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Looking Into Your Knee Problem

Your knees work hard each day. So it's not surprising that problems can develop. Injury, overuse, weakness, or aging can harm your knees. To help you move in comfort again, your orthopaedic surgeon may recommend arthroscopy. This procedure gives your surgeon access to your knee joint, using only small incisions.

Your Orthopaedic Evaluation

Your surgeon will ask about the history of your knee problem. You may be asked whether your symptoms began after an injury. You will also be examined. In some cases, one or more diagnostic tests may be needed.

Physical Exam

Your knee will be checked for swelling, tenderness, and stability. Your knee's ability to move (its range of motion) may also be checked.

Diagnostic Tests

X-ray images can show breaks in your bones or abnormal bone structures. X-rays may also show arthritis (wear and tear on the joint). Your surgeon may suspect damage to soft tissue. In that case, MRI (magnetic resonance imaging) may be used.

The Role of Arthroscopy

Knee arthroscopy is often done to confirm a diagnosis. It's usually an outpatient procedure. In most cases, your surgeon can treat your problem at the same time.

The Arthroscope

The arthroscope is a device that looks directly into joints. The arthroscope contains a light source, a camera, and a pathway for fluids. An intense, cool light is beamed into the joint. The camera sends an image of the knee joint to a monitor. Sterile fluid may be used to expand the joint. This makes it easier for the surgeon to work.

The Procedure

Lab tests may be done before your arthroscopy. On the day of your procedure, stop eating and drinking as directed. Just before the arthroscopy, you will receive anesthesia to make you comfort- able. Then, a few small incisions (portals) are made in your knee. The portals are half an inch long or less. An arthroscope is inserted through one portal, and your surgeon looks inside your knee. Knee problems can often be treated with special tools inserted through the other portals.

Inside Your Knee

A healthy knee moves easily. But when joint problems occur, movement may cause pain. In many cases, arthroscopy can help.

A Healthy Knee

The knee joins the upper and lower leg bones (femur and tibia). A cushion of cartilage (meniscus) sits between these bones. The ends of the bones and the back of the kneecap (patella) are covered by smooth articular cartilage. This helps the joint move easily. Soft tissues (muscles and ligaments) make the knee stable and strong.

Common Knee Problems

Meniscus Tears

A sudden twist or repeated squatting can tear the meniscus. This may make your knee hurt or swell. Your knee may also catch or lock when you move it.

ACL Ligament Tears

A fall, twist, or blow may tear the anterior cruciate ligament. ACL tears can cause pain, swelling, and an unstable knee.

Cartilage Wear

Aging or injury may wear away articular cartilage. A piece may break off in the joint. You may feel pain, stiffness, or grinding.

Patella Problems

Aging, overuse, or injury may damage cartilage under the patella. This can limit joint movement. Structural problems may cause uneven wearing or pain.

Common Treatment Options

Meniscus Removal or Repair

Your surgeon may remove or repair damaged meniscal tissue. Torn tissue on the inside of the meniscus is often removed. Newly torn issue on the outer edge of the meniscus can often be repaired. This tissue gets enough blood to heal properly.

Ligament Reconstruction

Your surgeon can reconstruct a damaged anterior cruciate ligament. The damaged tissue is replaced with healthy, strong tissue. The graft may come from the patellar ligament or from another source.

Cartilage Shaving or Removal

Your surgeon may smooth or shrink rough cartilage by shaving it or using a thermal device. Or, your surgeon may drill exposed bone to make the cartilage grow. Any loose bodies may be removed.

Patella Smoothing or Release

Your surgeon may smooth or shrink bands of cartilage under the patella by shaving them or using a thermal device. If the patella is tilted, your surgeon may clip bands of tissue. This is called a lateral release. It aligns the patella with the femur.

After Arthroscopy

You'll spend a brief time in recovery after surgery. Once you're home, take it easy. You'll have a few small incisions to care for. But with arthroscopy, scarring and pain are often limited.

In the Recovery Room

Your knee will be bandaged, iced, and elevated. Medications will help reduce swelling and pain. A nurse will monitor you. When you're awake and alert, the nurse will help you get ready to go home.

Going Home

You may go home a few hours after arthroscopy. The anesthesia and pain medication are likely to make you sleepy. So arrange to have someone drive you home. Before leaving, make sure you have all the prescriptions and instructions you'll need. You may receive crutches to help you walk.

Your Home Recovery

At home, follow your surgeon's instructions. He or she may want to see you during the first weeks after arthroscopy. If needed, you may be referred to a physical therapist to help you regain movement.

Relieving Pain

To reduce swelling and pain, elevate your leg. For the first two days, ice your knee 20 to 30 minutes a few times a day.

Showering

You can shower once your healthcare provider says it's OK. You may be asked to cover your leg with plastic to avoid wetting your bandage and incisions. Getting these wet increases your chance of infection.

Exercising

Certain exercises can speed recovery. Your doctor may ask you to walk or do the exercises shown here a few times daily. Use slow, steady movements. And always exercise both legs to keep your muscles balanced. A physical therapist may also design an exercise program for you. This will help improve muscle strength and joint function.

Getting Back in Action

Your surgeon's skills and your own efforts can help you get moving soon. After knee arthroscopy, most people can return to office work within a week. And many return to a more active life within 1 to 2 months.