Knee Arthroscopy
Since research has been done to improve the management of cartilage and ligament injuries in the knee, orthopaedic surgeons have a range of options to ensure the best option for any particular knee problem. After the development of fibre optic instruments 40 years ago, orthopaedic surgeons have the ability to do intricate accurate surgery through small incisions allowing for less invasive surgery with better recovery. The advantages of arthroscopic techniques for the knee joint are that access to the knee can be achieved with the limited damage to the capsule of the knee.
What are the indications for knee arthroscopy?
Knee arthroscopy can be used to treat and diagnose various knee conditions such as a torn meniscus, damaged ligaments, misaligned or dislocated patella (kneecap) and damaged to the knee cartilage.
The most common knee arthroscopy procedures include:
- Partial meniscectomy
- Repair of meniscus tears
- The debridement of chondral lesions
- Repair of chondral lesions and chondral graft procedures
- Synovial biopsies and plica excisions
- Anterior and posterior cruciate ligament reconstructions
- Fixation of cruciate ligament avulsion
- Irrigation of infections (septic arthritis)
- Partial synovectomies
- Reconstruction of the ACL or MCL
Surgical approaches for a knee arthroscopy
The procedure is done as a day procedure under general anaesthetic. A routine knee arthroscopy usually takes 30 minutes to 45 minutes. With high definition camera technology, the inside of the knee can be viewed on monitors while surgery can be performed with tiny instruments through 5mm incisions into the knee joint. Afterwards a soft bandage is applied and the patient is given postoperative physiotherapy with specific instructions determined by the particular procedure. Follow-up by a physiotherapist takes place 1-week post procedure and follow up with the surgeon at 2 weeks.
Possible Complications
Although arthroscopic surgery has a very low complication rate, no medical procedure with zero complication risk exists.
- Deep vein thrombosis (DVT) can occur after knee arthroscopy.
- Infections are very rare, but can occur.
- Haemarthrosis (contained blood in the knee) can also be a painful complication.
- Pain (caused by Complex Regional Pain Syndrome or Bone marrow oedema pattern/bone bruising)in the knee after an arthroscopy is most probably the most troublesome complication to keep in mind.
Frequently asked questions
Will I need crutches after knee arthroscopy?
In most cases, patients do not need crutches. In some special cases where micro-fracturing or fixation of the osteochondral lesion was indicated, the patient will be supplied with crutches for partial weight-bearing mobilisation.
What happens if I am the one patient to suffer an infection?
Infections are rare, but if that happens, then, the patient will have to undergo another arthroscopic procedure. In this case, the knee will be irrigated, and intravenous antibiotics are given. Most cases a drain will be placed which can be removed 2-3 days.
How can deep vein thrombosis (DVT) be prevented?
Prevention is better than cure. Early mobilisation, decreased waiting period before the surgery in the hospital, general anaesthetic and surgery time as short as possible, good hydration and foot exercises are all part of prevention. In high-risk cases trombo-prophylaxis medication (blood thinning injections or tablets) will be used.
What if I am on Warfarin, Disprin (Ecotrin) or Plavix medication?
Warfarin, Plavix, Disprin or Ecotrin needs to be stopped at least 5 days before the procedure. Your cardiologist will be contacted by Dr Morkel to discuss your particular case prior to surgery, for your safety.
What is bone marrow oedema pattern?
Bone marrow oedema is swelling/water that can be seen in an MRI in a patient's bone. It can be spontaneous with no known cause or caused by trauma, osteoarthritis, infection and even arthroscopy. It is quite often very painful, especially night pain. The treatment includes analgesics, decreasing load on that particular bone with the help of crutches or unloader brace and the adjustment of activities
What can be expected after a torn meniscus is removed?
The meniscus plays an important role in protecting the chondral knee cartilage from wear. As an orthopaedic surgeon, Dr Morkel is well aware of this and will try to keep as much of the meniscus intact and try to repair a torn meniscus if possible. If a repair is not possible, then the unstable unrepairable flap of the meniscus will be removed. It is obvious that the smaller the removed meniscus is, the lesser the effects on the chondral cartilage. In certain cases, a very large part of the meniscus is removed. Although meniscus transplants are possible, the outcomes and recovery process aren't favourable. The long term results with a partial meniscectomy with no other underlying pathology/instability are decent, with only 25% reoperation rate at 25 years .