Knee Arthroscopy

Knee Arthroscopy

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Questions and Answers

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Do I need a knee arthroscopy?

Knee arthroscopy is done for a variety of reasons. The most common reasons are meniscus cartilage tear, removal of a loose body, cleaning and tidying of the joint in early arthritis, reconstruction of ligaments in the knee especially the anterior crucial element ligament (ACL injury). Uncommon reasons are patellofemoral pain, partial synovectomy and biopsy in inflammatory disorders of the knee and washout of infection in the knee.

Meniscus surgery is by far the most common reason for knee arthroscopy. Patients start symptoms after a twisting or sporting injury occasionally it comes on without specific injury in older patients. Often patients have pain on the inside or outside of the knee, there is often irritability with local tenderness (or soreness) over that area and rotation or valgus force (such as the in-step of the foot hits something whilst walking) accidentally creating sudden and severe pain. The knee often swells up after episodes of pain and settles down gradually over a few days. Sometimes there are catching and locking symptoms from the knee.

The symptoms can be episodic at times, with the interval of a perfectly normal knee for a few days or weeks in between bad episodes of pain.

What tests do I need and how long does it take?

Usually after I have spoken to you and examined you, I will arrange for an MRI of the knee. I can make a clinical diagnosis in the clinic and confirm it with MRI scan. Occasionally I may get plain X-ray’s if there is an element of arthritis in the knee.

Depending on which hospital you see me at, MRI takes anywhere between few days to few weeks.
If you have other medical conditions that need further tests they may also be done.
What does not get better with arthroscopic surgery?

The symptoms from arthritis (surface damage or wear and tear) of the knee or biological problems and any pain coming from outside the knee do not get better with arthroscopy. Pain coming from torn cartilage or mechanical problems will get better successfully in most cases.

What are the risks and complications of the procedure?

There is small risk of infection. There is risk of thrombosis and embolism and you will be indi-vidually assessed for it and prophylactic treatment may be given. There is a risk of persistent pain from arthritis or sources of pain outside the knee. In some circumstances, there may be a problem that needs a different operation another day. Also in the long run you may need a dif-ferent treatment for arthritis of the knee

What do you do in the knee arthroscopy surgery?

Arthroscopic surgery of the knee is usually a day case procedure, meaning you will come in and go home on the same day.

On your admission, the anesthetist and I will see you, mark your leg and perform consent for the procedure.

You will very probably have a general anaesthetic (go to sleep) for the procedure. Then I apply a tourniquet to stop blood flowing to the knee for a short time so the procedure can be per-formed efficiently and safely. I normally make two tiny stab incisions (approximately 1 cm) on the front of the knee; rarely do I need to make a 3rd incision. These are called portals. I use the portals to see inside the knee, test the areas with a probe, take pictures, and perform the procedure with different instruments as needed. At the end of the procedure, I will infiltrate the portals with local anaesthetic so there is minimal soreness when you wake up from the procedure. Then I apply a padded dressing and bandage.

Why does meniscus cartilage damage?

Meniscus is a bushing cartilage between two surfaces of the knee. It can get damaged because of being trapped and pulled whilst in a twisting injury. It can sometimes get trapped or chewed in uneven surface of the knee when it is beginning to get arthritis. Sometimes it gets worn out or laden with crystals in conditions like gout or pseudo gout.

The damaged meniscus doesn’t cause the pain. Meniscus itself has no nerve supply. It is the repeated trapping of damaged cartilage pulling on its sensitive root causes the pain.

How long do I need to recover from the procedure?

Usually you are walking with crutches for support in a few hours after the procedure. You will go home the same day unless procedure was carried out later in the day. You can give up crutches as soon as you are safe. I advise patients to take painkillers early – as soon as pain starts to come back. Stay on top of pain. First day or two if you are taking painkillers it is not too bad. Of course everyone is different and you may need more or less pain control and for a different period of time. After this you can take painkillers as you need. The big dressing on the knee can be taken off in 48 hours and inside dressing changed by the patients. You can have a shower with cling film around the knee after that. The sutures come out in 10-14 days in the doctor’s surgery or the hospital and it is arranged by the nurses before you go home.

The knee feels a little bit bruised and painful for first 2-4 weeks and you have Physiotherapy after initial soreness has improved. You will come back to see me in the clinic in 6-8 weeks. The nurses will arrange your Physiotherapy and follow up visit before discharge from the hospital.

When can I drive and go back to work?

You can drive as soon as you are confident of controlling the vehicle. It is self-certification and I cannot certify when exactly you can or cannot drive. Usually most patients start driving 3-6 weeks after the procedure depending on what was done and how confident or comfortable they are.
You can go back to work between 2-6 weeks. It depends on what you do for work and what exactly was done as procedure. Most people who have desk job can return in 2-3 weeks and manual workers between 4-6 weeks.

When can I return to sport?

It depends on what sport you enjoy and how complex your procedure was. I usually advise to give it at least 4 – 6 weeks after simple procedures like a meniscus cartilage operation. This allows you to return to normal and allow some conditioning with Physio before returning to sports. You can start swimming as early as 3 weeks after the procedure when the wounds have healed well.

Will I get the same problem again in the future?

It depends on what you do. If you have a further injury, you may get similar problems again.

Will I get arthritis of the knee?

You may get arthritis of the knee because of the meniscal surgery in the long run. This may be no different if you did not have surgery as the torn cartilage is not functioning normally and damage to the knee may have already happened in the original injury.

How can I stay healthy and active without damaging my knee further?

The knee is best preserved if impact sports can be avoided such as running, jogging, hard court games, football etc. The best sports are non-impact such as cycling, swimming, rowing ma-chine, gym exercises i.e. the cross trainer and weights are fine except squats and some pro-longed aerobic exercises that may involve jumping on hard floors.

Obviously day to day activities that involve walking the stairs etc. can’t be avoided and are fine.
Sometimes, especially with manual jobs that involve lifting heavy weights, going up and down a lot or walking a lot on the job can be detrimental in long run. It may be wise to look at options available and discuss with your employers if a change in your job description is possible.

Your weight is important factor. Up to 7 times your body weight goes through the knee with day today activities. If you can bring the weight down to a BMI of 25 or less it would help pre-serve your knee considerably. Remember for every pound of weight you lose its 7 pounds less for your knee to carry.

How do I get fit and lose weight?

It is a specialty in its own right; I cannot give you comprehensive advice about it. I suggest you discuss this with your GP or a specialist.

The principles are a combination of a controlled diet (what you eat and how much you eat) and incorporating REGULAR exercise into your everyday routine (to spend energy) over a pro-longed period (more than 6 months) will allow you to be fit and slim.

If you are starting exercise do not do too much on day one. You will hurt yourself and go away thinking this is not for me. Start with slow and small amount of exercise and build it up gradual-ly over a period of time. Take advice from specialists.