(including Cartilage & Meniscal surgery)
(including Cartilage & Meniscal surgery)
What is the aim of this surgery? Keyhole knee surgery, known as arthroscopy, is used in non-arthritic conditions where the soft tissues of the knee (cartilage, meniscus and ligaments) are damaged. Almost all repair and reconstructive techniques on these important structures can be performed through this minimally invasive technique.
Who might benefit from this procedure? Damage to the knee soft tissues can cause pain, catching, clicking, giving way and locking of your knee. These are termed “mechanical symptoms” and can make the knee feel unsafe. A clinic visit and full examination followed by an MRI scan will be used to define the exact cause. Repair of these tissues is beneficial but relies on an early diagnosis (and therefore early referral after the symptoms start); ideally within 2-3 weeks. When cartilage or meniscus repair is no longer possible then these structures can be trimmed or stabilised, termed as chondroplasty or meniscectomy respectively. When a ligament, such as the ACL (anterior cruciate ligament), is torn then it too can be repaired if diagnosed rapidly. When not repairable then an arthroscopic ACL Reconstruction may be preferred.
Will I need to stay in hospital overnight? No – this is commonly a day case procedure. The surgery is typically performed under general anaesthetic. A supplementary nerve block (see other information regarding what to expect before surgery) may be used in more complex cases.
What does the procedure involve? A tourniquet will be inflated to improve visualisation. Two small (1cm) incisions will then be made on either side of the kneecap, one for the camera and one for any surgical instruments. Sometimes extra incisions are needed above the kneecap, particularly in more complicated cases (Ligament reconstruction). A full keyhole (arthroscopic) assessment of your knee joint will then be carried out to confirm the damage and evaluate the knee fully. Pictures of the knee are taken and we can go through these at the follow-up clinic appointment.
What are the chances of an improvement in my symptoms: Knee arthroscopy is a safe and effective operation for improving mechanical symptoms (catching, clicking, locking and giving way) and pain associated with damage to the knee soft tissues. When your knee has painful arthritis (complete loss of cartilage with underlying bone pain) then arthroscopy will not be successful as further trimming of the soft tissues can make the situation worse.
What can I expect after surgery? – Once the local anaesthetic has worn off you will need tablet painkillers for a period of time; this can range from a few days to a few weeks depending on the complexity of your surgery. You will be encouraged to mobilise early with the onsite specialist physiotherapy team and typically discharged home on the day of surgery. For more complex cases, such as ligament reconstructions or meniscal repair, you will need to take blood thinning tablets (Aspirin commonly) or a daily injection for up to 6 weeks after surgery whilst less mobile and on crutches. Ongoing physiotherapy after surgery is essential in order to restore a good range of motion and ultimately to help you build muscle bulk for strength and control.
Driving: You can drive once you are no longer reliant on crutches. For most arthroscopic procedures this is usually 1-2 weeks. For more complex reconstructions then up to 8 weeks is typical.
Returning to Work
Simple knee arthroscopic procedures – Desk-based duties: Usually 1 week. When a long or difficult commute is required, or in cases of return to more manual work 2 or 3 weeks may be necessary. Complex knee reconstructions & repairs: up to 8-12 weeks depending on your job complexity. Often a period of amended duties will be necessary for heavy manual work.
Returning to Sporting activities
- Simple knee arthroscopic procedures: 3-4 weeks
- Complex knee reconstructions & repairs: 9-12 months
What are the potential complications or risks associated with this surgery?
Bleeding/bruising: Bleeding is typically minimal and occurs in the first couple of days after the surgery. This may necessitate a change of dressings if they come loose. Bruising can be significant, particularly after more complex surgery, and will often track down the leg to the ankle and foot but will settle and does not cause long term problems. Elevating the operated leg when resting (including at night) on a pillow will help to minimise swelling in the first few weeks after surgery. Regular icing should also be used liberally – this improves swelling and pain after surgery. An ice pack for 10 minutes in every hour can be used.
Infection: This is a rare complication and occurs in less than 1% of cases. It is a potentially serious complication when it does happen, however. Usually the infection is superficial involving the skin and will settle with antibiotics but if it is a deeper infection, this will require further surgery to wash out the wound.
Nerve and vascular injury: Damage to the major nerves and blood vessels at the back of the leg are, thankfully, very rare after keyhole surgery (less than 0.1%). The small superficial nerves that supply the area of skin on the front of the leg, known as cutaneous sensory nerves, are commonly in the operative incision line and damage is unavoidable. This results in a numb patch near the scars which may track down the lower leg towards the ankle. The usual course is that the affected numb area will reduce in size during the first year after surgery but may never go away completely.
Blood clots in legs or lungs: We worry about leg vein clots (Deep Vein Thrombosis or DVT) because clots can be dislodged and travel to the lung where they can become a life-threatening problem (1:10,000). For this reason you will be given blood thinning injections until fully mobile and weight bearing normally. For less complicated cases you will be able to fully weightbear straight away and these measures will not usually be required. For complex cases blood thinning injections or Aspirin may be necessary for up to 6 weeks following surgery.
Anaesthetic risks: Modern anaesthesia is usually very safe, but there are small risks associated with general anaesthetics including airway problems and unexpected allergic reactions. There are separate risks associated with receiving a nerve block. The anaesthetist will be able to go through these risks with you prior to the operation.