Knee Arthroscopy

Knee Problems

The knee is one of the most versatile joints of the body.  Unfortunately, because the knee connects the upper and lower leg bones (femur and tibia), it is one of the most vulnerable joints to injury.  Knee problems can be the result of daily wear and tear.  Injuries can be caused by overuse, a sudden twist or blow, genetic predisposition to knee problems, or when the knee joint starts to show signs of aging.

What are common knee problems?

• Meniscus tears:  Sudden twists can tear the meniscus cartilage causing pain.  The knee may lock or give away when stressed by running, kneeling or squatting.
• Ligament tears:  Twisting injuries, even those that seem minor can injure ligaments.
• Patella Problems:  Tracking problems with the kneecap, which can be traumatic or developmental.
• Osteoarthritis:  The cartilage in the patient’s knee joint gradually deteriorates due to wear and tear, genetic predisposition, and primary arthritic diseases.  This results in pain and aching in the knee joint when the patient moves the knee or puts weight on it
• Popliteal cysts:  (also called a Baker’s Cyst) Occurs when the membrane that lines the joint becomes inflamed.  Bending the knee may be painful because bulging cysts may form behind the knee due to excess fluid produced by the joint.
• Tendonitis:  Inflammatory problems with various tendons around the knee that create discomfort with activities.

How knee problems are diagnosed?

Before treatment, to ascertain the extent of the joint damage, the orthopaedic surgeon will carefully examine the patient.  The examination may include the patient’s medical history, a physical exam, and other diagnostic tests, such as x- rays and MRI (magnetic resonance imaging), to evaluate your problem.  X-rays provide pictures of the bones to diagnose any cracks, breaks, abnormal bone structures, or arthritis (severe joint wear).    On the other hand, MRI provides the surgeon with computer images that may show any soft tissue, cartilage, or ligament injuries. Often the orthopaedic surgeon will perform an arthroscopy to confirm the diagnosis, and in most cases will treat the problem during this procedure.

What is the arthroscopic proceedure?

The arthroscopy is a procedure in which the orthopaedic surgeon makes 2 to 3 small incisions and inserts an arthroscope into the knee.  The arthroscope is a telescopic instrument which is less than ¼ inch in diameter.  When inserted inside the joint space, it allows the surgeon to see the internal joint structures directly.  A camera attached to the arthroscope gives the physician a clear image of your knee joint on a monitor.

Preparation for Arthroscopy

• The patient cannot eat or drink anything (including water) after midnight the day before surgery unless the doctor instructs the patient differently. Undigested food in the stomach can cause complications and the surgery is likely to be postponed if the patient forgets to follow this instruction.
• The patient needs to refrain from smoking after midnight the day before surgery.  The patient cannot wear makeup or nail polish. We also suggest that the patient wear casual clothing.
• Patients receiving sedation, regional, or general anesthesia may not drive themselves home.  The patient should make arrangements for a driver, and someone should take care of the patient after the surgery.  Patients needing to travel home by taxi must have someone accompanying them. The patient may also need transportation to the doctor's office for the postoperative follow up.
• The patient cannot take any kind of medicine the morning of the surgery, unless told to do so by the doctor or the pre-op nurse.
• The patient needs to call the surgeon if he\she gets sick or needs to cancel the surgery between now and the date on which the procedure has been scheduled.
• It is imperative that the patient does not operate machinery, drive a car, sign any important papers or make important decisions for at least 24 hours following discharge.
• The patient cannot drink alcoholic beverages or take any medication not prescribed by the physician for 24 hours following discharge. 

How is the arthroscopy performed?

Arthroscopy is considered a surgical procedure.  At the beginning of the procedure the patient will receive general anesthesia to put him/her to sleep, or spinal anesthesia to numb him/her from waist down.  To avoid blood loss a tourniquet is usually applied above the joint to restrict bleeding of the joint during the procedure.  Then, the surgeon makes small portals (incisions) in the knee. In one of the portals the surgeon will insert the arthroscope.  The joint is distended with sterile fluid. In the other portal the physician will place instruments to accomplish the procedure.  During the procedure, the surgeon inspects the type and degree of the joint damage and treats the problem using the arthroscope, shavers, and other specialized instruments. After the procedure a sterile dressing will be placed over the wound and then an elastic bandage or T.E.D. hose will be placed on the leg.  This dressing can be removed five days after the procedure. However, the knee is re-wrapped daily with the elastic bandage or T.E.D. hose until the doctor tells you to stop.

What can I expect after arthroscopy?

After arthroscopy the patient’s knee is bandaged and elevated. The patient will be given pain medications and an ice bag is put on the knee to reduce swelling and pain. In the recovery room, and for the next 3-4 days, the patient needs to move the feet (ankle pumps) to improve circulation and avoid blood clots.  The patient may be able to go home two or three hours after the procedure; however, the patient needs to rest the joint for 12-24 hours. Someone will need to drive the patient home because of the anesthetic. To reduce pain and discomfort on the patient leg, the physician may suggest the use of crutches.  Depending on the surgery that was performed, the patient will need the assistance of crutches for a few days or weeks after the surgery.  The patient should check with the surgeon for weight bearing status because it varies according to the surgery preformed.

After going home to help reduce the swelling during the first two, days the patient should apply ice to the knee a few times a day for 20 to 30 minutes.  To avoid infection the patient’s dressing needs to be clean and dry. Therefore, before taking a shower the patient should cover the leg with a plastic bag tied above the dressing.  The patient can shower without a dressing usually after 5 days. It is essential that the patient schedule a post-operation visit 5-10 days after the surgical procedure.