Arthroscopy is a keyhole procedure that allows very detailed visualisation of the knee joint through two small incisions, each less than 1cm, at the front of the knee, allowing associated procedures to be performed including trimming of loose articular and meniscal cartilage flaps and removal of loose bodies in a “walk in – walk out” day surgery procedure.
The knee sometimes develops injuries to the rubbery shock absorption c-shaped disks of meniscal cartilage between the two main bones of the knee (femur, tibia) or to the load bearing articular cartilage located on the ends of all three bones (femur, tibia, patella). These structures can be readily visualised using a small cylindrical fibre optic camera or arthroscope, passed via two small “key hole” sized incisions of 1cm or less at the front of the knee, during “knee arthroscopy”. Small handheld instruments can be introduced via these key holes to remove loose bodies and to trim torn meniscal cartilage in a meniscectomy or remove loose flaps of articular cartilage in a chondroplasty. The loose cartilage flaps are trimmed and smoothed off using any or all of the following three devices – arthroscopic punches, oscillating suction shavers and/or a heat ablation chondrotome.
Occasionally, the type of meniscal tear will be suitable for meniscal repair, which can almost always be performed using “all-inside” minimally invasive sutures passed through the two small key hole arthroscopy portals without need for any other incisions. Articular cartilage damage, if focal, can sometimes be like a small pothole in an otherwise good road, leading to bruising within the bone, and these lesions can sometimes be treated at the time of arthroscopy with “microfracture” where a series of small holes are created to stimulate the underlying bone marrow, to encourage new fibrocartilage to fill the defect.
Common Causes for Knee Injuries
Other procedures such as cartilage transplant need to be performed in two stages, with cartilage biopsy performed first arthroscopically and reimplanted one month later via a second incisional procedure. Common causes for knee injury include stop and start sports such as touch football, netball and martial arts as well as change in direction sports such as soccer, rugby league and rugby union.
Repetitive “Micro” Trauma Knee Injuries
Often, injuries can occur without a memorable single episode of “macro” trauma, but rather from repetitive “micro” trauma experienced during activities such as jogging, pump class and boot camp. Also, as our age improves, the quality of our collagen often does the exact opposite and our meniscal cartilage may begin to develop degenerate tears, and/or the articular cartilage begin to develop splits and unstable flaps. Common signs and symptoms of an injured knee with unstable cartilage (chondral tears and flaps) include swelling, pain, catching, giving way and locking.
What happens to Knee Cartilage that is not Repaired?
As the cartilage in the knee has a poor blood supply, more often than not, they will not heal of their own accord and will likely persist or deteriorate with time and can damage surrounding structures inside the knee. Thus, if your knee has stopped behaving normally and has pain or swelling, it is time to let your physiotherapist or GP look at your knee, and if it persists, then consideration of an MRI and/or review by an orthopaedic knee surgeon is appropriate.
What to Expect with an Arthroscopy
If an arthroscopy is required, it may be comforting to know that it is a common procedure that is almost always performed as day surgery and that you will most likely be able to walk out of hospital without crutches (unless having a meniscal repair, microfracture or lateral release). This keyhole surgery can be performed with minimum disruption to the surrounding tissue of the knee, allowing for a swift recovery from nothing more than two small incisions which usually heal within a week or two and is able to be coupled with other procedures such as meniscal suture repairs, microfracture, cartilage transplant and possibly stem cell therapy in the future.
Recovering from an Arthroscopy
Patients can usually return to work within a week or so, sometimes within a few days, depending on the individual’s pathology and circumstances and often patients are able to resume more vigorous activities including sports activities within three weeks or so.