Knee Arthroscopy (Key Hole Surgery)

 

Overview

Keyhole surgery of the knee is a minimally invasive technique using a camera and instruments through very small (<1cm) incisions. This can be used for a variety of problems such as to remove or repair damaged tissue or guide ligament reconstruction (see ACL reconstruction). Commonly arthroscopy is used to trim or repair damaged meniscal tissue. This can be achieved with very little irritation to the surrounding joint.

Generally procedures take under 1 hour, depending on complexity. Patients can return home the same day as surgery. Specific post-operative instructions will vary depending on the details of your procedure

 

 

 

 

 

 

 

 

 

 

 

 

Introduction 

Arthroscopic surgery involves the surgeon operating using a camera and instruments through several very small (<1cm) incisions. 

The camera allows for thorough exploration and assessment of the joint. Arthroscopic surgery can be for a wide variety of reasons and the surgical procedure performed can vary considerably. 

Common reasons for surgery include meniscal repair, removal of loose bodies, trimming of cartilage, cartilage regeneration, further diagnosis or to assist with ligament reconstruction, patella stabilisation or other more complex surgery. 

 

Immediate post-operative goals 

  • You will be able to walk independently either with or without the assistance of crutches or a stick. 

  • You will be able to climb up and down stairs safely. 

  • You will be shown a programme of home exercises. 

  • Climb stairs one at a time until there is no pain on attempting a normal pattern. 

  • Please ask your nurse for advice on your dressings and care of the wound. 

 

Post-operative instructions 

  • Swelling is the main problem following this surgery; it restricts range of movement and can increase pain. In order to reduce swelling in the initial period, avoid long periods of walking and standing. You should rest and elevate the leg frequently for as long as you have significant swelling and/or pain. 

  • Ice can also help with the swelling. Ice up to five times a day for 15 minutes. A good time to ice is after you complete your exercises. Use an ice pack or a packet of peas in a plastic bag. Put a tea towel between the ice and your knee (never apply a bag of ice directly to the skin). You will have been advised about pain relief before leaving the hospital. 

  • Do the exercises three to five times a day. The exercises are designed to help you restore your range of movement which is your first goal post-operatively. Do not rest with a pillow under your knee; it is better to rest with the knee straight. You should continue with these until you have full movement in your knee equal to the other, your swelling and pain have resolved and you are walking normally. If you are seeing an outpatient physiotherapist, they will progress you through an exercise programme and oversee return to your normal activities. Do not rest with a pillow under your knee: it is better to rest with the knee straight. 

  • Wear shoes which are supportive and comfortable, i.e. low-heeled, good treads, closed heel and toe. 

  • Do not drive until you are able to perform an emergency stop without feeling pain.. You may want to double check with your insurance company first. 

 

 

Post-op exercises 

These initial exercises are designed to get you started and back on your feet, but if you have any other exercises from before your surgery, please discuss these with the ward therapist, and they will be able to advise whether you should continue. Avoid impact or heavy loading 

(e.g. running or jumping) until your follow-up review with your consultant at which point you may wish to discuss return to sports. 

  • Static quadriceps. Lying on your back.
    Pull your toes up towards you and push your knee down onto the bed so that your muscles in the front of the thigh tighten. Hold for five seconds then relax. Repeat 10 times. 

 

  • Inner range quadriceps. Lying on your back. Place a rolled up towel under your operated knee tighten the muscles at the front of the thigh and lift your heel off the bed whilst keeping your knee on the towel. Hold for five seconds then lower. Repeat 10 times

 

  • Straight leg raises. Lying on your back. Tighten the muscles at the front of the thigh. Lift your straight leg about 10 cm off the bed. Hold for five seconds then slowly lower. Repeat 10 times 

 

  • Lying on your back. Slowly bend your operated knee by sliding your heel towards your bottom. Go as far as feels comfortable then straighten. Repeat 10 times. 

 

  • Wall squats. Stand with your back against a wall and your feet about 20cm from the wall. Slowly slide down the wall as far as you feel in control (about 40°). Then return to the upright position. Repeat 10 times. 

 

 

 

 

 

 

 

  • This last exercise is more difficult so do not start immediately. When you feel your knee is strong enough you can start this exercise but stop if you experience increased swelling in your knee or you have a significant increase in pain.

Knee Arthroscopy (keyhole knee surgery) image showing torn cartilage. Nick Howells Specialist Knee Surgeon