Harley Street Knee Clinic

Knee Arthroscopy

An arthroscopy is a simple procedure that needs to be performed for the correct reasons, safely and at all times with an emphasis on avoiding complications.

This information is designed to explain what is involved in an arthroscopy, the reasons why you might require one and what to expect on the day of surgery and afterwards.

What is an Arthroscopy?

Arthro means joint and scope is to look at; a knee arthroscopy therefore allows the surgeon to see inside your knee and directly inspect the bones, cartilages and other structures within the joint. This gives a much more accurate picture than any other investigation such as X-rays or MRI scans.

In addition the surgeon can perform procedures to improve the function of the knee. In the modern era arthroscopies are only rarely required for just diagnostic purposes – nearly always a procedure is also undertaken to improve the function of the knee.

Arthroscopy is commonly known as key hole surgery as the incisions are minimal and therefore reduce scarring and allow quicker recovery. Prior to the advent of the arthroscope, such operations would mean a full open operation with extensive scarring and a much longer period of recovery.

During an arthroscopy a small camera-type device is inserted into the knee and this relays pictures to a television screen. At the same time instruments can be inserted into the knee so that surgery can be performed e.g. removing a portion of meniscus (cartilage). After the procedure you will be given a video recording of the procedure.

Reasons for Arthroscopy

The commonest reason to undergo an arthroscopy is for relief of PAIN – only you know how much pain you are in. You therefore decide if the pain you are experiencing warrants an operation, albeit a relatively minor one.

There are many other reasons for an arthroscopy. Listed here are the most common ones. However please bear in mind one major principle – the decision to proceed to an arthroscopy is entirely one of YOUR choice. Our role is to tell you what is wrong with your knee and what can (and cannot) be done to fix it – it is your decision as to whether you wish to proceed to surgery.

To resect (trim) or repair a torn meniscus (cartilage). The menisci are two semi – circular structures of soft fibrocartilage which act as shock absorbers within the joint. They are often injured by twisting activities. If you have a tear in the meniscus the torn section is resected – ‘trimmed’ back to healthy stable meniscus. Occasionally it is possible to repair the torn cartilage, most commonly in the young adult or child. An important principle here is that only the damaged meniscus is removed, not normal or healthy meniscus.
Arthroscopy allows a clear view and physical inspection of the cruciate ligaments. The cruciate ligaments are two strong ligaments, the anterior (ACL) and the posterior (PCL), which provide stability of the knee on twisting and pivoting activities. They are often injured in contact sports and skiing. The cruciate ligaments do not have the ability to repair themselves and it may be necessary to operate at a later date to reconstruct them. We do not normally need to perform an arthroscopy simply to visualise these ligaments however – MRI is usually sufficient for this.
Often through trauma or degenerative changes (osteoarthritis) small fragments of bone or articular cartilage can become loose within the knee joint. These can be removed and washed out of the joint.
The smooth articular cartilage lining of the bone which allows smooth movement can be damaged when the knee is injured. This may result in a divot of cartilage becoming loose and causing pain and/or locking of the joint. Via an arthroscopy the extent of the damage can be assessed and procedures carried out. The lesion can be shaved or a procedure known as micro-fracture performed where small pricks are made in the bone to stimulate healing from the deeper levels. If the lesion is too large for this further surgery can be planned from the arthroscopy findings.
If the joint lining is particularly inflamed then a small area of this lining (biopsy) can be taken and sent for further investigations.
The kneecap (patella) can be a source of pain in the knee. The arthroscope allows inspection of the under surface of the patella. If there is any loose articular cartilage this can be shaved. Another procedure called a lateral release can be performed. This is the surgical division of the soft tissues on the outer aspect of the patella. These structures can be extremely tight causing the patella to track in the wrong position. This tightness over a long time can place excess pressure on the under surface of the patella resulting in pain.

What to expect after your Arthroscopy

In 90% of patients undergoing routine arthroscopies there is little or no pain – this is because the procedure is relatively non-traumatic and also because a number of analgesic drugs are placed into the knee at the time of the procedure. If you are in any significant pain, further analgesics are given to you.

It is normal for the knee to feel a little uncomfortable on the day after your operation. This is because the local anaesthetic inserted into the knee at the end of the operation may have started to wear off. Pain-relieving tablets may be required for a few days. These will be given to you on discharge from hospital.

You can normally go home 3-4 hours after the procedure. You will be given a CD-ROM / DVD of the procedure and we will explain what was found and what procedures were performed. This information will be repeated again at your first out-patient visit.