Arthroscopy of the Knee

Knee arthroscopy allows direct inspection of the joint and its structures, and treatment of several conditions that can occur within it. This is usually done as same-day surgery.

Knee Arthroscopy Surgery

Knee arthroscopy is performed to treat problems with the menisci (commonly referred to as “cartilages”), ligaments, joint lining, or the joint surfaces (“hyaline cartilage”). Occasionally surgery will be to remove loose bony fragments, take a sample of tissue (biopsy), or diagnose or treat joint infection.

Before Surgery

You should stop any anti-inflammatory medications, including aspirin, one week before surgery. These drugs may interfere with blood clotting. If you are taking aspirin or Warfarin for anti-clotting purposes associated with previous blood clots or heart disease, you may need to continue with this medication. This should be discussed with Dr Parker. Remember to bring your X-rays and any other tests, such as MRI scans to the hospital with you. Please ensure that you have no cuts or scratches on your skin, as this is an infection risk, and will usually result in surgery being deferred.

Day of Surgery

Prior to surgery you will meet the anaesthetist who will discuss your past medical problems and anaesthetic history. The surgery is almost always performed under a general anaesthetic. Dr Parker will also see you prior to the surgery. You will be repeatedly asked by the hospital staff “which side”. Don’t be alarmed, it is not that we don’t know but is a check.

After anaesthesia is commenced your leg is examined to assess ligamentous stability, and then the arthroscope and instruments are inserted by two small incisions approximately one centimetre long at the front of the knee. The joint is distended with fluid to allow a clear view. Surgery is performed through the small incisions with the images on a television monitor. Local anaesthetic is injected into the joint to reduce pain after surgery. This wears off after 12 hours and you may notice an increase in pain at this time.

Following surgery, a three layer dressing of gauze, padding and tubigrip bandage is applied which should remain in place for approximately 2 days. You should keep this dressing dry. You will see Dr Parker in the recovery area or ward after surgery. He will give you a brief report of the operation with an instruction sheet and a referral for your physiotherapist. If you do not have a regular physiotherapist, Dr Parker will recommend one near to your home or work. It is helpful if a relative is with you after the Surgery as you may not retain all that you are told because of lingering effects of anaesthetic agents.

After Surgery

Postoperative Pain

The local anaesthetic injection into the joint at surgery wears off approximately 12 hours after the surgery. You may notice a gradual increase in pain at this time. Rest, elevation, ice and pain medication are all helpful in relieving pain for the first 1 to 2 days after surgery. On discharge from hospital you will be provided with a prescription for some painkillers which you can use when this occurs. The prescription painkillers will be quite strong and should be used when the knee is very uncomfortable. If the pain is relatively mild then a non-prescription tablet such as paracetamol can be used.

Pain the day after surgery usually occurs with activity and a quiet day at home should be planned. Too high an activity level soon after surgery can prolong recovery time and cause unnecessary setbacks.

If you are having trouble walking then you may need to use crutches for a short period until you feel as though you are walking relatively normally. These can be supplied by the Physiotherapist at the hospital if it looks as though they will be necessary.

Dressings

Your knee will have a heavy bandage on at the end of the procedure. This can be decreased in size on the second post-operative day. On the second morning after surgery remove the dressings down to the paper tapes (called Steri-strips) which hold the portals closed. Usually there are no sutures. Leave the Steri-strips in place and partly cover with the adhesive dressings given to you at the hospital. Then reapply the outer elastic bandage over the top of these dressings. The waterproof dressings allow you to have a shower but not swim or bathe. Dry the area thoroughly after showering. The wounds need to stay dry until you are seen by Dr Parker.

Follow up Visits

Please call Dr Parker’s office the next working day to schedule a follow up visit 2 weeks after surgery. Usually one visit only is required. If you have any concerns, then you should get in touch with Dr Parker prior to the arranged appointment. This can be done by calling the rooms at the above number during office hours (8.30am to 5.30pm) or by calling the North Shore Private Hospital (02 8425 3000) or Royal North Shore Hospital (02 9926 7111) switchboards outside office hours who can then contact Dr Parker.

Rehabilitation

Rehabilitation starts immediately after surgery.

  • Tense your thigh muscle (quadriceps for 10 seconds then relax for 10 seconds). Repeat for two minutes every waking hour
  • Ankle movement exercises to prevent blood pooling in the calf. Move toe from fully pointed down to up for 2 to 3 minutes every hour
  • Straight leg raising exercises to 45 degrees, 3 sets of 10, three times daily

Physiotherapy

You will be given a referral to a physiotherapist for post-operative supervised rehabilitation. This is to help you regain your movement and strength. You should see the physiotherapist within 2-3 days of leaving the hospital. Usually only 3-5 visits are required, with the physiotherapist teaching exercise routines that are appropriate for your age and activity level

Return to Work & Sport

Sedentary work

2 - 3 days

Physical work

2 to 6 weeks

Light training

10 days - 3 weeks depending on swelling

Competitive sport

3 to 6 weeks depending on progress. Speed of recovery will obviously vary depending on what is actually done at the time of the arthroscopy.

Complications

Arthroscopic knee surgery is very commonly performed and usually without any significant complications. However all surgery carries risks including infection, blood clots, problems related to the anaesthetic and inadvertent injury to blood vessels or nerves.

Infection is exceedingly rare following arthroscopic knee surgery. When it occurs it is manifested by increasing pain, swelling, fever or redness around the incision. If in doubt check with Dr Parker. Blood clots (deep venous thrombosis) may present as calf pain or unexplained swelling and should be reported to Dr Parker immediately.

Costs of Knee Arthroscopy

Dr Parker’s charges and any associated gap not covered by Medicare and your health fund will be discussed with you when your surgery is arranged. Please feel free to discuss any aspect of this which is unclear to you, either with Dr Parker or his secretary.

If you have any questions concerning your surgery, its risks, benefits, likely outcome or complications please do not hesitate to contact Dr Parker.

CHATSWOOD

Level 1, The Gallery
445 Victoria Ave
Chatswood NSW 2067
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Suite 1.08, Mater Clinic
25 Rocklands Road
Wollstonecraft NSW 2065
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