An arthroscopy is a ‘keyhole’ daycase surgical procedure, performed under a general anaesthetic, that specialist knee surgeons use to visualise, diagnose and treat many different problems inside the native or even replaced knee joint.
We all know that degenerative osteoarthritis, inflammation and accidental injuries can damage bones, cartilage, ligaments, muscles and tendons. For ALL conditions the treatment begins with a thorough personalised medical history, face-to-face physical examination and either x-rays and very commonly magnetic resonance imaging (MRI) – which has the advantage of very accurately visualising both the cartilage / soft tissues and the bones.
Symptoms that may require you to have an arthroscopic knee examination include:
- Synovitis, an inflammation of the lining of the knee can be diagnosed and biopsied (for histological examination) via an arthroscopic procedure.
Acute (recent) or chronic (long-standing) knee injuries
- Loose bodies of bone and/or cartilage in the knee
- Meniscal (cartilage) tears, chondromalacia (wearing or injury of the cartilage cushion) and anterior cruciate ligament tears with instability
‘Wear and tear’ arthritis is a common ailment in patients that can start after age 40 years.
Many ‘mechanical’ problems associated with osteoarthritis can be treated with an arthroscopy, with some procedures combining both arthroscopic and standard open surgery:
- Repair or resection of torn knee cartilage (meniscus)
- Reconstruction of anterior cruciate ligament in the knee (ACL)
- Removal of inflamed lining (synovium) in the knee
- Repair of other torn knee ligaments
- Removal of loose bone or cartilage from the knee
Other joints most frequently examined using an arthroscopy include the shoulder, elbow, ankle, hip and wrist joints.
As advances are made in fibreoptic technology and orthopaedic surgeons develop new techniques, other joints may be treated more frequently using this method in the future.
What happens during an arthroscopic operation?
During an arthroscopic examination, the orthopaedic surgeon makes a small incision (5mm) in the skin, either side of the kneecap (patella) tendon and inserts a pencil-sized diameter arthroscope instrument. The arthroscope instrument contains a small lens and lighting system to magnify and illuminate the structures inside the joint, giving the surgeon and patient a magnified and high definition view of the structures within the knee joint.
The benefit of the arthroscopic television camera is that it allows the surgeon to magnify an image of the small knee joint on a television screen, allowing one to look thoroughly at all areas within the joint.
The advantages and disadvantages of an arthroscopic procedure
Arthroscopy is keyhole surgery, so the biggest advantage of arthroscopy is that the procedure is generally easier to recover from compared to old-fashioned ‘open’ surgery. Patients are often back at home a few hours after the procedure.
While it can take several weeks for the joint to fully recover, the small puncture wound heals in a week and it is not unusual for patients to go back to work, school or resume daily activities within a few days. Athletes and patients in good physical condition may in some cases return to athletic activities within a few weeks.
There may be many different diagnoses and pre-existing conditions in patients who have an arthroscopy, so each patient’s surgery and experience is clearly unique and recovery time will vary from patient to patient. This will be discussed with you in person during your initial consultation and before the surgery is undertaken as part of the consent process.
Whilst uncommon (occurring in less than 1% of patients) possible complications can occur during or following an arthroscopy, such as:
- Infection (within the knee joint or skin incisions)
- Deep vein thrombosis (blood clots)
- Excessive swelling or bleeding
- Damage to the local blood vessels or numbness and pain from local nerves
About Professor Philip Chapman-Sheath
Philip Chapman-Sheath is a highly specialist knee surgeon based in the South Central UK, and he receives referrals from all over the UK, Europe and worldwide.
He has over 20 years of specialist experience in treating both adult and paediatric (children) knee disorders and injuries.
Make an appointment with him today – to discuss your symptoms and see whether a knee arthroscopy may be right for you