Knee arthroscopy is the technique which people commonly refer to as keyhole surgery. Through
two tiny little incisions, they are able to get inside the knee joint with the camera
and tools to look around the knee, producing a fantastic view of all the tissues. We can
identify problems and we could deal with them surgically, all through minimally invasive,
low trauma techniques.
We perform knee arthroscopy in a very careful standardised fashion. Initially make sure
the patients have lots of analgesia, and in this case, there will be an anaesthetic which
could be a general anaesthetic, which is the commonest, spinal or epidural and very rarely
under pure local anaesthesia. We make sure that the patient is carefully prepared on
the table. The skin is painted with antibacterial solution and cleaned. The area is dressed
and wrapped. And we often use a tourniquet on the leg. Through two tiny holes in the
front of the knee, we introduce the camera and tools. We gently inflate the knee with
fluid. It's a clear salt solution that enables us to look around the knee with high definition
cameras which produce a fantastic view as if you're watching on your television. At
that point, we can identify the problem and then deal with this surgically. Depending
on the level of invasiveness of the procedure, most cases only require two tiny incisions.
At the end of the procedure, we wash out the knee very carefully and suck out any damaged
debris or tissue. The wounds are then dressed with simple paper strips or simple stitches.
We inject the knee with lots of local anaesthetic to make sure patients are pain-free. The vast
majority of knee arthroscopy patients can walk out of hospital within a few hours of
admission and very few of them actually even require crutches. We're able to mobilize them
and hopefully get them back to activity as quickly as possible.
There are a very large number of procedures that were performed with arthroscopic techniques
within the knee. From the big pieces of surgery like ligament reconstruction, typically anterior
cruciate ligament, posterior cruciate ligament, or we can work on the cartilages, the menisci
within the knee. Again, a very common procedure to trim torn cartilages or indeed to repair
them by suturing them back together again. Then we look at tissues such as the joint
surface which is a different form of cartilage. And you can think of this as a non-stick surface.
If this has been damaged, this can be smoothed off, or in places we'll even try and regenerate
surface. Overall however, there are many, many different procedures from simple removal
of loose pieces to the more complex reconstructive surgery. The advantage of performing them
through the arthroscopic technique is that we minimise pain, minimise trauma, and ensure
a quick recovery. Indeed, some of the procedures are performed more easily through an arthroscopic
technique and certainly they give us a fantastic visualisation of what's happening within the
knee allowing us to be very accurate with our surgery.
The recovery from the arthroscopic knee surgery very much depends upon the procedure that's
been performed. It can be very simple. From removal of a loose piece or loose body within
the knee or simple meniscal surgery. For example, a torn cartridge which is trimmed. In those
cases, we'd expect people to be back at work within two to three days. They would have
to ice the knee, perform physiotherapy and they'd be back to full activity level in about
six to eight weeks including sports. For the more complex surgeries such as ligament reconstruction,
then the recovery is a lot longer. The commonest will be the anterior cruciate ligament. In
this case, I'd expect most patients to walk back into the clinic at two weeks coming off
their crutches. At six weeks they would walk normally, 12 weeks. Most would be at the stage
where they could do some light jogging, and at 24 weeks they start twisting turning and
jumping. But full recovery actually takes nine months. So, as you can see, the recovery
is very much dependent on the complexity of the procedure that is performed. Having said
that, the results from arthroscopic anterior cruciate ligament surgery are fantastic with a success
rate of 90 to 95%. And it's certainly a very gratifying procedure to see patients getting
back to their sports. I love it when they send me a photograph of them playing rugby,
when they're skiing, playing hockey, or all the other crazy sports they love to enjoy.