The ins and outs of knee arthroscopy

Posted on 3 August 2021

This procedure is performed to diagnose problems with the knee –  as well as to perform surgery or monitor disease.

Knee arthroscopy is a common surgical procedure performed using an arthroscope (a viewing instrument) to look into the knee joint to diagnose or treat a knee problem. It is a much less invasive technique than traditional open surgery, and typically means a quicker recovery time and less pain post-surgery. This is a relatively safe procedure that can be performed at one of Mediclinic’s ten day clinics around the country.

“The knee joint is one of the most complex joints of the body and is vulnerable to a variety of injuries,” says Dr Hennie Bosch, an orthopaedic surgeon at the Orthopaedic Institute, Mediclinic Durbanville. He explains that the most common knee problems where knee arthroscopy may be recommended for diagnosis and treatment are:

• Torn meniscus (Menisci act as shock absorbers providing cushioning to the joints.)
• Torn or damaged cruciate ligament (Bands of tissue, including the cruciate and collateral ligaments, keep the different bones of the knee joint together and provide stabilisation to the joint.)
• Torn pieces of articular cartilage
• Inflamed synovial tissue
• Misalignment of patella (kneecap)
• Baker’s cyst (This is a fluid-filled cyst that develops at the back of the knee due to the accumulation of synovial fluid. It commonly occurs with knee conditions such as meniscal tear, knee arthritis and rheumatoid arthritis.)
• Certain fractures of the knee bones

“Knee arthroscopy is performed under local, spinal or general anaesthesia, depending on your age and health condition,” says Dr Bosch. “First, the surgeon makes two or three small incisions around the knee. Next, a sterile saline solution is injected into the knee to push apart the various internal structures. This provides a clear view and more room for the surgeon to work.”

An arthroscope (a narrow tube with a tiny video camera on the end) is then inserted through one of the incisions to view the knee joint. “The structures inside the knee are then visible on a video monitor in the operating room,” says Dr Bosch.

Your surgeon will examine the structures inside the knee joint to assess the cause of the problem. “Once a diagnosis is made, surgical instruments such as scissors, motorised shavers or lasers are inserted through another small incision, and the repair is performed based on the diagnosis,” he adds.

The repair procedure may include any of the following:

• Removal or repair of a torn meniscus
• Reconstruction or repair of a torn cruciate ligament
• Removal of small torn pieces of articular cartilage
• Removal of loose fragments of bones
• Removal of inflamed synovial tissue
• Removal of a Baker’s cyst
• Realignment of the patella
• Making small holes or microfractures near the damaged cartilage to stimulate cartilage growth

“After the repair, the knee joint is carefully examined for bleeding or any other damage,” says Dr Bosch. “The saline is then drained from the knee joint. Finally, the incisions are closed with sutures or steri-strips, and the knee is covered with a sterile dressing.”

Most patients are discharged the same day after knee arthroscopy, although recovery after the surgery depends on the type of repair procedure performed. Your doctor might recommend pain medication, crutches or a knee brace and a rehabilitation programme for a full, successful recovery.