Arthroscopy of the knee joint

Name of the procedure:
Arthroscopy of the knee joint

When is surgery indicated?
Pain in the knee, unexplained tendency to swell up, limitation of movement, instability, locking, meniscal, cartilage or ligament damage demonstrated on MRI scan.

Surgical technique:
The knee joint is explored after the insertion of a special camera via a tiny incision in the skin (a procedure known as "keyhole surgery"). Meniscal tissue can be smoothed, removed or sutured in the same session and cartilage or cruciate ligament damage repaired.

Inpatient stay:
The procedure is usually carried out as an outpatient or, if the patient has previous illnesses and/or a lack of home care in place, as a day case.

Depending on the treatment carried out, the patient may be able to weight bear immediately or gradually increase the amount of weight they bear on the joint. Accompanying physiotherapy exercises and thrombosis prophylaxis.

The knee joint is the largest joint in the human body: it is formed from the upper thigh, the lower leg and the patella, each of which are covered in a layer of cartilage. The elastic tissue of the meniscus is positioned between the gliding surfaces of the upper and lower leg in order to increase the surface area and transfer forces. The anterior and posterior cruciate ligament, as well as the lateral ligaments, play a key role in ensuring the joint's stability. Any damage to the interior structures generally leads to premature joint wear, a condition known as arthrosis, if the stress on the joint remains constant.

Nowadays, every effort is made to use endoscopic surgical procedures known as arthroscopies to resolve any damage to the knee without having to open it up. This means that the normal function and weight-bearing capacity can be restored or maintained.

When is an arthroscopy indicated?
If, as a result of an accident or an awkward movement, a patient suddenly develops pain with accompanying swelling in the knee, clinical suspicion falls on damage to the interior structures of the knee such as the meniscus, cruciate ligaments or cartilage. If there is already joint wear present, damage can also occur without any external events. Pain, limitation of movement, locking or a feeling of instability are all characteristic of knee damage.
If, despite resting and protecting the knee, there is no improvement in symptoms, an arthroscopy is usually recommended. Where the symptoms do not point to a precise diagnosis, this can be resolved in advance with an MRI scan.

How is the procedure performed?
The procedure is carried out under partial or full anaesthesia and is largely bloodless. Using two tiny incisions in the skin, a camera and small surgical instruments are introduced into the knee and the images transferred to a monitor. The treatment is then carried out depending on the findings. If there is a tear in the meniscus, for example, the "damaged" section that is causing the pain is removed with small cutting instruments until only healthy, firm tissue remains. Where there are certain types of fresh tear, the meniscus can be sutured and therefore fully preserved. Techniques involving special suture anchors and suturing systems are used for this. Cartilage injuries can also be treated using various techniques. In the case of a cruciate ligament tear, a cruciate ligament replacement procedure can be carried out using the body's own tendon tissue.

How long will I have to stay in hospital?
The length of stay depends on the type of procedure carried out. Generally speaking, a knee arthroscopy is carried out as an outpatient or as a day case. This means that you attend our facility just prior to the surgery and are discharged again following the procedure that same day or after one night. Depending on the surgical procedure required, however, you may require a few days on the ward.
Essential for outpatient surgery is guaranteed care and support at home from relatives or friends. There should be no pre-existing conditions that may impair your ability to look after yourself, and of course you should be followed up by your general practitioner. Preparation for the surgery takes place a few days prior to the procedure and involves an examination, an explanation of the procedure involved, the taking of new X-rays and blood tests as well as a consultation with the anaesthetist.

What form will my follow-up take?
After surgery, physiotherapy exercises involving movement, muscle-strengthening and gait training are particularly important. We get this underway in order to facilitate a rapid achievement of joint function.
If the damaged area of a meniscal tear is removed, then partial weight-bearing is required on under-arm crutches for around a week. After this, weight-bearing is rapidly increased – depending on the patient’s symptoms and condition – over the course of a further week. The time required off work in such cases is around two weeks. If the meniscus is sutured, cartilage treated or a cruciate ligament replaced, then not only will movements need to be restricted with a splint, but prolonged partial weight-bearing or even no weight-bearing may also be required. During this time, thrombosis prophylaxis with heparin injections will be needed.

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