Arthroscopy
An arthroscopy (keyhole surgery) involves using small diameter tubes inserted through at least 2 small incisions. One incision is used for the telescope to look inside the knee with a high-definition camera and instruments are inserted through the second incision. Some conditions may require additional incisions. The operation is usually performed under general anaesthetic but other forms of anaesthetic are also available. A variety of conditions can be treated and the most common procedures are described here. Usually the small incisions are closed with steristrips (no stitches) and the knee can be fully loaded immediately in the majority of cases (walking sticks or crutches not required). Muscle strengthening exercises are essential to improve knee function and it can take 3 months to reach optimal recovery.
Arthroscopy - meniscal tear
Arthroscopy - meniscal tear
In the majority of cases a meniscal tear occurs in an area which has no blood supply. The tear is not going to heal and during the arthroscopy the loose or frayed portion is removed or trimmed. In the short and intermediate term a full recovery can be expected. However, in the long term arthritis can develop at an earlier stage as the meniscal tear and removal of part of it loads the joint cartilage more which can subsequently develop signs of wear.
On rare occasions a complete vertical tear occurs in the periphery of the meniscus which has a blood supply. This is called a bucket handle tear - as the name suggests a meniscal fragment can flip forward like a bucket handle locking the joint and prevent full knee straightening. In these cases the tear can be repaired with sutures. The repair needs to be protected and a brace and/or crutches are used for a period of time.
Arthroscopy - loosy body
A loose piece of cartilage or bone can be removed but if the loose fragment is large the incision has to be increased in size. The knee can be inspected to see where the fragment has come from and sometimes this area needs treatment.
Arthroscopy - chondroplasty
Cartilage damage or wear can make the surfaces irregular. Sometimes flaps of cartilage become partially detached. As cartilage has no blood supply damage does not heal or regenerate. Chondroplasty means making the cartilage surface smoother and getting rid of unstable cartilage that is about to break off. Often a chondroplasty is carried out in addition to other treatments, for instance trimming of a meniscal tear. In general chondroplasty can help in cases of mild or moderate arthritis but is not successful in severely arthritic knees.
Arthroscopy - impingement
Prominent synovium (inside knee lining) can be removed to stop it from getting pinched between the bones. Unfortunately this tissue can grow back again. Alternatively scar tissue forms as a result of surgery which can also cause impingement.
Arthroscopy - plica syndrome
Arthroscopy - plica syndrome
Abnormal symptomatic folds can be diagnosed and removed during an arthroscopy. As with impingement the tissue can grow back again or scar up leading to a recurrence of symptoms.
Arthroscopy - microfracture
Microfracture is a technique to fill an area of complete cartilage loss where the bone is exposed. The best lesions to treat are fairly small punched out defects on the inside of the knee. With a special awl small holes are made in the bone. From the bone marrow stem cells flow into the defect and a scar tissue type cartilage (fibrocartilage) fills the defect. This tissue is not as hard and durable as normal cartilage but can provide pain relief. This technique does require the use of crutches for a period of time to protect the repair.
Arthroscopy - removal of scar tissue
Arthroscopy - removal of scar tissue
Scar tissue can build up inside the knee after infection, bleeding or after joint replacement surgery. Scar tissue can be removed with an arthroscopy. Unfortunately scar tissue can grow back again but this can be controlled to a certain degree using anti-inflammatory measures afterwards.
Arthroscopy - lateral patella facetectomy
When the outer patella cartilage surface has arthritis extra bone grows on the outside of the patella (osteophyte). This can be large enough to overhang the outer thigh bone. Pain relief can be obtained by strengthening the inner quadriceps muscle (vastus medialis obliquus). A lateral facetectomy removes the overhanging bone allowing the patella to move inwards.
Arthroscopy - lateral release
When the outer tissues connected to the patella (knee cap) are too tight it can cause abnormal tracking or tilting of the patella, leading to an overload syndrome and pain. A lateral release reduces the pull of the tight tissues allowing the patella to run in a more physiological way and provide pain relief. This is often done at the same time as an arthroscopy where the abnormal tracking or tilting can be diagnosed.The release is done through a separate incision on the outside of the patella. This reduces bleeding and bruising in comparison to a technique where the release is done from the inside during the arthroscopy.
Intermediate surgery