KNEE ARTHROSCOPY (KEYHOLE SURGERY )
Knee arthroscopy explained
During this procedure small camera (The size of an average ball point pen) is inserted into the knee and the images are relayed to a television screen. Specialist instruments are introduced into the joint through small incisions (less than 1cm). Using these instruments a surgeon can thoroughly visualise and assess the joint and perform several procedures including cartilage removal or repair, assessment of the menisci (specialised cartilages within the knee which can be injured during twisting sporting activity) and reattaching fragments of cartilage which have become loose within the joint.
Knee arthroscopy is both diagnostic and therapeutic. The cartilage lining the surfaces which make up the knee can be clearly visualised with the knee in a fixed position and during movement of the knee (dynamic assessment), the position and movement of the patella (kneecap) can be accurately visualised and assessed for pain and instability occurring in this region. The lining of the joint (the synovium) can be clearly visualised and biopsies taken if required.
Injury to the menisci (specialised semi circular cartilages which lie in the joint) can be visualised either by removal of the injured part or by repairing the cartilage during knee arthroscopy. The anterior and posterior cruciate ligaments (two strong ligaments which lie deep within the knee and can be injured by twisting sports related injuries) can be visualised and examined during arthroscopy for any signs of injury.
Mr Sandiford performs these as a day case procedure. It is normally performed under a general anaesthesia (the patient is asleep).
Although arthroscopy is a relatively small operative procedure it can affect day to day function, ability to perform sport and recreational activity, returning to work and driving. These issues will be discussed with you by Mr Sandiford prior to surgery. Any specific rehabilitation will be discussed with you by a physiotherapist before the operation.
Physiotherapy will begin prior to surgery (prehabilitation).
It is important that your expectations of the operation are discussed pre operatively and we encourage you to discuss any specific concerns which you may have.
The operative procedure
The procedure is carried out under a general anaesthetic and takes between 30 and 60 minutes to perform. A pneumatic tourniquet is placed around the thigh for the duration of the procedure. This might lead to a feeling of tightness around the thigh after surgery but rarely causes any concerns.
Patients are usually discharged on the same day but rarely require overnight admission hence we ask that you come to the hospital with an overnight bag and be prepared to stay overnight.
Two small incisions are placed on either side of the patella tendon to allow insertion of the instruments. The knee is filled with sterile fluid to distend it and allow visualisation of the structures within the joint. Most of this fluid is removed but some can be left which leads to the knee feeling ‘full’ and swollen. This will dissipate after 1-2 weeks.
After the procedure local anaesthetic is placed around the incisions, a dressing is applied followed by a bandage. You will be able to remove the bandage at home after 48 hours.
With modern anaesthesia most patients do not have significant nausea or vomiting which have been problems encountered in the past. They usually wake up comfortably and the vast majority go home on the same day of surgery.
You will be able to fully weight bear unless specifically advised not to do so. You will be given painkillers with instructions on how to take these. These will include anti-inflammatories (once there are no contra indications). You will be given advice on activity levels and techniques such as cryotherapy (cold therapy) to compliment your painkillers and minimise swelling, pain and discomfort.
You will also be given specific instructions on your follow up protocol with Mr Sandiford as well as post operative physiotherapy. At the follow up appointment we will discuss what was found at the operation, the status of the knee and the outlook for the future.
At 48 hours you can remove the bandages at home. Under these there will be a small waterproof dressing (usually Tegaderm). These are to be left alone until you are reviewed by Mr Sandiford.
You can have a light shower with these on. Once these are healed then you can resume baths.
Potential risks of surgery
Complications following arthroscopy are very uncommon and occur in less than 1% of cases. These mainly include swelling, pain, stiffness, thromboses (blood clots), bleeding, infection and recurrence of pre operative symptoms.