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Knee Arthroscopy

(Also known as Arthroscopic Knee Surgery, Knee Arthroscope)
What is knee arthroscopy?
Knee arthroscopy is a minimally invasive surgical procedure that is used to investigate structures within the knee joint and treat a variety of knee conditions (such as a meniscal tear, ligament tear or arthritis). This is usually performed by inserting a small camera (arthroscope) into the knee joint via small incisions or portals (usually of less than 1cm in length). Other tiny instruments capable of cutting or shaving tissue within the knee joint may be inserted through other small incisions if required.
The knee joint primarily comprises of the union of two bones: the long bone of the thigh (femur) and the shin bone (tibia). The knee cap (patella) also sits on top of the femur forming the patellofemoral joint. Between the bone ends of the femur and tibia are two round discs made of cartilage called the medial (inner) and lateral (outer) meniscus. Articular cartilage also lines the joint surfaces of the femur, tibia and patella. The articular cartilage and menisci act as shock absorbers, cushioning the impact of the bones on each other during weight-bearing activity. In addition, strong ligaments and connective tissue hold the bones of the knee together, giving it stability.
Structures within the knee (such as cartilage or ligaments) may be damaged due to overuse or trauma. Occasionally these injuries may be beyond the body's healing capacity and may warrant the use of knee arthroscopy to assess or treat the condition. This may be particularly indicated in patients who have not responded to appropriate physiotherapy treatment and rehabilitation.
Knee arthroscopy is usually performed as a day procedure for patients who are having it as an investigative procedure or to treat torn cartilage within the knee.

Indications for knee arthroscopy
Knee arthroscopy may be indicated in patients with certain knee injuries, particularly those that do not respond to appropriate physiotherapy treatment and rehabilitation for their condition.
Knee arthroscopy may also be indicated as an investigative procedure to assess the integrity of structures within the knee such as the ligaments, menisci and articular cartilage. In this event, surgical treatment (such as trimming of a torn meniscus) may be indicated according to findings.
Some of the more common conditions treated via knee arthroscopy include:
An orthopaedic surgeon can assess a patient and determine the suitability of knee arthroscopy based on a number of factors. Some of these may include:
  • injury diagnosis and severity
  • degree of pain and disability experienced by the patient
  • patient age, occupation and activity levels
  • expected symptomatic and functional improvement following surgery
  • cost
Signs and symptoms following knee arthroscopy
Following knee arthroscopy, symptoms vary significantly from patient to patient depending on a number of factors such as the severity of injury prior to surgery, type of pain relief or anti inflammatory medication, strength and flexibility of the knee prior to surgery, age of the patient and quality of rehabilitation following the procedure.
  • A small percentage of patients may experience little or no symptoms following knee arthroscopy and may only notice minor soreness or stiffness. This is usually the case in younger patients who have had minor meniscal damage and excellent strength and flexibility of the knee prior to surgery.
  • Patients usually experience swelling, pain and knee stiffness with symptoms ranging from mild to severe. Pain may be felt in the front, back or sides of the knee or occasionally the thigh, calf, ankle or foot. Symptoms typically increase with excessive twisting or weight bearing activity (especially walking up hills or on uneven surfaces or standing still for prolonged periods), when climbing stairs, attempting to kneel or when squatting. The patient may also walk with a limp or be unable to weight bear due to pain. Symptoms may also increase with rest and may present as an ache, pain or stiffness that is particularly prominent at night or first thing in the morning.
  • Tenderness is usually experienced when firmly touching the knee joint line or surgical scars. The knee may also feel weak or unstable and in some cases may give way with certain movements. Occasionally bruising, pin and needles or numbness may also be experienced.

Treatment following knee arthroscopy
Following knee arthroscopy, most patients heal well with appropriate physical therapy. The success rate of treatment is largely dictated by patient compliance. A vital aspect of treatment is that the patient rests sufficiently from any activity that increases their pain. Crutches and / or a protective knee brace are often required for days to weeks as guided by the surgeon and treating physical therapist. Activities which place large amounts of stress through the knee should also be avoided particularly excessive twisting and weight bearing activities (such as prolonged standing or walking, lifting, squatting, kneeling and running etc). Rest from aggravating activities allows the healing process to take place in the absence of further damage. Once the patient can perform these activities pain free, a gradual return to these activities and weight bearing forces is indicated provided there is no increase in symptoms. This should take place over a period of weeks to months with direction from the treating physical therapist.
  • Ignoring symptoms or adopting a 'no pain, no gain' attitude is likely to cause further damage and may slow healing or prevent healing of the knee all together. Immediate appropriate treatment is vital to ensure an optimal outcome.
  • Following knee arthroscopy, patients usually benefit from following RICE. RICE is beneficial in the first 72 hours following surgery or when inflammatory signs are present (i.e. morning pain, pain with rest, or new swelling). This involves resting from aggravating activities, regular icing, the use of a compression bandage and keeping the leg elevated. Anti-inflammatory medication may also significantly hasten the healing process by reducing the pain and swelling associated with inflammation.
  • Patients who have undergone knee arthroscopy should perform pain-free flexibility, strengthening and balance exercises as part of their rehabilitation to ensure an optimal outcome. One of the key components of rehabilitation is pain-free strengthening of the quadriceps muscle (vastus medialis obliquus– VMO), along with hamstring, gluteal and calf strengthening to improve the control of the knee joint with weight-bearing activities. Hydrotherapy exercises or stationary bike are also often indicated to strengthen the knee in a low weight bearing environment. The treating physical therapist can advise which exercises are most appropriate for the patient and when they should be commenced.
  • In the final stages of rehabilitation, a gradual return to activity or sport can occur as guided by the treating physical therapist provided there is no increase in symptoms. The use of a protective brace or strapping tape may be indicated to provide additional stability to the knee during this phase of rehabilitation and as an ongoing form of injury prevention.

Prognosis following knee arthroscopy
Those patients who have a knee arthroscopy for minor meniscus tears can sometimes return to sport or activity within 4 – 6 weeks, although most surgical repairs (especially when the meniscus tear is moderate to severe) will usually require a rehabilitation period of 6 - 12 weeks or longer.
If there are signs of arthritis or damage to other structures in the knee, such as the articular cartilage, patellofemoral joint cartilage or knee ligaments, or if the patient experiences other surgical complications such as infection, or damage to local blood vessels or nerves, rehabilitation may require an extended period.
Those patients who have had an ACL reconstruction associated with their knee arthroscopy can usually expect a lengthy rehabilitation period lasting approximately 6 – 12 months.

Physical therapy following knee arthroscopy
Physical therapy treatment is vital to hasten the healing process and ensure an optimal outcome in all patients following knee arthroscopy. This should ideally begin prior to surgery. Treatment may comprise:
  • soft tissue massage
  • electrotherapy
  • the use of crutches
  • taping or bracing to support the knee
  • the use of a compression support
  • mobilization
  • dry needling
  • hydrotherapy
  • ice or heat treatment
  • progressive exercises to improve flexibility, balance and strength (especially the VMO muscle)
  • the use of Ultrasound to assess and retrain the VMO muscle
  • activity modification advice
  • education
  • biomechanical correction
  • anti-inflammatory advice
  • weight loss advice where appropriate
  • a gradual return to activity program
Other intervention following knee arthroscopy
Despite appropriate physical therapy management, some patients fail to improve adequately following surgery. When this occurs the treating physical therapist or doctor can advise on the best course of management. This may include further investigations, pharmaceutical intervention, corticosteroid injection, or further surgery. In patients with significant knee arthritis, who experience ongoing pain and disability, total knee replacement surgery may be indicated.