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The arthroscope is a fibre-optic telescope that can be inserted
into a joint (commonly the
knee, shoulder and ankle) to evaluate and
treat a number of conditions. A camera is attached to the arthroscope
and the picture is visualized on a TV monitor. Most arthroscopic
surgery is performed as a Day-Only procedure and is usually done under
Arthroscopy is useful in evaluating and treating the
1. Torn floating cartilage (meniscus): The cartilage is trimmed to
a stable rim or
2. Torn surface (articular) cartilage
3. Removal of loose bodies (cartilage or bone that has broken off)
4. Reconstruction of the Anterior Cruciate ligament
5. Patello-femoral (knee-cap) disorders
6. Washout of infected knees
7. General diagnostic purposes
Basic Knee Anatomy
The knee is the largest joint in the body. The knee joint is made
up of the femur, tibia and patella (knee cap). All these bones are
lined with articular (surface cartilage). This articular cartilage
like a shock absorber and allows a smooth low friction surface for the
knee to move on. Between
the tibia and femur lie two floating cartilages called menisci. The
medial (inner) meniscus and the Lateral (outer) meniscus rest on the
tibial surface cartilage and are mobile. The menisci also act
as shock absorbers and stabilizers. The knee is stabilized by
ligaments that are both in and outside the joint. The medial and
lateral collateral ligaments support the knee from excessive
side-to-side movement. The (internal) anterior and posterior cruciate
ligaments support the knee from buckling and giving way. The knee
joint is surrounded by a capsule (envelope) that produces a small
amount of synovial (lubrication) fluid to help with smooth motion.
Thigh muscles are important secondary knee stabilizers.
A routine X-Ray of the knee which includes a standing
weight-bearing view is usually required.
An MRI scan which looks at the cartilages and soft tissues may be
needed if the diagnosis is
unclear. There is little value in the use of Ultrasound in
investigating knee problems.
Meniscal Cartilage Tears:
Following a twisting type of injury the medial (or Lateral)
meniscus can tear. This results either
from a sporting injury or may occur from a simple twisting injury when
getting out of a chair or standing from a squatting position. Our
cartilages become a little brittle as we get older and
therefore can tear a little easier. The symptoms of a torn cartilage
- Pain over the torn area i.e. inner or outer side of the knee
- Knee swelling
- Reduced motion
- Locking if the cartilage gets caught between the femur and the
Once a meniscal cartilage has torn it will not heal unless it is a
very small tear which is near the capsule of the joint. Once the
cartilage has torn it predisposes the knee to develop osteoarthritis
(wear and tear) in 15 to 20 years. It is better to remove torn pieces
from the knee if the knee is symptomatic.
Torn cartilages in general continue to cause symptoms of
discomfort, pain and swelling until the loose, ragged pieces are
removed. Only the torn section is removed and the knee should recover
and become symptom free. If the entire meniscus is removed, the knee
will develop osteoarthritis in 15 to 20 years. Now a days only the
torn section is removed and it is hoped that this will delay the onset
of long-term wear and tear osteoarthritis.
Occasionally, provided the knee is stable and the tear is a certain
type of tear in a young patient (peripheral bucket handle tear), the
meniscus may be suitable for repair. If repaired one has to
avoid sports for a minimum of three months.
Articular Cartilage (Surface) injury:
If the surface cartilage is torn, this is most significant as a
major shock-absorbing function is compromised. Large pieces of
articular cartilage can float in the knee (sometimes with bone
attached) and this causes locking of the joint and can cause further
deterioration due to the loose body floating around the knee causing
further wear and tear. Most surface cartilage wear will ultimately
lead to osteoarthritis. Mechanical symptoms of pain and swelling due
to cartilage peeling off can be helped with arthroscopic surgery.
The surgery smoothes the edges of the surface cartilage and removes
Unstable cartilage can be removed. It is common for the surgeon to
then perform micro fracture.
This is where a small, sharp pick is used to perforate the underlying
bone and encourage healing
of the cartilage defect. This can result in a good outcome, but does
not replace the defect with
Occasionally cartilage replacement is required. This can be achieved
using various techniques.
The most common way of treating smaller defects is by a
method known as
This is where small cylinders of bone and cartilage are
harvested from a less
important area of the knee and packed into the defect, creating a
with true cartilage.
The other method of cartilage replacement used is
Transplantation. It involves harvesting cartilage cells from the
affected knee, sending these cells
to a laboratory and then culturing the cells to multiply into many
cells. The large amounts of cells
produced are then placed back into the affected knee, into the defect
Results are still short term but are looking encouraging. After a
major cartilage or ligament
injury has been treated the knee can return to normal function. There
is however a small increase
in the risk of developing long term wear and tear (Osteoarthritis) and
depending on the degree of
injury, activity modification may be required. Activities that help
prevent knees deteriorating
- Low impact sports like swimming, cycling and walking
- Reducing weight and maintaining a healthy diet
Anterior Cruciate Ligament Injuries:
Rupture of the Anterior (rarely the posterior) Cruciate Ligament
(ACL) is a common sporting injury.
Once ruptured the ACL does not heal and usually causes knee
instability and the inability to return to normal sporting activities.
An ACL reconstruction is required and a new ligament is fashioned to
replace the ruptured ligament. This procedure is performed using the
Patella (knee-cap) disorders:
The arthroscope can be used to treat problems relating to kneecap
disorders, particularly mal-tracking and significant surface cartilage
tears. Patients may need to stay overnight if a lateral release has
been performed as knee swelling is quite common. The majority of
common knee -cap problems can be treated with physiotherapy and
Occasionally arthroscopy is used in inflammatory conditions (e.g.
Rheumatoid Arthritis) to help reduce the amount of inflamed synovium
(joint lining) that is producing excess joint fluid. This procedure is
called a synovectomy. After the surgery a drain is inserted into the
knee and patients generally require one or two nights in hospital.
Bakers cysts or popliteal cysts are often found on clinical
examination and ultrasound / MRI scan. The cyst is a fluid filled
cavity behind the knee and in adults arises from a torn meniscus or
worn articular cartilage in the knee. These cysts usually do not
require removal as treating the cause (torn knee cartilage) will in
most cases reduce the size of the cyst. Occasionally the cysts rupture
and can cause calf pain. The cysts are not dangerous and do not
require treatment if the knee is asymptomatic.
Arthroscopy of the knee: Patient Information
Please stop taking Aspirin and Anti-inflammatories 5 days prior to
your surgery. If pain medication is required use Panadol / Panadine or
Panadine Forte. You can continue taking all your other routine
medication. If you smoke you are advised to stop a few days prior to
You will be admitted on the day of surgery and need to remain
fasted for 6 hours prior to the procedure.
The limb undergoing the procedure will be marked and identified
prior to the anaesthetic
Once you are under anaesthetic, the knee is prepared in a sterile
fashion. A tourniquet is placed around the thigh to allow a ‘blood –
The Arthroscope is introduced through a small (size of a pen)
incision on the outer side of the knee. A second incision on the inner
side of the knee is made to introduce the instruments that allow
examination of the joint and treatment of the problem.
- You will wake up in the recovery room and then be transferred
back to the ward
- A bandage will be around the operated knee.
- Once you are recovered your drip will be removed and you will be
shown a number of exercises to do.
- Your Surgeon will see you prior to discharge and explain the
findings of the operation and what was done during surgery.
- Pain medication will be provided and should be taken as directed
- You can remove the bandage in 24 hours and place waterproof
dressings (provided) over the wounds.
- It is NORMAL for the knee to swell after the surgery. Elevating
the leg when you are seated and placing Ice-Packs on the knee will
help to reduce swelling. (Ice packs on for 20 min 3-4 times a day
until swelling has reduced)
- You are able to drive and return to work when comfortable unless
- Please make an appointment 7-10 days after surgery to monitor
your progress and
remove the 2 stitches in your knee.
Risks of Arthroscopy:
General Anaesthetic risks are extremely rare.
Occasionally patients have some discomfort
in the throat as a result
of the tube that supplies oxygen and other gasses. Please
with the Specialist Anaesthetist if you have any specific
Risks specifically related to the surgery.
Risks related to Arthroscopic knee surgery include:
- Postoperative bleeding
- Deep Vein Thrombosis
- Numbness to part of the skin near the incisions
- Injury to vessels, nerves and a chronic pain syndrome
- Progression of the disease process
The risks and complications of arthroscopic knee surgery are
extremely small. One must however bear in mind that occasionally there
is more damage in the knee than was initially thought and that this
may affect the recovery time. In addition if the cartilage in the knee
is partly worn out then arthroscopic surgery has about a 65% chance of
improving symptoms in the short to medium term but more definitive
surgery may be required in the future. In general arthroscopic surgery
does not improve knees that have well established Osteoarthritis.
|Post –Operative Exercises and
Following your surgery you will be given an instruction sheet
showing exercises that are helpful in speeding up your recovery.
Strengthening your thigh muscles (Quadriceps and Hamstrings) is most
important. Swimming and cycling (stationary or road) are excellent
ways to build these muscles up and improve movement.
Frequently asked questions:
How long am I in Hospital?
A: Approx 4 hours
Do I need crutches
A: Usually not required (Unless having Anterior Cruciate Ligament
When can I get the knee wet
A: After 24 hrs remove the bandage and apply waterproof dressing
When can I drive
A: After 24 hrs if the knee is comfortable
When can I return to work
A: When the knee feels reasonably comfortable
When can I swim
A: After removal of the stitches
How long will my knee take to recover
A: Depending on the findings and surgery usually 4 to 6 weeks
following the surgery.
When Can I return to Sports
A: Depending on the findings, 4-6 weeks after surgery
After ACL reconstructing 6-9 months for return to full sports such as
soccer, rugby, netball.
After articular cartilage surgery it can be up to 6 months.