What is Arthroscopic Knee Surgery?
The word arthroscopy is derived from the two Greek words “Arthron” which means joint, and “Skopein” which means to look at. Arthroscopic surgeries are carried out for several different joints including the knee, shoulder, and elbow.
Knee arthroscopy allows an orthopedic surgeon to visualize, diagnose and treat problems inside the knee joint. Your specialist may recommend knee arthroscopy if you have a condition that does not respond to non-surgical (conservative) treatments, but has not progressed so far as to indicate that a total knee replacement is needed. 
During the procedure, the surgeon makes two or more small incisions near the knee joint and an arthroscope in inserted. It is a very thin telescope with fibre-optic lighting attached to a camera that displays the interior of the joint on a TV screen. The image is used to guide small, specially designed instruments that work as very effective tools to treat some problems within your knee. 
History of Arthroscopy
Arthroscopy of the knee was developed in the 1970s and came into general use in the 1980s. Moreover, arthroscopic Instruments or devices were created and refined for specific surgical tasks during knee surgeries and diagnosis purpose. 
Arthroscopic Knee Surgery
This procedure is used in examination and repair of several different types of conditions such as a meniscal tear, ACL tears with instability, chondromalacia (wear and injury of cartilage cushion), bone spurs formation, synovial tissue damage due to Rheumatoid Arthritis to name a few. In a knee arthroscopy procedure, the surgeon typically first observes the diseased parts and then may decide to carry out the minor surgical procedure to remove the diseased part, or smoothen the bone spurs.
Arthroscopy of the Shoulder
Shoulder arthroscopy began in the 1980s and came into general use in the 90’s.Like knee arthroscopy, the instruments used for shoulder surgery have been developed and refined to allow doctors to do more through smaller exhibitions. Shoulder arthroscopy is used in the examination and repair of conditions such as the rotator cuff tendon tear, recurrent dislocations, and impingement syndrome.
Other Surgical Applications of Arthroscopy
Special instruments were developed to allow arthroscopic surgery on elbows, wrists or ankles. Many of the underlying problems are addressed in these joints with arthroscopy and have much less downtime than open surgery. 
Carpal tunnel syndrome is a disorder in the wrist joint that leads to the pinching of the nerve. Arthroscopic surgery can help relieve the symptom. Arthroscopic surgeries are also useful in removing any loose bodies of bone and cartilage in various joints such as knee, shoulder, elbow, ankle or wrist.
Indications for Knee Arthroscopy
According to the American Orthopedic Society for Sports Medicine, more than four million knee arthroscopies are performed worldwide each year.
Knee arthroscopy is commonly used for:
- Repair or remove torn meniscal cartilage which cushions the space between the bones in the knee
- Reconstruct a torn ACL (anterior cruciate ligament) or PCL (posterior cruciate ligament)
- Trim torn pieces of articular cartilage
- Remove loose fragments/bodies of bone or cartilage
- Repair misalignment of the patella (kneecap)
- Remove inflamed synovial tissue which lines the knee in patients with rheumatoid arthritis
- Removal of a swollen bursa(Baker’s cyst) behind the knee that fills with fluid causing inflammation
- Used for arthritis treatment in younger patients.[1, 3]
Knee Arthroscopy Procedure
The arthroscope is a fiber-optic telescope that can be inserted into a joint to evaluate and deal with some conditions such as ACL injuries, meniscal tears, etc. A camera is attached to the arthroscope and the picture is visualized on a TV screen. Most of the arthroscopic surgery is performed as a day surgery and is usually done under a general anesthesia. Knee arthroscopic surgery is common and millions of procedures are performed each year around the world.
The surgeon injects a local anesthetic drug during surgery to numb the part being examined. The regional (spinal) or general anesthetic will be used for better pain control during surgery. Regional anesthesia is the preferred method of anesthesia. Then several small incisions (at least two incisions about half an inch long) are made in the knee. An arthroscope is inserted, and the surgeon sees inside the knee. Other instruments can be used during surgery to cut, shave, remove particles in the joint or repair damaged tissue.
Knee arthroscopy surgery is done approximately for one hour. After surgery, once the patient feels comfortable, able to walk with crutches, able to take fluids by mouth, and can urinate, they will be discharged to go home in the care of a responsible adult. In most cases, patients are discharged from the hospital to go home the same day of surgery.
Risks and Complications of Knee Arthroscopy
Arthroscopic knee surgery is safe for the treatment of knee injuries, but there are some risks that you should consider. Risks and complications may include:
- Bleeding into the joint (after surgery).
- Damage to the meniscus,cartilage, and ligaments in the knee.
- Injury to a blood vessel or nerve.
- Knee stiffness following the procedure.
- Blood clot formation in the leg.
- Infection in the knee joint.
- Compartment syndrome.
During the knee arthroscopy, you will be under anesthesia, and a tourniquet may be put around your thigh to control bleeding. The surgeon makes 2 or 3 small stab wounds around the knee, and a saline solution is pumped into the knee joint, inflating it to make room for the small camera and surgical instruments. At the end of surgery, the saline is drained from the knee joint, and the surgical incisions are stitched. 
Recovery Time for Arthroscopic Knee Surgery
Everyone recover after arthroscopic knee surgery at a different pace. If necessary, patients use crutches or a walker for one to three days after surgery. If the pain is minimal, then you do not have to use crutches or a walker. Even you can walk with only a slight limp within five days after the operation. Some people find a stick to be useful.
It takes up to six weeks for the knee to restore normal joint fluid after arthroscopic surgery. Because of this, most of the patients do not realize the benefits of surgery for four to six weeks. There is a high degree of variability in recovery times. Some patients can return to normal activities within two weeks, but most require about six weeks before they can return to their activities – including sports – comfortably. Pain reduction and improvement in strength, and co-ordination may continue for three to four months. [2, 4]
Importance of Physiotherapy after Arthroscopic Knee Surgery
After undergoing arthroscopic knee surgery, it is important to begin exercising immediately to restore knee strength and to maintain a full range of motion. Initial activities should be non-weight bearing in nature, and should focus on strengthening the muscles surrounding the knee, as well as increase the range of joint motion.
You should expect to feel a gentle stretch in the performance of their initial exercises, but should not experience any pain. Any activity that causes significant distress or pain should be stopped immediately. It is also a good idea to ice and leg raises after performing these exercises to reduce swelling.
Your physical therapists aim to return you safely to the best function possible for your knee in the shortest period. They will assist you through their professional expertise to maximize your surgical outcome.
The following exercises are appropriate for immediate post-knee arthroscopy rehabilitation. The movements should be gentle and steady. Read on to review these four exercises. 
Lay on your back ( in supine position) on a flat surface. Place a rolled towel under your ankle between you and the surface. Push ankle down into the towel roll. Straighten knee as far as possible and hold the position for 5 sec. Relax and repeat ten times.
The quadriceps contraction exercises are an excellent way to get your quadriceps muscles working after surgery.
Hamstring Contraction Exercises
Hamstring muscles help bending the knee joint, and keeping them strong is important after surgery. Here is how you get them moving:
Lie on your back with knees bent a 10 to 120 angle position. Without moving your leg, pull heel into the floor, as if you were trying to bend your knee, but the floor is preventing a motion from happening. This will cause the hamstring muscles on the back of your thigh to contract. Hold this for 5 sec. Relax and repeat ten more times.
The gluteal set exercise is an excellent way to get your hips working and to help keep blood moving in your knees and hips after surgery. It is a simple exercise to do – here’s how:
Lie on your back with knees bent a 10 to 15-degree angle. Squeeze your buttock muscles together, like you are holding back flatulence. Hold for 5 sec. Relax and repeat ten more times.
Straight Leg Raises (SLR)
Straight leg raising(SLR) is a significant exercise to do after the operation, as they can help you in your hip and knee muscles work. Here is how you do them.
Lie on your back(supine position) on a flat surface. Bend the knee of your uninvolved leg to a 90-degree angle with your foot flat on the surface. Keep your affected leg straight without the knee bent. Slowly lift the affected leg six inches off the floor. Hold for 5 sec. Slowly lower your leg to the floor. Relax and repeat ten more times. 
Alternatives to Arthroscopic Surgery
- Modify activities to those less strenuous or demanding
- Weight loss. For many, weight loss is a basic but significant way to help avoid knee surgery
- Anti-inflammatory medications
- Physiotherapy and strengthening exercises
- Using a walking aid or wearing a brace
- Glucosamine sulfate and chondroitin to reduce pain and stiffness
- Therapeutic massage, acupuncture, or other body work
Latest on Knee Arthroscopy
Knee arthroscopic surgery is one of the most common orthopedic procedures in worldwide. Arthroscopic knee surgery — is proving to be an additional course of action for many patients who’s meniscus is torn. To validate the need for this procedure, a recent study published in the New England Journal of Medicine, compared patients who had a particular type of meniscal tear. These participants, who were between 35 to 65 either, had surgery or a sham procedure that mimicked everything related to surgery, but never actually carried out the operation. The authors found that both operated and unoperated patients reported an improvement in their knees a year later.[4, 5]
In 2007, a Canadian study compared the benefits of arthroscopic surgery to physical and medical therapy for osteoarthritis of the knee. The researchers concluded that physical and medical therapy provides a benefit equal to surgery. [4, 5]
In 2013, researchers compared the functional results of arthroscopic versus physiotherapy for patients with meniscal tears. They found that arthroscopy followed by post-operative physical therapy had no benefit over physiotherapy alone. [4, 5]
Of course, other non-invasive treatments can be equally useful. However, it is becoming clear that knee arthroscopy may not be as useful as claimed in certain situations, such as a torn meniscus. Surgeries, be minor or major come with some risks. Therefore, it is prudent to evaluate the pros and cons of undergoing any such procedure by consulting with multiple experts and by taking a reliable medical opinion. 
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- Complications in knee arthroscopy; Reigstad, Ole; Grimsgaard, Christian Knee Surgery, Sports Traumatology, Arthroscopy, Volume 14 (5) – May 1, 2006
- Exercise therapy is more beneficial than arthroscopic surgery in older knee patients; Nursing Standard, Volume 29 (43) – Jun 24, 2015
Dr. Kaleem Mohammed graduated as a Bachelor of Physiotherapy in 2014 from Deccan College of Physiotherapy, affiliated to Dr. N.T.R. University of Health Sciences, Vijayawada, India. Dr. Kaleem is an expert at handling physiotherapy needs of patients suffering from orthopedic and spinal conditions and post-surgery rehabilitation. Dr. Kaleem is associated with HealthClues since its inception where he facilitates diagnosis and advanced consultation with senior doctors. He is also a medical researcher and prolific writer who loves sharing insightful commentaries and useful tips to educate the patient community about fitness, treatment options, and post-treatment recovery.