Knee arthroscopy (keyhole surgery)

An arthroscopy literally means looking inside a joint with a camera. It is also commonly known as keyhole surgery as it is done through tiny incisions.  During the knee arthroscopy a telescope is inserted in the knee through a small incision on the front of the knee.  The telescope is connected to a camera and the inside of the knee is visualised. Any problem that is detected in the knee is addressed with the help of instruments that are inserted through a second small incision. 

Arthroscopy of the knee is a relatively quick operation taking about 20 minutes to perform. The commonest conditions treated by knee arthroscopy include a torn cartilage and early arthritis of the knee. The arthroscopic technique is also used for anterior cruciate ligament reconstruction using hamstring tendons.

What happens during knee surgery?

Depending on the medical conditions affecting anaesthetic fitness the knee arthroscopy can be generally done as a day surgery procedure. A general anaesthetic is the commonest anaesthetic used for the operation. The procedure is carried out under a tourniquet to reduce the amount of bleeding and to better visualise the inside of the knee. 

The incisions made on the front of the knee are generally no more than 1cm in length. At the end of the procedure the incisions are closed with steristrips (small sticky tape) and usually stitches are not required. Local anaesthetic is injected at the site of the incisions to prevent immediate post-operative pain.

What happens after the knee surgery?

Once you wake up you will notice a bandage around your knee. Once you recover from the general anaesthetic you will generally be able to go home the same day. You do need somebody to drive you home and to keep an eye on you on that particular day. The bandages can be removed in 48 hours time. The inner dressings covering the cuts should be kept dry for 10 days.  At 10 days the dressings can be peeled off and the steristrips can be removed. After the operation you should start gently exercising the knee and work on the muscle at the front of the thigh (quadriceps). You generally will be able to return to your everyday activities within two weeks following surgery. Occasionally the knee may remain sore and swollen for a period of up to six weeks. 

The risks of knee arthroscopy include the following:

• Infection (less than 1%): the wound site may become red, hot and painful and the surgical incisions may discharge fluid.  The infection is usually treated with antibiotics but can require a repeat arthroscopy for knee washout, which helps in settling of the infection.
• Deep vein thrombosis (DVT): this is a blood clot in the veins of the leg.  The blood clot can go into the general circulation and can go to the lungs, which is termed as pulmonary embolus.  To reduce the risk of DVT it is advisable to get the calf muscles moving as quickly as possible following the knee surgery.
• Failure of symptoms to settle: in case of pre-existing arthritis or damage to the bearing surface of the knee the pain may not settle down completely following arthroscopy and may need further knee surgery, the nature of which can be indicated by the findings during arthroscopy.
• Less common complications around the knee surgery include damage to the structures within or around the knee, numbness of the skin around the knee and tenderness of the scars on the front of the knee.