After the Procedure
After the surgery, you will have an ace bandage on your knee over the dressing. Most people go home the same day they have surgery. Your doctor will give you an exercise program to follow.
Outlook (Prognosis)
Whether or not you have a full recovery after knee arthroscopy depends on what type of problem was treated.
Problems such as a torn meniscus, broken cartilage, Baker's cyst, and problems with the synovium are usually fixed easily. Many patients remain active after these surgeries.
Recovery from simple procedures is usually fast. You may need to use crutches for a while so that you do not put weight on your knee and to control pain. This will depend on what kind of surgery you had. Your doctor may also prescribe pain medicine.
Recovering from more complicated procedures will take longer. When anything in your knee is repaired or rebuilt, you may not be able to walk without crutches or a knee brace for several weeks. Full recovery may take several months to a year.
If you also have arthritis in your knee, you will still have arthritis symptoms after surgery to repair other damage to your knee.
References
Phillips BB. Arthroscopy of the lower extremity. In: Canale ST, Beatty JH, eds. Campbell's Operative Orthopaedics. 11th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 48.
Miller MD, Hart J. Surgical principles. In: DeLee JC, Drez D Jr, Miller MD, eds. DeLee and Drez's Orthopaedic Sports Medicine. 3rd ed. Philadelphia, Pa: Saunders Elsevier; 2009:chap 2.
Reviewed By: Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; and C. Benjamin Ma, MD, Assistant Professor, Chief, Sports Medicine and Shoulder Service, UCSF Dept of Orthopaedic Surgery. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
