Knee Arthroscopy: An Overview of Minimally Invasive Knee Surgery

19 April,2024

Imagine you are playing a sport or just walking and suddenly feel an intense pain in your knee. You go back home, and the pain persists for weeks. You pay a visit to the doctor and get a normal X-ray. An MRI scan is then performed, which reveals a torn meniscus as the cause of the pain. Despite trying several treatments such as rest, pain medicines, and physical therapy, the pain continues even after a month. At this point, surgery may seem like the only option, and you get scared by the name of it.

This is a common scenario for many individuals. However, with advancements in surgical techniques, you no longer need to worry about the complexities of knee surgeries. Knee arthroscopy is one such advancement that has changed the scenario for knee surgeries. Annually, over 2,000,000 knee arthroscopy procedures are performed worldwide.

This blog will help you better understand knee arthroscopy, how orthopedic specialists perform the surgery, its recovery time, and much more.

What is Knee Arthroscopy?

Knee injuries and conditions can vary from mild to severe. Sometimes, you may require surgery to replace part or all of the knee joint. However, in other cases, only the tissues around the knee joint, such as the ligaments, cartilage, and tendons, may need to be treated or repaired.

Knee arthroscopy is a minimally invasive orthopedic procedure that allows surgeons to view, diagnose, and correct problems inside the knee joint. It involves inserting a mini camera (arthroscope) through a small incision in the knee.

The camera displays real-time images on a screen, allowing the surgeon to see inside the knee and identify any issues. The surgeon can then use small instruments to repair or remove damaged tissue or bone.

Knee arthroscopy is often used to treat conditions such as torn meniscus, bursitis, damaged cartilage, or ligament injuries.

Standard knee arthroscopy procedures include meniscectomy, loose body surgery, ACL surgery, PCL reconstruction, and patella realignment surgery.

When is Knee Arthroscopy Recommended?

Orthopedic specialists recommend knee arthroscopy when there is excruciating pain in the knee. When non-surgical treatments such as physical therapy, icing, NSAIDs, and rest do not help improve pain, it is time for you to get the procedure.

The three primary reasons to have knee arthroscopy are –

• Diagnosis: Knee arthroscopy is a medical procedure in which a doctor examines painful or swollen areas in the knee. They use a camera to show images of damaged tissues and bones, which helps them diagnose injuries and plan the proper treatment. 
• Surgery to repair soft tissues: If surgery is needed to repair tendons, ligaments, or cartilage, the doctor uses special tools. They use a camera to guide them during the procedure and use tiny tools to stitch soft tissues or suture bones together. 
• Removing damaged tissue: The doctor uses specific tools to remove damaged or inflamed tissue, such as the synovium, by carefully shaving it off from the knee.

Who Needs Knee Arthroscopy?

Knee arthroscopy is a standard orthopedic procedure to diagnose and treat several knee conditions and injuries. You might need knee arthroscopy if you have the following conditions – 

• Torn anterior or posterior cruciate ligaments (ACL and PCL tear)
• Swollen synovium (the lining in the joint)
• Knee sepsis
• Bursitis
• Torn meniscus (cartilage between knee bones)
• Pieces of torn cartilage in the joint
• Baker’s cyst
• Patella that’s out of position
• Fractures in the knee bones

If you have any of the above conditions, knee arthroscopy will be effective in the following ways -

• Relieving pain
• Removing loose bodies (cartilage or bone spurs)
• Improving stability
• Repairing tissue tears and damage
• Improving function and range of motion

What Happens Before Knee Arthroscopy?

• Before undergoing knee arthroscopy, inform your doctor about all your medications. The surgeon may ask you to stop taking certain medicines such as naproxen, aspirin, ibuprofen, and other blood thinners.
• If you are a smoker or drinker, you might need to stop them as well. Smoking severely affects the healing process and is not recommended at all.
• You will undergo diagnostic and evaluation tests such as X-ray, MRI, electrocardiogram, and blood tests. These tests are necessary to identify the severity of your condition and your fitness for the surgery.
• Your healthcare team will brief you about the procedure, including the type of anesthesia and risks associated with knee arthroscopy.
• You will also receive instructions about when to stop eating before the procedure. Usually, overnight fasting is required before knee arthroscopy.

How is Knee Arthroscopy Performed?

Knee arthroscopy is a keyhole surgery that can diagnose and treat specific knee conditions. Let's understand the procedure by breaking it into three parts.

Preparation

• When you enter the operating room, the anesthesiologist will administer anesthesia. Your surgical team will clean the skin on your knee to prevent surgical site infections. 
• They will cover your leg with surgical draping to expose the incision site.
• They will also place a positioning device on your leg to stabilize the knee during the arthroscopic procedure.

Surgery

• The surgeon will then create small incisions in your knee and wash the joint with a sterile solution to remove any cloudy fluid. It will enable them to see the structures inside your knee clearly and in detail. 
• The surgeon will diagnose your problem by inserting the arthroscope and using the image projected on the screen to guide it. 
• They will insert tiny instruments through other small incisions if surgical treatment is needed. 
• The surgeon will use specialized instruments for tasks like shaving, cutting, grasping, and tissue repair. 
• In many cases, particular devices are used to anchor stitches into bone.

Closing the incision

• Knee arthroscopy procedures usually last less than an hour, and the length of the surgery will depend on the findings and necessary treatment. 
• After surgery, each incision will be closed with a stitch or steri-strips (small adhesive strips). 
• The surgery team will wrap your knee with a soft bandage; sometimes, braces are used post-operatively to protect a repair or reconstruction.

What is it Like to Recover After Knee Arthroscopy?

Once the knee surgery is complete, the nursing staff will take you to the recovery room. Most arthroscopy procedures are done on an outpatient basis, and you can go home on the same day.

Recovery after knee arthroscopy is swift compared to traditional open surgery and starts as soon as the procedure is complete.

Managing Pain

• Pain management is a crucial part of the rehabilitation process. 
• You will likely be given opioid pain medications such as tramadol to help manage pain after the surgery.
• Opioid medications can be addictive and cause side effects like constipation, nausea, vomiting, and abdominal pain.
• Do not self-medicate with OTC painkillers, as they might interfere with tissue healing and increase the chances of bleeding.

Physical Therapy

• Physical therapy is necessary to return to everyday life after the surgery.
• Your healthcare professional will decide whether you can get physical therapy on an outpatient basis or if you need to stay at the hospital for the first few days. The decision will be based on the extent of your injury and the complexity of the procedure.
• The general physical therapy plan consists of exercises 3-5 times a week for at least 4 to 6 weeks. Complex procedures, such as ACL/PCL reconstruction and meniscus surgery, can warrant physical therapy for up to 1 year.
• Physical therapy exercises help knee arthroscopy patients:
  • Improve knee joint's range of motion.
  • Strengthen quadriceps, hamstring, and glutes.
  • Improve the ability to do squats and climb stairs.
  • Maintain balance while walking. 
  • Return to sports and other physical exercises.

Weight Bearing Restrictions

• Knee arthroscopy patients have weight-bearing restrictions throughout their recovery process.
• You'll need to limit the pressure on your leg while standing and walking. Your surgical team will tell you when your knees have enough strength to handle body weight.
• You can use crutches and walkers after the surgery to avoid straining the knee with too much pressure.
• "Weight-bearing as tolerated" can also be an option for many arthroscopy patients. They can walk or stand, bearing as much weight as their body allows. 

How to Improve Recovery Process?

Recovery from knee arthroscopy can vary based on the type of procedure performed. Therefore, it is crucial to follow all instructions from your orthopedic surgeon and physiotherapist to promote optimal healing. Here are some recommendations for improving the recovery process:

• Have a healthy diet and manage your weight.
• It is essential to have a good night's sleep, ideally for seven to eight hours, as it helps in the healing process.
• Adhere to the weight-bearing precautions to avoid any complications.
• Avoid high-impact activities like running, weightlifting, and sports until your knee has enough strength and stability.
• Stay hydrated throughout the day. Drinking plenty of water and juices.
• Avoid sitting for prolonged periods to keep your knee from getting stiff.
• Keep a positive attitude and learn to manage stress.
• Stick to the exercise program recommended by your physical therapist.

What are the Risks of Knee Arthroscopy?

Knee arthroscopic surgery is a safe and sound procedure. It has a success rate of 85 to 90%. The complication rate after knee arthroscopy is very low. However, every surgery carries a slight risk of complications with them. If complications occur after knee arthroscopy, they are usually minor and easily treatable. A few postoperative problems with knee arthroscopy are –

• Infection
• Blood clots
• Knee stiffness
• Bruising
• Swelling
• Accumulation of blood in the knee
• Injury to blood vessels
• Damage to surrounding tissues

Risks associated with the use of anesthesia are breathing difficulties, infection, allergic reactions to the medications, and bleeding.

To Conclude

Knee arthroscopic surgery is a keyhole (minimally invasive) procedure that helps diagnose and treat specific knee conditions. During the procedure, orthopedic surgeons use small cameras and instruments to view the inside of the knee joint. This approach improves the accuracy of the surgery and usually requires fewer and smaller incisions than traditional surgery. Knee arthroscopy is most effective in treating injuries and conditions that have affected or damaged the knee's cartilage, ligaments, tendons, and other soft tissues.