Your Knee Operation- Mr Walsh Orthopaedic surgeon

Knee arthroscopy can used to treat a range of problems you may have with your knee. These can include symptoms of locking or giving way or episodes of pain.

Knee arthroscopy can deal with lots of issues that affect your knee, these include meniscal tears, joint surface damage or loose bodies. The consultation, examination and subsequent investigations will help to identify these. The menisci, the two crescent shaped shock absorbers in the knee, can be torn. During the arthroscopy the damage menisci fragments can either be excised or if possible repaired. Within the knee, the joint surface, cartilage, can have areas of damage. This can either be areas of degeneration or areas of complete loss of cartilage. At arthroscopy these areas can be either smoothed away or techniques can be used to help regenerate new cartilage, such a microfracture where small holes are made in the bone to promote healing. Loose bodies can also be found in the knee, these can cause trapping and the knee to give way. Arthroscopy can be used to remove these. 

During your consultation  your doctor will take a thorough history and examine the knee, this often points to the problem. It is likely you will then have an X-ray of the knee and then an MRI scan of the knee. The MRI is a test that gives a clear picture of problems with the soft tissues within the knee and helps decide the best form of treatment for your problem. The MRI involves going into a ‘tunnel’ like scanner that uses powerful magnets to get pictures of what’s going on inside the knee.

Any operation should always be seen as a big undertaking, however Arthroscopy is generally done as a day case and only takes a few minutes. Depending on the findings and the treatment carried out during the arthroscopy, most patients walk out of the hospital on the same day with minimal pain. 

The hospital will send any information you need about when to fast and what to bring on the day of surgery. Prior to your operation it is always good to prepare by doing some gentle exercising and strengthening of the muscles around the knee. This will help with your recovery from surgery.

An arthroscopy is carried out as a ‘Keyhole’ operation. Two small cuts are made around the knee to allow the instruments and camera to access the joint. The knee is filled with fluid so the knee joint can be viewed with the camera and the instruments can be used to deal with the problem. These instruments may be tools designed to cut or nibble away at tears or may be tools such as a shaver which can removed damaged tissue and was the knee joint out.

Traditionally Knee arthroscopies have been carried out using General anaesthetic., however more recently we have been using short acting local anaesthetic through a spinal injection.   General anaesthetics can take a few hours to wear off and can sometimes leave the patient feeling nauseous and groggy. Using spinal anaesthesia is safer and the patient recovers quicker with less effects such as nausea and vomiting. The biggest advantage however is that you remain awake during the procedure and you can choose to watch the arthroscopy on the screen. I have been able to talk patients through the procedure which gives a much better understanding of the reasons for the symptoms and what you should expect as part of the your recovery. 

The time taken to perform an arthroscopy depends on what procedure is being carried out within the knee. Generally an arthroscopy takes between 15 mins to 30 mins to carry out.

Once your surgery has been completed you will go to a recovery area then back to the ward. Once on the ward you will be seen by the physiotherapy team who will give you exercises and advice depending on the treatment carried out. Occasionally you will be required to use crutches or wear a brace and instructions will be given to you about this on the ward. Once you have recovered from the anaesthetic and the therapy and nursing teams are happy you will be allowed to go home.  You will then have physiotherapy as an outpatient and you may also be reviewed by the consultant in clinic. 

Normally you are discharged a couple of hours after surgery. In most cases following surgery you can fully weight bear. Occasionally procedures are carried out, such as microfracture, that mean that you need to partial or non-weight bear on your operated leg. This will mean you will need crutches for up to 6 weeks, the physiotherapy team will show you how to use these. 

As a rule, you normally need a couple of weeks off work after surgery. This allows the wounds to heal and for you to recover. Certain procedures may require a longer time of work and this will be discussed with you prior to the operation.   Getting back to sport and activities again is very dependent on the procedure. In most cases returning to sport is a gradual process and is dependent on your recovery. In most cases getting back to competitive sport may take between 6 weeks to 3 months. 

Knee arthroscopy is an operation and inevitably some pain and swelling should be expected during the recovery period. The pain should be manageable, and advice will be given on how to treat the discomfort post operatively. Normally simple analgesia such as Paracetamol or Cocodamol will control the pain sufficiently.

Recovery after surgery depends on what procedures were carried out. Most knee arthroscopies recovery quickly with the knee feeling comfortable by 2 weeks and  getting back to normal by 6 weeks.