Health Society of South Africa

KNEE ARTHROSCOPY
Diagnosing and treating your problem

Looking into Your Knee Problem

Think of the work your knees do - day in and day out. It's little wonder that they can fall prey to problems. You might have a sudden injury from a twist or blow or an injury caused by overuse, such as from repeated squatting. Knee problems can also result from a structural weakness or simply be a natural part of ageing. Whatever the cause, knee problems are often successfully diagnosed and treated with arthroscopy, a technique that allows your orthopaedic surgeon to see clearly inside your knee, using only small incisions.

The Arthroscope
The arthroscope is an instrument used to look directly into joints. This makes it useful for both diagnosis and treatment. The arthroscope contains magnifying lenses and coated glass fibres that beam an intense, cool light into the joint. A camera attached to the arthroscope allows your surgeon to see a clear image of most areas of your knee joint on a monitor.

Your Orthopaedic Evaluation
Before treatment, your surgeon evaluates your knee to diagnose your problem. An evaluation may include a medical history, physical examination and one or more diagnostic tests. To confirm the diagnosis, arthroscopy is often done. It's usually an outpatient procedure, which means no overnight hospital stay is needed. In many cases, your surgeon can treat the problem at the same time.

Medical history and physical examination
Your medical history may include questions about your symptoms and whether they began after an injury. Your surgeon will examine your knee for swelling and any tender areas. The stability of your knee joint may be evaluated. How far your knee can move in different directions (its range of motion) may also be checked.

Diagnostic tests
Routine x-rays provide pictures of bones, helping your surgeon diagnose any cracks or breaks. X-rays also can help reveal abnormal bone structures and arthritis (severe joint wear). If your surgeon suspects damage to soft tissue, MRI (magnetic resonance imaging) may be used. It produces computer images that may show any soft tissue injuries.

The Arthroscopic Procedure
You may have laboratory tests before admission and you'll be asked not to eat or drink anything after midnight the day before your surgery. At the beginning of the procedure, you will receive an anaesthetic. It will make you sleep (general anaesthesia), numb you from the waist down (spinal anaesthesia) or just numb your knee (local anaesthesia). Then, your surgeon makes a few incisions (portals) in your knee. Sterile fluid is inserted through one portal to expand your knee joint. This makes it easier to see and work inside your joint. After inserting the arthroscope through another portal, your surgeon confirms the type and degree of knee damage. Whenever possible, your surgeon treats your knee during arthroscopy, using surgical instruments such as shavers or laser.

Risks and complications
As with similar surgeries, arthroscopy carries the risk of bleeding, infection and stiffness, as well as recurring knee problems.

Inside Your Knee

Learning the parts of a healthy knee may help you better understand your knee problem. Which treatment option is best for you depends on the type and seriousness of your knee problem.

A Healthy Knee
You knee acts like a hinge to connect the upper and lower leg bones (femur and tibia). Articular cartilage (tough, fibrous tissue) covering the ends of these leg bones and the underside of your kneecap (patella) helps your joint glide with ease. The meniscus is a crescent of cartilage that provides cushioning between your leg bones. Ligaments, tendons and muscles are soft tissues that give your knee stability and strength.

Common Knee Problems and Treatment Options

Meniscus Cartilage Tears
A sudden twist or repeated squatting can tear the meniscus. This may cause your knee to hurt or swell. Your knee may also catch or lock when you bend it.
Treatment: Meniscus Removal or Repair. Your surgeon may remove or repair damaged tissue, depending on its location. Torn tissue on the inside of the meniscus is usually removed. Torn tissue on the outer edge of the meniscus is often repaired because it receives enough blood to allow proper healing.

Ligament Tears
A fall, twist or direct blow may tear the anterior cruciate ligament. Tears can cause pain and swelling, as well as instability, which can make your knee give way.
Treatment: Ligament Reconstruction. Your surgeon can reconstruct an injured anterior cruciate ligament. This is done by replacing the damaged tissue with healthy, strong tissue (a graft) taken from an area near your knee. Usually, a section of the patellar tendon is used. In very rare cases, a ligament may be repaired if it is only slightly damaged.

Articular Cartilage Wear
Ageing or injury may wear away articular cartilage. A piece may even break off in the joint (called a loose body). Damage to cartilage may cause pain, stiffness, or grinding.
Treatment: Cartilage Shaving or Removal. Your surgeon may use an instrument or laser to remove rough articular cartilage. If the cartilage has worn away, exposing the bone beneath, your surgeon may burr or drill the bone to try to stimulate cartilage growth. If a loose body or other debris is present, your surgeon may insert an instrument through a portal to remove it.

Patella Problems
Ageing, overuse, or a direct blow may damage the cartilage under your patella, restricting joint movement. Structural problems, such as an off-centre patella, may cause uneven wearing or pain.
Treatment: Patella Smoothing or Realignment. Your treatment will depend on whether you have a wear-and-tear or a structural problem. To smooth the patella, your surgeon may shave or use a laser to remove bands of cartilage under your patella. If your patella is off-centre, your surgeon may clip, or release, bands of tissue (called a lateral release) to realign your patella.

After Arthroscopy

You'll spend a brief time in recovery following arthroscopy. Once you're home, take it easy. Since arthroscopy needs only small incisions, you can expect less scarring and pain and often a quicker recovery than after open surgery.

In the Recovery Room
After arthroscopy, expect to have your knee bandaged and elevated. An ice pack is put on to help reduce pain and swelling. Pain medication may be given either orally or through an IV (intravenous) line. A nurse will monitor your temperature, blood pressure and heartbeat. When you're awake and alert, the nurse will help you get ready to go home.

Going Home
You may be able to go home two or three hours after arthroscopy. Because the anaesthetic and pain medication may make you sleepy, you'll need to arrange ahead of time to have someone drive you home. Before leaving, make sure you have any prescriptions or home care instructions you'll need until your first follow-up visit with your surgeon.

Using crutches
When you first stand on your leg, your knee may throb or hurt. To reduce the weight on your operated leg and limit discomfort, your surgeon may suggest you use crutches. If possible, try out your crutches beforehand, so walking will be easier on the day of arthroscopy.

Your Home Recovery
At home, elevate your knee, exercise and follow your surgeon's instructions. To check your progress, your surgeon may see you one or two times during the first few weeks after arthroscopy. Call your surgeon if you have bleeding, pain uncontrolled by pain medication, fever, numbness or shortness of breath.

Relieving pain
Don't dangle your leg for long periods. Elevate your knee above heart level to reduce swelling and pain. Ice and rest can also help. During the first two days after arthroscopy, ice your knee for 20 to 30 minutes a few times a day. Straighten your knee several times a day while you heal.

Showering
Wait to take your first shower until you are able to stand comfortably for 10 to 15 minutes. Cover your leg with plastic to avoid getting your bandage and incisions wet, which increases your chance of infection.

Exercising
Building up the muscles that support your knee and improving joint mobility are the best ways to speed recovery. Your surgeon may have you try limited walking and do each of the following exercises several times a day. Use slow, steady movements and always exercise both legs to keep your muscles balanced. Ask about low-impact exercises like swimming or bicycling.

Using physiotherapy
Depending on your needs, your surgeon may refer you to a physiotherapist, a specialist in the rehabilitation of joints. A physiotherapist can design a personalised exercise programme to help improve your muscle strength and joint function.

Quadriceps sets. Tighten your front thigh muscles (quadriceps), pressing your knee toward the floor. Hold for 5 to 10 seconds; then relax.

Straight leg raises. Lift your leg 20 to 30 centimetres, keeping your knee straight. Hold for 5 seconds. Lower your leg slowly back to the ground.

Heel slides. Bend your knee and slide your heel toward your hip as far as you can. Hold for 5 seconds. Slide back down until your knee touches the floor.

Moving Towards Recovery

Your surgeon's arthroscopic skills, combined with your dedication to recovery, can help you get up and moving soon. Physiotherapy may make your recovery go even more smoothly. After knee arthroscopy, many people are able to return to desk jobs within a week and to more strenuous activities within a month.

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