Knee arthroscopy (keyhole surgery)

An arthroscopy involves looking inside a joint with a camera. It is also commonly known as keyhole surgery as it is done through small 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 bearing cartilage damage in the knee. The arthroscopic technique is also used for anterior cruciate ligament reconstruction.

What happens during knee surgery?

The knee arthroscopy is done as a day surgery procedure under general anaesthetic. The procedure sometimes is carried out under spinal anaesthetic. The procedure is done using a tourniquet to minimise bleeding and for better visualisation of 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 sutures. Local anaesthetic is injected at the site of the incisions to ensure good pain control.

What happens after the knee surgery?

Following the surgery, you will have a bandage around your knee. Once you recover from the general anaesthetic you will be able to go home the same day. You can put full weight through the leg and start moving the knee straightaway. You will need somebody to drive you home and to keep an eye on you on that day. The bandages can be removed in 48 hours. The inner dressings covering the cuts should be kept clean and dry for 10 days.  At 10 days the dressings and the stitches 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 need to rest the knee for the first two weeks following which you can gradually increase your activity level.

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.
  • Bleeding can be a risk due to small veins on the front of the knee.
  • Deep vein thrombosis and pulmonary embolus: deep vein thrombosis (DVT) is a blood clot in the veins of the leg.  The blood clot can go into the general circulation and go to the lungs, which is termed as a pulmonary embolus.  To reduce the risk of DVT you may be given blood thinners as well as stockings on your legs.  One of the best ways to prevent a DVT is to get the calf muscles working by ankle exercises and keeping yourself well hydrated.
  • Failure of symptoms to settle: in case of pre-existing arthritis or damage to the bearing cartilage 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.
  • Swelling in the knee can persist for few weeks following the surgery due the fluid circulated through the knee during the surgery.