Knee Arthroscopy

What to expect
Knee arthroscopies ("scopes") are generally outpatient procedures, meaning that you come and go home on the same day. You can expect to be under general anesthesia, with rare exceptions. Afterwards, you are on crutches for a short time period. Depending on the type of surgery done, you may or may not have weight bearing restrictions. Knee scopes are usually performed through two or three small holes, each about 1-cm or less. One hole is for the camera. One is for the instruments. One is an optional inflow or outflow portal to allow the saline solution into or out of the knee. The saline is used to bathe the knee in fluid to allow the lens to get a good picture, kind of like an underwater camera. Without it, the natural joint fluid and blood would make the pictures streaky or blurry. The saline also allows the structures to be pushed apart to allow room to see and maneuver instruments. This is also why there will always be some swelling in the joint after surgery. We pumped it in there during the procedure! Physical therapy is very important following knee surgery, and any type of surgery for that matter. The therapist will help you regain your motion, decrease your swelling, and strengthen your muscles.

What can be done
As instruments and techniques have improved, surgeries that used to be performed with large, open incisions can now be done arthroscopically. Meniscus tears are the most common knee injury. Oftentimes, they need to be either trimmed (meniscectomy) or repaired, both of which can be done through the scope. Ligament reconstructions, such as the anterior cruciate ligament (ACL), are now done with arthroscopic assistance. Certain fractures that go into the knee joint can be visualized with a scope to line up the pieces. Unstable flaps of cartilage can be trimmed. Loose bodies floating around the knee can be removed. Microfractures and transferring cartilage plugs from one part of the joint to another are also done. A surgeon can also remove inflamed joint lining to reduce swelling (synovectomy).

Knee arthroscopy and arthritis
With regards to knee arthroscopy and arthritis, you may have heard about a study published in the New England Journal of Medicine in 2002. A group of doctors in the Houston VA Hospital showed that arthroscopy was no better than placebo for knee osteoarthritis. However, there were some fairly significant design flaws in that study. Most doctors would agree that arthroscopy is beneficial in patients with a mechanical, or structural, cause of pain. Meniscus tears, cartilage flaps or loose bodies can inhibit muscle strengthening. A meniscectomy can eliminate a source of pain. A chondroplasty can remove unstable cartilage flaps before they break off. If they do break loose, they float around the joint and cause pain. Removing the loose bodies will allow people to accelerate their rehabilitation. As you can see, arthroscopy will not cure knee arthritis by itself. However, it is a tool to improve associated conditions, which may help with the pain and swelling associated with arthritis.