Back to Knee Topics
An arthroscope is a fibre-optic telescope that
can be inserted into a joint (commonly the knee, shoulder and ankle)
to evaluate and treat a number of conditions. A camera is attached
to the arthroscope and the picture is visualized on a TV monitor.
Most arthroscopic surgery is performed as a Day-Only procedure and
is usually done under general anaesthesia.
Knee arthroscopy is a
common procedure and over 100 000 arthroscopies are performed in
Australia each year.
Arthroscopy is useful in evaluating and
treating the following conditions
Basic Knee Anatomy
Torn floating cartilage (meniscus): The
cartilage is trimmed to a stable rim or occasionally repaired
Torn surface (articular) cartilage
Removal of loose bodies (cartilage or bone
that has broken off) and cysts.
Reconstruction of the Anterior Cruciate
Patello-femoral (knee-cap) disorders
Washout of infected knees
General diagnostic purposes
The knee is the largest joint in the body. The
knee joint is made up of the femur, tibia and patella (knee cap).
All these bones are lined with articular (surface cartilage). This
articular cartilage acts like a shock absorber and allows a smooth
low friction surface for the knee to move on. Between the tibia and
femur lie two floating cartilages called menisci. The medial (inner)
meniscus and the Lateral (outer) meniscus rest on the tibial surface
cartilage and are mobile. The menisci also act as shock absorbers
and stabilizers. The knee is stabilized by ligaments that are both
in and outside the joint. The medial and lateral collateral
ligaments support the knee from excessive side-to-side movement. The
(internal) anterior and posterior cruciate ligaments support the
knee from buckling and giving way. The knee
joint is surrounded by
a capsule (envelope) that produces a small amount of synovial
to help with smooth motion. Thigh muscles are
important secondary knee stabilizers.
A routine X-Ray of the knee which includes a
standing weight-bearing view is usually required. An MRI scan which
looks at the cartilages and soft tissues may be needed if the
diagnosis is unclear. There is little value in the use of Ultrasound
in investigating knee problems.
Meniscal Cartilage Tears:
Following a twisting type of injury the medial
(or Lateral) meniscus can tear. This results either from a sporting
injury or may occur from a simple twisting injury when getting out
of a chair or standing from a squatting position. Our cartilages
become a little brittle as we get older and therefore can tear a
little easier. The symptoms of a torn cartilage include
Once a meniscal cartilage has torn it will not
heal unless it is a very small tear which is near the capsule of the
joint. Once the cartilage has torn it predisposes the knee to
develop osteoarthritis (wear and tear) in 15 to 20 years. It is
better to remove torn pieces from the knee if the knee is
Torn cartilages in general continue to cause
symptoms of discomfort, pain and swelling until the loose, ragged
pieces are removed. Only the torn section is removed and the knee
should recover and become symptom free. If the entire meniscus is
removed, the knee will develop osteoarthritis in 15 to 20 years.
Now-days only the torn section is removed and it is hoped that this
will delay the onset of long-term
wear and tear osteoarthritis.
Occasionally, provided the knee is stable and
the tear is a certain type of tear in a young patient (peripheral
bucket handle tear), the meniscus may be suitable for repair. If
repaired one has to avoid sports for a min of three months.
Articular Cartilage (Surface) injury:
If the surface cartilage is torn, this is most
significant as a major shock-absorbing function is compromised.
Large pieces of articular cartilage can float in the knee (sometimes
with bone attached) and this causes locking of the joint and can
cause further deterioration due to the loose body floating around
the knee causing further wear and tear. Most surface cartilage wear
will ultimately lead to osteoarthritis. Mechanical symptoms of pain
and swelling due to cartilage peeling off can be helped with
The surgery smoothes the edges of the surface
cartilage and removes loose bodies.
Anterior Cruciate Ligament Injuries:
Rupture of the Anterior (rarely the posterior)
Cruciate Ligament (ACL) is a common sporting injury.
the ACL does not heal and usually causes knee instability and the
inability to return to normal sporting activities. An ACL
reconstruction is required and a new ligament is fashioned to
replace the ruptured ligament. This procedure is performed using the
Patella (knee-cap) disorders:
The arthroscope can be used to treat problems
relating to kneecap disorders, particularly mal-tracking and
significant surface cartilage tears. Patients may need to stay
overnight if a lateral release has been performed as knee swelling
is quite common. The majority of common knee -cap problems can be
treated with physiotherapy and rehabilitation
Occasionally arthroscopy is used in
inflammatory conditions (e.g. Rheumatoid Arthritis) to help reduce
the amount of inflamed synovium (joint lining) that is producing
excess joint fluid. This procedure is
called a synovectomy. After
the surgery a drain is inserted into the knee and patients generally
require one or two nights in hospital.
Bakers cysts or popliteal cysts are often found
on clinical examination and ultrasound / MRI scan. The cyst is a
fluid filled cavity behind the knee and in adults arises from a torn
meniscus or worn articular cartilage in the knee. These cysts
usually do not require removal as treating the cause (torn knee
cartilage) will in most cases reduce the size of the cyst.
Occasionally the cysts rupture and can cause
calf pain. The cysts
are not dangerous and do not require treatment if the knee is
Isolated areas of articular cartilage loss can
be repaired using cartilage transplant technology. This is a new and
exciting field that is developing in the treatment of specific
isolated cartilage defects in younger patients
The process is called Autologous Chondrocyte
Grafting. It involves harvesting cartilage cells from
affected knee, sending these cells to a laboratory and then
culturing the cells to multiply into many cells. The large amount of
cells produced are then placed back into the affected knee into the
defect requiring resurfacing. Results are still short-term follow-up
but are looking encouraging.
After a major cartilage or ligament injury has
been treated the knee can return to normal function.
however a small increase in the risk of developing long-term wear
and tear (Osteoarthritis) and depending on the degree of injury
activity modification may be required. Activities that help prevent
knees deteriorating quickly include:
Low impact sports like swimming, cycling and
Reducing weight and maintaining a healthy diet
Arthroscopy of the knee: Patient Information
Please stop taking Aspirin and Anti-inflammatories
5 days prior to your surgery. If pain medication is required use
Panadol / Panadine or Panadine Forte. You can continue taking all
your other routine medication. If you smoke you are advised to stop
a few days prior to your surgery.
You will be admitted on the day of surgery and
need to remain fasted for 6 hours prior to the procedure.
The limb undergoing the procedure will be
marked and identified prior to the anaesthetic
Once you are under anaesthetic, the knee is
prepared in a sterile fashion. A tourniquet is placed around the
thigh to allow a ‘blood – free’ procedure.
The Arthroscope is introduced through a small
(size of a pen) incision on the outer side of the knee. A second
incision on the inner side of the knee is made to introduce the
instruments that allow examination of the joint and treatment of the
You will wake up in the recovery room and then
be transferred back to the ward
A bandage will be around the operated knee.
Once you are recovered your drip will be
removed and you will be shown a number of exercises to do.
Your Surgeon will see you prior to discharge
and explain the findings of the operation and what was
Pain medication will be provided and should be
taken as directed
You can remove the bandage in 24 hours and
place waterproof dressings (provided) over the wounds.
It is NORMAL for the knee to swell after the
surgery. Elevating the leg when you are seated and placing Ice-Packs
on the knee will help to reduce swelling. (Ice packs on for 20 min
3-4 times a day until
swelling has reduced)
You are able to drive and return to work when
comfortable unless otherwise instructed
Please make an appointment 7-10 days after
surgery to monitor your progress and remove the 2
stitches in your
Risks of Arthroscopy:
General Anaesthetic risks are extremely rare in
Australia. Occasionally patients have some discomfort
in the throat as a result of the tube that supplies oxygen and other
gasses. Please discuss with the Specialist Anaesthetist if you have
any specific concerns
Risks specifically related to the surgery.
Risks related to Arthroscopic knee surgery
Deep Vein Thrombosis
Numbness to part of the skin near the
Injury to vessels, nerves and a chronic pain
Progression of the disease process
The risks and complications of arthroscopic
knee surgery are extremely small. One must however bear
Post –Operative Exercises and Physiotherapy
in mind that
occasionally there is more damage in the knee than was initially
thought and that this may affect the recovery time. In addition if
the cartilage in the knee is partly worn out then arthroscopic
surgery has about a 65% chance of improving symptoms in the short to
medium term but more
definitive surgery may be required in the
future. In general arthroscopic surgery does not improve
have well established Osteoarthritis.
Following your surgery you will be given an
instruction sheet showing exercises that are helpful in speeding up
your recovery. Strengthening your thigh muscles (Quadriceps and
Hamstrings) is most important. Swimming and cycling (stationary or
road) are excellent ways to build these muscles up and improve
Frequently asked questions
How long am I in Hospital?
Approx 4 hours
I need crutches
A: Usually not
required (Unless having Anterior Cruciate Ligament Reconstruction)
When can I get the knee wet
After 24 hrs remove the bandage and apply waterproof dressing
When can I drive
A: After 24 hrs if the knee is comfortable
When can I return to work
When the knee feels reasonably comfortable
When can I swim
After removal of the stitches
How long will my knee take to recover
A: Depending on the findings and surgery usually 4 to 6 weeks following the surgery.
When Can I return to Sports
Depending on the findings, 4-6 weeks after surgery