Knee Problems

Knee Arthroscopy

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Arthroscopy is a surgery that uses the latest technology to look inside a joint, clean it up and to repair any abnormalities that are found. Essentially, there are at least 2 small 1cm cuts. One has the camera and the other is and entrance for the tools that are used. During this procedure lots of water is pumped into the joint to minimize the bleeding and to expand the joint. This also allows us to get a clear picture of what is going on inside the joint.
 
There are many reasons for needing an arthroscopy. The most common are arthritic changes causing pain and loss of movement, torn cartilage, damaged ligaments and damage to the joint surface. Sometimes we do an arthroscopy to get a biopsy of the joint tissue in order to get a diagnosis on what is affecting the joint.
 
The most common joints that are investigated and treated in this way are: Shoulder, elbow, wrist, hip, knee and ankle joints.
 
In my practice I most commonly do knee and ankle scopes.
 

KNEE ARTHROSCOPY

Usually this is done under general anaesthetic but can also be done under spinal anaesthesia. Most of these are done as day cases with admission and discharge from the hospital on the same day.
 
2 small cuts are made on either side of the knee, just below the knee cap.
We look at the knee in 4 parts:
 
  • The patello-femoral joint, which is the joint between the knee cap and the thigh bone. This is an amazing joint that takes more pressure than any joint in the body. There are often changes involving the articular cartilage or the joint surface. This can be a source of considerable pain in the front of the knee due to the pressures that these damaged surfaces experience. 
    The ligaments that keeps the knee cap in place can also be damaged resulting in the knee cap dislocating
  • The lateral compartment, which is the outside half of the knee. It contains the lateral meniscus or cartilage that helps the knee distribute weight evenly in that compartment. The meniscus is commonly injured during sporting activities. The joint surface cartilage is different to the meniscus and can be damaged on either the femur (thigh bone) side or the tibia (shin bone side) or on both. There are also structures right at the back of this compartment that are very important for the stability of the knee and if damaged, may need repair.
  • The medial compartment, which is the inside half of the knee. It contains the medial meniscus or cartilage that helps the knee distribute weight evenly in that compartment. The meniscus is commonly injured during sporting activities. It can also commonly be affected by arthritis. The joint surface cartilage is different to the meniscus and can be damaged on either the femur (thigh bone) side or the tibia (shin bone side) or on both.
  • The Intra Articular Ligaments. These are the Anterior Cruciate ligament (ACL) and the Posterior Cruciate Ligament (PCL). Usually, if these are injured I will recommend reconstruction as they are crucial to the stability of the knee.
 

Procedures done through the arthroscope

If abnormalities are found during arthroscopy, some can be treated using the arthroscope and other tools.
 
Damage to the medial or lateral meniscus: Usually, I will try to repair tears to these cartilages using stitches. The cartilages have very poor blood supply and don’t usually heal by themselves. Stitching them makes them more stable and gives them a chance at healing. They don’t always heal and may need further treatments to encourage healing.
 
If the cartilage is very thin and has poor blood supply or the tear is small or very old, it is sometimes better to remove the torn bit. This is called a partial meniscectomy.
 
Removal of the entire cartilage is done very seldom nowadays as it contributes towards the development of Osteoarthritis over a long period of time.
 
Damage to the articular cartilage is either sudden as in a single incident or it can be a long term ongoing part of arthritis. If it is sudden recent incident the piece that is damaged may be able to be replaced – especially if it has a piece of bone attached.
 
Commonly, this is part of a long term arthritic process and the cartilage has worn away slowly causing bone to be exposed. This cartilage does not grow back and the best we can hope for is that we can stimulate scar tissue to serve a similar function to that of the cartilage. I use a technique known as Micro-fracture which basically encourages bleeding of the bone and therefore allows healing by means of scar tissue formation. The results of this technique are unreliable but usually we are faced with no alternative as all other current treatments are at best experimental.
 
Damage to the ligaments is usually the result of trauma to the knee and these can be reconstructed arthroscopically. This is covered in the ACL section of this site.
 

Rehabilitation

After knee arthroscopy, you will wake up with a big bandage on the knee covered with Ice-Packs. You will have a bit of pain but I usually inject local anaesthetic into the joint so the pain will probably get worse when this wears off and then it will start improving.
We always give you crutches but you may not need to use them if you are comfortable enough to walk without too much pain. If micro-fracture has been done, I prefer you not to bear weight on the joint for 6 weeks. Most cartilage and ligaments procedures are encouraged to bear weight as soon as they are comfortable enough to do so.
 
You will get an appointment to see me in a couple of days time and some pain killers.
 
At the first follow up appointment, I will remove the bulky bandage and do movements and exercises that I want you to do. The most important thing is to get your knee straight. The waterproof dressing are checked and changed if needed so that you will be able to shower but not to soak the dressing in a bath or pool as they will come loose. You will get an appointment for 2 weeks time.
 
At the 2nd follow up you should be walking fairly comfortably but still have some stiffness and swelling. I will refer you to Physiotherapy, where they will help you get rid of the swelling and work on movement and power.
 
I will usually give you an appointment for 4 weeks time, roughly 6 weeks after the surgery.