Arthroscopic knee surgery allows the inside of the knee to be visualised and operated on through very small incisions. Many common knee problems can be fully identified this way. Some conditions, such as cruciate ligament tears may require further surgery, but many problems may be resolved by arthroscopic procedures, resulting in faster recovery, minimal scarring and shorter hospital stays. Up to 3 incisions are made around the knee, through which the arthroscope and other surgical instruments are passed. The instruments are 2-3mm in diameter and are seen clearly through a fibre optic camera attached to the scope.
The surgeon may decide to perform any of the following common procedures:
The menisci are 2 thick C shaped rings of fibrous cartilage. They are wedge-shaped and are attached to the tibia. One of the functions of the menisci is to cushion and distribute weight through the lower leg from the upper leg. These menisci may become torn following a twisting injury, or with time and wear and tear. In most cases the torn part is simply removed, but in rare cases the damaged portion may be repaired using ‘meniscal arrows’ or sutures.
The knee joint is contained within a bag-like structure called the ‘synovial membrane’. The membrane secretes synovial fluid that helps lubricate the joint. If this becomes torn, thickened or inflamed it can be trimmed or removed arthroscopically.
The surfaces of all the bones in the knee are covered with a layer of articular (chondral) cartilage. A smoother surface can be achieved by shaving flaps of damaged tissue following injury or chondral changes.
Returning to Work/Sports
You may return to work as soon as you feel able, but you may need to make alternative travel arrangements. This may also depend on whether your job is sedentary or more physical. Returning to sport should be at your consultant’s discretion.
You are advised not to undertake any exercise or sports, other than those taught by your physiotherapist, until your consultant is happy.
Depending on your consultant and the extent of your surgery you may need to arrange outpatient physiotherapy.
You may find that small nodular swellings occur at the site of the incisions. These will resolve spontaneously with time and should not cause alarm.
After Your Operation
Your physiotherapist will see you before or following your surgery. They will explain the exercises, make sure you can mobilise and manage the stairs safely, and advise you on what to do over the coming days.
Your knee will be bandaged, and your nurse will explain the exact procedure and time for removal of the dressings. It is important that you keep the knee dry until the incisions have healed (usually about 8-10 days).
Post-Op Aims of Physiotherapy
- Decrease swelling
- Restore strength and range of movement of the knee joint
- Restore normal walking pattern.
These should be done 4 times a day. You may increase the number of repetitions as able, starting with 10.
Once your bandage has been removed, you can apply ice to the knee. A packet of frozen peas in a pillow case applied to the top of the knee for 15-20 minutes will be effective. If you do not have a waterproof dressing, ensure the wound stays dry. The ice pack can be applied 3 or 4 times a day for 20 minutes. This will reduce swelling and pain, aiding movement of the joint.
You may get up and walk with supervision as soon as you feel able, following surgery. You will be supplied with crutches if they are required, and you will be taught how to use them correctly. It is important that you can manage the stairs prior to discharge from hospital. Your physiotherapist will explain the procedure and you should use this technique for the first few days. After this time, if you are able to manage the stairs normally, you should do so. If you are using crutches or are only able to do the stairs one step at a time, remember: Good leg up to heaven, bad leg down to hell
Exercises - Perform ALL exercises 4 times each day
1. Static Quadriceps Contraction
With your leg straight out in front of you, place a rolled up towel under your heel. Pull your foot towards you, tighten your thigh muscles and press your knee down onto the bed. Hold for 5 seconds and then relax. No towel will be necessary if extension is achieved. Repeat 10 times.
2. Straight Leg Raises
Starting in the same position as number 1, lift your leg a few inches off the bed, keeping the knee straight. Hold for 5 seconds and then slowly lower your leg back onto the bed and relax before repeating. Repeat 10 times.
3. Knee Flexion
Resting with your knee extended in front of you. Slide your foot up the bed towards you, bending the knee as far as pain allows. Do not force this movement. Repeat 10 times.
4. Inner Range Quadriceps
Place the rolled up towel under your knee, so that your knee is bent. Push the knee on to the roll, lift your foot and straighten the knee (ensure the knee remains on the towel). Hold for a few seconds and then relax. Repeat 10 times.
5. Hamstring Curls
Standing with support, bend your operated leg behind you, as far as possible. Hold at the end of your range of movement, then gently lower. Repeat 10 times.
6. Knee Extensions in Standing
Stand up straight, brace both knees back to straighten them by tightening your thighs and buttocks. Hold for a few seconds and then relax. Repeat 10 times.