Arthroscopy 

 Introduction 

Arthroscopy

Arthroscopy can be a safe and effective procedure for diagnosing and treating knee problems. Orthopaedic surgeon Mr Lawrence Freedman explains.

Media last reviewed: 21/10/2013

Next review due: 21/10/2015

Joints

A joint is the point where two or more bones meet. They allow the bones to move, while holding them in place, protecting and supporting them.

Joints are made up of five different types of tissue:

  • bones
  • tendons - tough, stringy tissue which connects muscles to bones
  • ligaments - similar to tendons but connect one bone to another bone
  • cartilage - tough, spongy tissue that lines the surfaces of bones and acts like a shock absorber within the joint, helping to reduce friction and prevent damage as the bones move
  • synovial fluid - thick, sticky fluid that acts as a lubricant inside the joint

An arthroscopy is a type of keyhole surgery used both to diagnose and treat problems with joints.

The procedure is most commonly used on the knees, ankles, shoulders, elbows and wrist.

An arthroscopy might be recommended to look at the inside of the joints if imaging tests have been performed and you have problems such as swelling or stiffness.

As well as allowing a surgeon to look inside a joint, an arthroscopy can also be used to treat a range of problems and conditions. For example, it can be used to:

  • repair damaged cartilage
  • remove fragments of loose bone or cartilage
  • treat frozen shoulder

Read more about when an arthroscopy is used.

What happens during an arthroscopy?

A piece of equipment called an arthroscope is used during an arthroscopy. An arthroscope is a small, metal tube about the length and width of a drinking straw. Inside, a bundle of fibre optics act as both a light source and a camera. Images are sent from the arthroscope to a video screen or an eyepiece so that the surgeon is able to see the joint.

It is also possible for tiny surgical instruments to be passed through an arthroscope to allow the surgeon to treat certain conditions.

The arthroscope is inserted into a small incision next to the joint. More small incisions may also be made to allow an examining probe or surgical instruments to be inserted.

An arthroscopy is usually carried out under general anaesthetic. In some cases, however, a spinal or local anaesthetic is used.

An arthroscopy is usually performed as a day case procedure, which means the person being treated is able to go home on the same day as the surgery.

Read more about how an arthroscopy is performed.

Safety

An arthroscopy is usually a safe type of surgery and the risk of serious complications developing is low (less than 1 in 100).

However, possible complications include infection and accidental damage to nerves near the affected joint.

Read more about the complications of an arthroscopy.

Advantages

An arthroscopy is carried out using keyhole surgery, where only small cuts are made in the skin. This gives the procedure some potential advantages over traditional, open surgery including:

  • less pain following the operation 
  • faster healing time
  • lower risk of infection
  • it can be performed as a day case procedure
  • you may be able to resume normal activities more quickly

Recovery

The time it takes to recover from an arthroscopy can vary depending on the joint involved and which procedure was necessary.

It is often possible for a person to do light, physical activities one to three weeks after having surgery. Full physical activities, such as lifting and sport, can often be resumed after six to eight weeks.

Read more about recovering from an arthroscopy.

Page last reviewed: 12/06/2013

Next review due: 12/06/2015

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Comments

The 5 comments posted are personal views. Any information they give has not been checked and may not be accurate.

JustAMan said on 20 November 2014

Part 2 (Continued)
I had the operation 9 weeks ago. I was told it would be about 4 to 6 weeks before I could expect to return to normal. Although I have done knee strengthening and mobility exercises 3 times daily from the outset, used an exercise bike on its lowest setting from week 4, and iced my knee at least twice a day, I have only just started to drive again (previously it hurt to depress the clutch), I can only just walk upstairs normally, and still have a slight limp when walking. I am improving but it is very very slow. I have also noticed that the affected knee VMO has been very slow to respond to my efforts to improve it post operation. My estimate of being back to normal is now 4 to 6 months, not weeks. When I saw my consultant for the post op follow up he looked a bit uncomfortable when I told him where I was compared to what he had predicted. However he did tell me that I have parts of my kneecap joint which have completely worn away.
And finally I have now talked to others who have had knee arthroscopies and they have all told me it was months before they fully recovered; even my consultant admitted that his own arthroscopy took 4 months to fully recover(!).
My conclusions?
1. My original injury was the probably the cause of my recent problems. I should have had better physio to get the VMO strength back.
2. I should have given the knee exercises I did about a year ago much more time and effort, and the physio should have stressed how important they were. However it is possible that even then they wouldn't have worked.
3. If I had been told that I would not be able to recover back to normal for up to 6 months post op, I would probably have not gone for it and put up with it as it was. After all, before the operation, I could walk up to 12 miles without any problem. Even now there is no guarantee that I will be able to fully recover.
4. Whatever happens I will carry on with knee exercises.
Hope this helps someone out there.

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JustAMan said on 20 November 2014

Part 1
I had a kneecap lateral release via arthroscopy 9 weeks ago. This is my experience. It may helps others.
I am a man in my mid 60s. In my teens I had a sports injury which damaged my left knee medial ligament. Although it did recover, and I carried on with sports until my late 40s albeit with a knee bandage, it never felt right again.
About 2 years ago I noticed my knee would very occasionally lock with a lot of pain when walking, but would very quickly clear itself. About 12 months ago I was sent for physio and was told my left knee cap was mistracking i.e. was moving further to the outside than it should be. I was also told that this was due to a weak VMO muscle. This muscle is important in controlling the position of the kneecap, and is very quick to deteriorate and slow to recover after a knee injury. It is likely therefore that my left leg VMO has never been as it should for most of my adult life, even though I have been sports active. I was given some VMO strengthening exercises by the physio but didn't really give them a chance because I didn't understand the problem, and so the knee locking problem didn't get resolved. So I saw a consultant who recommended a lateral release. Put simply this is where some soft tissue is cut to release the kneecap to allow it to track properly.
(Continued in Part 2).

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User910143 said on 07 October 2014

Hi,

I am booked in for an arthroscopy in January. I have a torn meniscus, a cyst in my knee an debris floating about. I'm 35 and have had to stop playing football and cycling due to the pain & discomfort.

I'm just wondering if anyone has had the same problem as me ?

Also how long are you anaesthetised for & how long is the op?

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allangmiller said on 17 August 2014

I'd read a few negative experiences, but suspect there's something of a reporting bias there. I had mine done 2 days ago, and have had no post-operative pain or discomfort whatsoever. The pain that led me to seek treatment has gone also. I was sent home with 3 different pain medications, and physio to perform 3-5 times daily for 4 weeks plus, so there is obviously an expectation of recovery issues (unsurprising: they're sticking all sorts in your joint!). But there no detectable evidence of the op itself - apart, obviously, from the bandage and holes! So, on that score alone, result! The painkillers remain unopened.

I'm 56 and a fellrunner, and started experiencing left knee pain about 7 months ago, after a brief layoff for problems in my other knee which healed on their own. It would take several days for pain to subside after a run, but it never really went away even after a lengthy layoff. It was particularly noticeable when the joint was held still for any period, eg driving - toothache-level pain which only eased when I walked about a bit.

MRI discovered a small tear in the meniscus, and I was offered arthroscopy. I continued to run at a low level in the run-up to the op, feeling that keeping the joint and muscles mobile, toned and active could be beneficial. I took no medication, since so long as pain is bearable I feel it is useful information from your joint! I tried to keep the weight off - only partially successfully!

And, as noted, it was actually a breeze. Early days, and running may introduce issues, but that's not the main point.

My strictly amateur opinion is that, if you have frequent pain and an arthroscopy is offered, regardless whether you wish to do sport or not, it is well worth a try. I think that keeping active, as permitted by the pain, and keeping the weight down, as permitted by enforced inactivity or your general approach to such things, may help the result.

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pilotlady said on 14 August 2014

I had an arthroscopy 11 weeks ago and waited until now to post my thoughts. Today my knee feels better and stronger than it did pre-surgery so, for me, the op was a good decision.

Recovery:
Day 1: I walked out of the Horton Hospital (was wheeled to the door) without crutches three hours after being knocked out. Very impressed (and hungry).
Week 1: Sore, but they gave me lots of painkillers and each day I got a little bit more movement and less pain. After five days I joined my husband walking our dogs and managed to (very slowly) walk about 400m. After nine days we went out for dinner and the theatre and my knee was sore, but not too bad.
Week 2: Back walking the dogs on our usual route and doing light exercise. Tire easily and get a sore knee if I overdid it.
Week 3: Same as week two but every day is an improvement. Stitches out!
Week 4: Back swimming (can cause pain). Can do everything except cross my legs or kneel. Go glacier trekking in Iceland!
Weks 5 - 11: Exercise regularly and increase time/difficultly gradually.
Week 11 (now): Pretty much as I was before the miniscus ripped but about half a stone heavier, due to diminished exercise for the last year. Still can't sit with my legs crossed completely but this should come.

Good luck if you are having this op. For me it was worth it.

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