What to Expect from your Knee Arthroscopy

What to Expect from your Knee Arthroscopy

What is knee arthroscopy?

Arthroscopy is a procedure for diagnosing and treating joint problems.

We insert a narrow tube attached to a fiber-optic video camera (arthroscope) through a small incision — about the size of a buttonhole. The view inside your joint is transmitted to a high-definition video monitor.

Arthroscopy allows us to see inside your joint without making a large incision. We can even repair some types of joint damage during arthroscopy, with pencil-thin surgical instruments inserted through additional small incisions.

The knee joint is surrounded by a water tight pocket called the joint capsule. This capsule is formed by the knee ligaments, connective tissue and synovial tissue. When the joint capsule is filled with sterile saline and is distended, we can insert the arthroscope into the pocket that is formed, turn on the lights and the camera and see inside the knee joint as if looking into an aquarium. The surgeon can see nearly everything that is inside the knee joint including: the joint surfaces of the tibia, femur and patella, the two menisci (plural for meniscus), the two cruciate ligaments, and the synovial lining of the joint.

Incisions will be small enough to be closed with one or two stitches, or with narrow strips of sterile adhesive tape.

What is the meniscus?

There are 2 menisci in the knee (one medial and one lateral). The medial meniscus is on the inner side of the knee and the lateral meniscus is on the outer side of the knee. These cartilage structures are "C"-shaped disks that function as shock-absorbers.

The menisci protect the articular cartilage on the surfaces of the thighbone (femur) and the shinbone (tibia). Articular cartilage is the smooth, slippery material that covers the ends of the bones that make up the knee joint. The articular cartilage allows the joint surfaces to slide against one another without damage to either surface.

What is the goal of the arthroscopy?

Knee arthroscopy is used in performing a wide range of different types of surgical procedures on the knee joint including confirming a diagnosis, removing loose bodies, removing or repairing a torn meniscus, reconstructing torn ligaments, repairing articular cartilage and fixing fractures of the joint surface.

Our goal is to fix or improve your problem by performing a suitable surgical procedure. The arthroscope is a tool that improves our ability to perform that procedure. The results that you can expect from a knee arthroscopy depend on what is wrong with your knee, what can be done inside your knee to improve the problem and your effort at rehabilitation after the surgery.

Are any other options available?

While I believe that surgery now is the best course of action, there are other available treatments including no treatment, just living with the condition; physical therapy exercises; medication or injections. Any of these treatment options may be successful in your situation, and some of these you may have already tried. In my experience if they haven’t worked yet, they may not work reliably now. Of course, we can arrange for any or all of these options if you desire.

What about stem cell treatments?

Stem cells are used in regenerative medicine to repair diseased or damaged tissues. While stem cell or PRP injections may not heal your knee on their own, there is emerging evidence that it can be used to augment and strengthen your knee after surgery.

These treatments can be done during your surgery. Unfortunately, they are currently not covered by insurance. Please contact us if you would like more information or would like to include this with your surgery.

What happens during the surgery?

Before surgery you will be placed under either general anesthesia. The skin around the knee is prepped with a sterile solution. Sterile drapes are placed to create a sterile environment for the surgeon to work. There is a great deal of equipment that surrounds the operating table including the TV screens, cameras, light sources and surgical instruments.

We begin the operation by making two small openings into the knee, called portals. These portals are where the arthroscope and surgical instruments are placed inside the knee. Care is taken to protect the nearby nerves and blood vessels. We then insert the arthroscope into the knee joint and fill the joint with sterile fluid.

We then take a “tour” (diagnostic arthroscopy) to look at all aspects of the knee joint. We then address any areas of damage or injury with specialized arthroscopic instruments.

Over the years since the invention of the arthroscope, many very specialized instruments have been developed to perform different types of surgery using the arthroscope to see what is going on while the instruments are being used. Today, many surgical procedures that once required large incisions for the surgeon to see and fix the problem can be one with much smaller incisions. For example, simple removal of a torn meniscus or loose body can be done using two small 1/4 inch incisions.

After the surgery, the arthroscopic portals and surgical incisions will be closed with absorbable sutures (no sutures need to be removed). A large bandage will be applied with a compressive wrap to reduce swelling and prevent blood clots in the leg. Once the bandage has been placed, you will be taken to the recovery room.

What is the anesthesia like?

The surgery is almost always performed under general anesthesia through a vein (intravenously). During the surgery, numbing medication is injected in and around the knee to help with pain control after the surgery.

How much time do I spend in the hospital?

You will enter the hospital in the morning, have the surgery and go home the same day. This is called outpatient surgery.

What are the risks of surgery?

The risks are similar to the risks of any surgical procedure. There is a less than 1% risk of infection. We minimize this risk by giving you antibiotics prior to the start of surgery. There is a less than 1% risk of bleeding or nerve injury. We are very familiar with the anatomy of the nerves and blood vessels around the knee. There is a very low risk of blood clots in the leg (called deep vein thromboses and pulmonary embolus if goes to lung). To further reduce this risk, we recommend you take an aspirin following surgery. There is a risk of arthrofibrosis (stiff knee). This occurs when there is too much scar tissue that forms in your knee. Most often this can be treated with physical therapy, but there are cases when you would need a second arthroscopic surgery to remove scar tissue.

There is a risk that your knee pain can persist. This mostly depends on how healthy or worn the cartilage is inside the knee. Early or advanced cartilage wear may lead to continued pain and swelling around the knee that does not improve after the arthroscopy.

My purpose in listing the types of complications that could possibly occur is to inform, not frighten you. While it would be preferable if we could perform surgery without any risk, this is not the case. The complications are rare (less than 1%) but despite our best efforts they do occur. I feel it is your right to know.

Will I be in a brace after surgery?

No brace is needed after this surgery. Some people find knee sleeves or low profile braces helpful as they return to activities.

Is ice or heat helpful after surgery?

Ice is recommended instead of heat. An ice pack should be applied to the knee (not directly on the skin) for at least 20 minutes, three times a day.

The use of a cold therapy device (e.g. PolarCare) device helps decrease pain and swelling after surgery. The use of the device may or may not be covered by the particular health insurance plan you have selected. You should check with your insurance company. It is optional to use. A cold-therapy device can also be purchased for you to own. Please contact us if you have questions about this.

How long will I be on crutches after surgery?

Crutches are recommended for your comfort. However you can put your full weight on the surgical leg. Most people stop using crutches 1-2 days after the surgery.

How long will it be until I can shower after surgery?

Incisions should stay dry until the first follow-up visit. You may shower 48-72 hours after surgery, but you must cover the incisions with plastic so that it does not get wet. If it does get wet, then use a clean towel and pat-dry the wet areas. Do not submerge or soak your knee in water until 3 weeks after surgery.

When is my follow-up visit?

At 7-10 days after surgery, you will return to the office. We will go over your surgery further, assess your motion, and examine the incisions. The sutures I use are buried under the skin, and do not need to be removed. We will then see you again in the office to evaluate your post-operative recovery at 2 months after surgery, 4 months, and as needed beyond that.

When do I start physical therapy (PT)?

We will give you a prescription for physical therapy to begin the same week as your surgery. In addition, we will give you a sheet of exercises that you can do easily on your own before beginning PT.

Why all the questions about my health?

Although the operation involves your knee, your entire body will react to the anesthesia and surgery. Your medical condition is obviously important. Before surgery you must see the anesthesiologist. They will go over your medical condition and request any tests (blood tests or EKGs) or consultations with other physicians if necessary.

What if I have more questions?

We encourage you to return to the office for a further discussion at any time. We will do our best to answer any questions by phone as well. We have a lot of information on our website, www.gomberamd.com There are surgical animations on the website as well.

How do I schedule surgery?

Contact Chantel at (713) 794-3457 or fdcj@fondren.com

American Academy of Orthopaedic Surgeons The American Orthopaedic Society for Sports Medicine Arthroscopy Association of North America american shoulder and elbow society international society for hip arthroscopy