Arthroscopy is a generic term
which implies you're looking inside a joint.
So you have to precede the word arthroscopy
with a knee arthroscopy, if you're looking inside the knee,
or a shoulder arthroscopy or a hip arthroscopy.
There are two reasons to advise the surgery.
The first is to make a diagnosis
if it's not been possible to make a diagnosis,
and the second is to carry out treatment.
The most common reason to carry out an arthroscopy of the knee
is for a torn cartilage.
This will be followed, perhaps, by arthroscopy for knee pain,
where there's arthritis
or where there's been damage to the cruciate ligaments.
The patients come to us with an injury to the knee,
they've got pain, perhaps they can't straighten the knee completely,
it might give away, they have a pronounced clicking sensation,
and the presumptive diagnosis is a torn cartilage.
They'd have an MRI scan which confirms the diagnosis,
and then we'd carry out arthroscopy to remove the damaged cartilage
and restore the knee to normal function.
Arthroscopy is a very common operation.
The reason is it's a very effective procedure with very few risks
and a very rapid recovery.
However, it's important for a patient to remember
it's not a risk-free operation,
and therefore they should have symptoms which are significant
before having surgery.
Surgery is offered either because the joint is unstable,
such as a ligament injury, or because it's painful.
If it's for pain, the level of pain determines the need for surgery.
The surgeon's first task is to provide a diagnosis
as to why they've got the pain,
and that will be an examination of the patient
and investigations, usually an MRI scan.
Following from the diagnosis, treatment will be advised.
But in most conditions with the knee, it's perfectly safe
to accept the pain and not have surgery.
So the decision to operate depends how intrusive the pain is,
and the patient's able to help, and should indeed help,
with making the decision whether to operate.
The surgeon can make a diagnosis,
but he doesn't know how painful it is for the patient.
So I always advise patients, only have surgery
if your symptoms are severe enough to warrant it.
The operation itself involves a general anaesthetic,
lasts about 20 to 30 minutes.
The surgeon makes two cuts in the knee.
Through one cut the arthroscope is inserted
and through the other cut instruments.
Initially a probe is used to move things around in the knee,
assess what the diagnosis is
and then the probe is removed and instruments are inserted
to repair or remove damaged tissue.
Recovery is quite swift.
The patient will wake up after surgery
and typically can get out of bed and walk within one to two hours
and go home at four to five hours after surgery
and would usually return to normal social activities, including driving,
around the third or fourth day, back at work on the fifth or sixth day.
No surgery is risk free. It's very low risk.
The two principal risks are infection and a deep-vein thrombosis.
In my own experience, the risk of developing an infection
is probably around one in 500,
and it's a similar risk for a deep-vein thrombosis.
The condition itself will determine the long-term care
rather than the surgery.
By three to four weeks, the recovery from surgery is complete
and there are no specific things the patient should or shouldn't do
on account of the surgery itself.
In the long term, it will depend what the injury was
or what the pre-existing diagnosis was that will determine the patient's care.
The patient will be seen by the physiotherapist
and shown what exercises they should do.
The exercises, principally to strengthen the thigh muscles,
are an important part of the recovery period.
The general advice will be, if the knee is swelling or painful, to rest,
and if it's not, they can carry on increasing their activity.