© Mr Amer Karim (2016)
Mr Amer Karim
MBBS(London), DIC(Orth Eng), MD(Res)
FRCS(Trauma & Orth), FRSA(UK)
Consultant Trauma & Orthopaedic Surgeon
Full British Training & Specialist Certification
About knee arthroscopy
A knee arthroscopy is a key hole procedure performed to investigate problems such as inflammation or injury, or to repair damaged tissue and cartilage within the knee. It is also used to take small tissue samples (biopsies), which can help to diagnose problems such as infection or some forms of arthritis.
Knee arthroscopy is performed through 2 small cuts in your skin (less than 1 cm across), using a special telescope (arthroscope) attached to a video camera. Compared with open surgery, arthroscopy has a much faster recovery time.
Preparing for a knee arthroscopy
The operation is usually done as a day case under general anaesthesia. This means you will be asleep during the procedure. Alternatively you may have the surgery under local or regional anaesthesia. This completely blocks the pain from the knee area and you will stay awake during the operation. You may offer also be offered a sedative with a local or regional anaesthetic, which relieves anxiety and helps you to relax during the operation. The advantages of each type of anaesthesia will be discussed with you beforehand.
If you're having general anaesthesia, you will be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand.
At the hospital, the nurse will check your heart rate and blood pressure.
I will have discussed the procedure with you beforehand, and will reconfirm it with you on the day of surgery. This is your opportunity to re confirm what will happen, and you can ask any questions you may still have. I will then ask you to sign a consent form.
You may be asked to wear a compression stocking on the unaffected leg to help prevent blood clots forming in the veins in your legs, but this is only if you have had clotting problems before.
What happens during a knee arthroscopy
An arthroscopy can take from 30 minutes to over an hour, depending on how much work needs to be done inside your knee joint.
A tourniquet is used during the procedure if a general anaesthetic is used, a tourniquet is a tight band applied around the upper thigh during the procedure. It helps reduce any bleeding in the knee and speeds up the operation. You will not be aware of it during the procedure, but afterwards your thigh may feel slightly tight where it was applied. This tight feeling will pass within a few hours and will not harm your thigh in any way.
Once the anaesthetic has taken effect, I will make the small cuts in the skin around your knee joint and pump sterile fluid into your joint to help produce a clearer picture and then insert the arthroscope. You will receive a dose of IV antibiotics during the procedure to reduce the chances of developing an infection. I will then examine your knee joint by looking at images sent by the arthroscope to a computer monitor. If necessary, instruments will also be used to repair damage or remove material that interferes with movement or causes pain in your knee. Photos will be taken inside the knee during the procedure and be added to your medical records.
At the end of the procedure, the fluid in the knee will be drained out and the cuts closed with 2 stitches. Local anaesthetic will be injected into the knee and then a bulky bandage will be wrapped around your knee.
What to expect afterwards
You will need to rest until the effects of the anaesthetic have passed. It may take several hours before the feeling comes back into your knee. Take special care not to bump or knock the area.
You may need pain relief to help with any discomfort as the anaesthetic wears off. Take simple things like Paracetamol or Ibuprofen that you can get from the chemist.
You will need to arrange for someone to drive you home. You should try to have a friend or relative stay with you for the first 24 hours.
Please keep the wounds dry for the first few days. The bulky bandages can be removed after 24 hours, but keep the smaller dressings on. Once comfortable, you will be able to move around as normal. But please be careful not to over stress the knee. Keep the wounds dry for the first few days while bathing, but you should be able to shower as normal after 5 days, avoid baths or immersing the wounds in water (pools etc) for 2 weeks.
The length of time your dissolvable stitches will take to disappear depends on what type you have. However, for this procedure they should usually disappear in about six weeks. Non-dissolvable stitches are removed 10 to 14 days after surgery.
Recovering from knee arthroscopy
General anaesthesia temporarily affects your co-ordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 24 hours afterwards.
Continue with the general exercises, as they will help to improve your knee movement and strength, but don't over do it.
Your knee joint is likely to feel sore and swollen for at least a week. This can last longer if you have arthritis. Try to keep your leg raised on a chair or footstool when you're resting. You should apply a cold compress such as ice or a bag of frozen peas, wrapped in a towel, to help reduce swelling and bruising. Don’t apply ice directly to your skin as it can damage your skin.
Your recovery time will depend on what, if any, treatment your surgeon performs on your knee joint. You should be feeling normal by 2 weeks and be able to resume your usual activities after six to eight weeks depending on the severity of your knee problems and your level of fitness.
What are the risks?
Knee arthroscopy is commonly performed and one of the safest orthopaedic procedures. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications of this procedure.
These are the unwanted, but mostly mild and temporary effects of a successful treatment, for example feeling sick as a result of the general anaesthetic.
After a knee arthroscopy you will have small scars on your knee from the cuts.
This is when problems occur during or after the operation. Most people aren't affected. The possible complications of any operation include an unexpected reaction to the anaesthetic, a wound infection, excessive bleeding or developing a blood clot, usually in a vein in the leg (DVT).
Arthroscopy complications can include:
accidental damage to the inside of your joint
loss of feeling in the skin over your knee
bleeding into your joint
the surgery may not be successful or it may have to be repeated
The exact risks are specific to you and differ for every person, so I haven't included statistics here.
I will see you in my outpatient clinic approximately 2 weeks and then 6 weeks after the procedure to ensure that the wound has healed and you are making good progress. We can also discuss the findings of the procedure. Should you wish to see me sooner or if you have any questions, please phone my secretary who will be happy to book you in at a time of your convenience.
Want more information ?
More information can be found on my website: www.amerkarim.com