Up until about 1975, the majority of knee operations were done through large, open incisions. Patients usually stayed in the hospital for a few days and the recovery period was long and painful. In the late 1970’s, arthroscopic knee surgery started to become the new standard. The invention of and improvement upon arthroscopic surgery techniques has revolutionized the way that knee surgeries are done. Knee Arthroscopy uses a scope (a tiny fiber optic camera), inserted into the knee joint, to help the surgeon visualize mechanical problems that can be fixed surgically or other problems that may be causing pain or loss of function. A large screen in the operating room shows the surgeon and his team what the scope is seeing. The scope provides an amazing level of acuity and great magnification of the area being examined. This scope, as well as the other surgical instruments, has been specially-designed to be inserted through small incisions in the skin and to work in the small compartments of the knee joint. Many conditions can be successfully treated using arthroscopy.
What problems can be addressed using arthroscopy?
There are specific problems for which we would recommend urgent arthroscopic surgery, such as:
• A locked knee from a displaced meniscal tear
• Acute and chronic ACL tears in active patients (who desire to return to a high level of function)
• Some acute ligament tears (that have been shown to not adequately heal with non-operative treatment)
• Certain Knee Fractures
Where can I have knee arthroscopy done?
Arthroscopic knee surgery is almost always done as an outpatient procedure, unless the patient has other medical conditions that may require their being admitted to the hospital for post-surgical monitoring for a longer period. The patient will report to the Ambulatory Surgical Center at a pre-determined time for their surgery, where they will be prepped and sedated for the procedure. We use a short-acting anesthesia that is more easily tolerated by patients and reduces that groggy and foggy feeling after surgery. We will supplement the anesthesia by injecting a long-acting pain reliever around the knee during surgery, and by providing the patient oral pain medications for use at home after surgery.
What is the actual surgery like?
Once the patient is sedated, the surgeon will make a small incision in the knee, into which the arthroscope is inserted into the knee. The surgeon will make a second, small incision, through which the surgeon inserts surgical instruments. Once the entire knee can be seen through the fiber-optic camera, the operative part of the procedure begins – perhaps removing or repairing a torn meniscus, or reconstructing a torn ACL. When the surgery is complete, the patient is taken to an outpatient recovery room to fully-awaken and to be monitored by the staff for any signs of complication. Most outpatient arthroscopic knee surgeries take about 45 minutes to an hour, although some can be completed in as little as 30 minutes. It typically only takes a few hours from check-in to discharge for these arthroscopic procedures.
After surgery, patients are wheeled to the recovery room where recovery room nurses monitor them until they are fully alert. As someone must accompany a patient to and from the surgical procedure, the surgeon will usually review with this person a list of post-surgical instructions, including what prescriptions to take and how to take them. Typically, patients go home on a narcotic pain medicine, which may be supplemented with Tylenol and Aleve, to take on a regular basis through recovery. Pre-operatively, we show patients exercises to do at home until they are seen in the office a week after their surgery. We will have already discussed issues such as bathing, showering and how to use their crutches.
What is the recovery period like after Arthroscopic Knee Surgery?
Most people do extremely well after having arthroscopic knee surgery. Most have minimal pain during recovery, which is easily managed with over-the-counter pain medication. Depending upon the condition or injury that was treated and the magnitude of the problem, a patient may be given crutches to use while their incision and repair heals. They may also/instead wear a brace, splint or fabric support for the knee. We will order Physical Therapy (PT) for the patient who may need to spend more time working to regain their strength, range of motion and flexibility in the knee. Some surgeries almost always require PT, such as after repair of tears of the Anterior Cruciate Ligament. Physical Therapy plays a vital role in helping the patient learn correct and safe ways of engaging the knee, not only after surgery, but also with regard to daily activities and during sports.
What are the benefits of having an arthroscopic knee surgery over a traditional surgery?
As experienced surgeons, we can confidently say that using a scope to look inside your knee provides us with a vastly improved view and enables us to quickly define the problem. Newer, smaller surgical instrumentation allows us to access the problematic areas of the knee and to fix defects or remove worn or torn tissue. We spend much less time closing incisions as they are so much smaller. As a patient, you will also see many benefits to having arthroscopic knee surgery. These benefits include:
• No hospital stay (in most cases)
• Less blood loss
• Less tissue trauma
• Smaller incisions
• Less scarring after surgery
• Less post-operative pain from surgical incisions
• Lower risk of complications
• Easier recovery period
Arthroscopic knee surgery has dramatically changed the treatment of knee problems over the past 35 or so years. As technology advances, better cameras and instruments will allow orthopaedic surgeons to continue to improve on current treatments. Our patients will also benefit greatly from these advances. It is a win-win for everyone!