ACL ReconstructionA Guide to Knee Arthroscopy

At The Orthopaedic Clinic, we are genuinely concerned that our patients have a full understanding of their injury, treatment options, and the rehabilitation required for a full, speedy recovery.  This handout is meant to complement the information you receive during your visit with Dr. Wilson.  We encourage you to read this and feel free to ask any questions concerning your treatment.  Our goal is to help you make a fully informed decision about your knee.

The Orthopaedic Clinic is the leading regional center of excellence for sports medicine and arthroscopy.  Utilizing state-of-the-art diagnostic and treatment techniques, Dr. Wilson offers a wide variety of conservative and surgical options for the patient with knee injuries.  Dr. Wilson has specialty training and extensive experience in the use of arthroscopic surgery to diagnose and treat the injured knee.

Our treatment philosophy for all patients is the same as it is for the athletes under our care; we pledge to deliver the highest quality care using state-of-the-art diagnostic and treatment techniques.

What is arthroscopy?

The arthroscope is a fiber optic instrument, narrower than a pen.  It is placed into the knee through a tiny incision (portal).  A small camera attached to the arthroscope, allows the surgeon to view the knee structures on a television monitor.  Using additional portals (usually 1), small instruments ranging in size from 3-5 millimeters are inserted into the knee.  These instruments allow Dr. Wilson to inspect and feel the joint structures, more accurately diagnose the injury, and then repair, reconstruct, or remove the damaged structures.

In the past, many orthopaedic injuries required complicated operations with large incisions, long hospital stays, and extensive physical therapy.  Today, many procedures are done entirely or in combination with the arthroscope, allowing for more accurate diagnosis, less invasive surgical intervention, and an accelerated rehabilitation process.  It must be kept in mind that not all surgery can be done through the arthroscope

What types of procedures can be done with arthroscopy?

Some of the more common arthroscopic procedures in the knee are partial menisectomy

(removal of torn cartilage) or meniscal repair, removal of loose fragments, smoothing of joint surfaces (chondroplasty), removal of inflamed joint lining (synovectomy), and lateral release of unbalanced kneecap (patella).

What is the difference between meniscal repair and partial menisectomy?

The meniscus is a cushion in the knee joint between the leg bone (tibia) and the thigh bone (femur).  It is commonly torn by twisting and bending activities in sports or even in routine daily activities.  Sometimes the tear is degenerative, meaning the damage is the result of wear and tear over time.

The location of the tear is an indication of whether the meniscus can be repaired or removed.   If the tear is in the outer third of the meniscus, there is usually an adequate blood supply so that it can be stitched together and healing will occur.  If the tear is located in the inner two-thirds of the meniscus, where most tears occur, the torn portion needs to be removed.  There is not an adequate blood supply in the inner two-thirds of the meniscus to permit adequate healing.

If the tear is removed, the patient can walk on the knee immediately.  If the tear is repaired, the meniscus requires six weeks to heal.  During the initial six weeks, the patient may bear weight on the knee, but must wear a brace to walk with the knee locked straight.

Don’t I need the meniscus?

If the meniscus is damaged it can cause further joint destruction, so it is better to remove the torn portion.  In the past, when the whole meniscus was removed, patients had good knee function for many years but eventually developed arthritis.  The arthroscopic procedure removes only part of the meniscus; normal knee functioning is expected unless pre-existing arthritis or chondromalacia (bad cartilage) is detected.

What are possible complications?

While complications are not common, all surgery has associated risks.  Possible complications include excessive stiffness after the surgery or pain in the knee or under the kneecap.  Your rehabilitation after surgery is specifically designed to address these issues.  Other complications, although rare, can arise from infection of the wounds, phlebitis, bleeding into the knee, or nerve injury.

What do I need to do to prepare for surgery?

Our staff will work with you to set up the surgery through your insurance company.

Prior to surgery you may be asked to perform some exercises at home or with a physical therapist.  These exercises prepare the knee for surgery by decreasing swelling, increasing motion, and maximizing the strength of your leg.

What type of anesthesia is used?

Spinal, epidural, or general anesthesia can be used for arthroscopic surgery.  Except for when general anesthesia is used, the patient can stay awake and watch the procedure on the television monitor.  An anesthetist is always present if there is a need for further sedation or pain control.  Prior to surgery, an anesthetist will discuss with you the various options and answer your questions.  Because Dr. Wilson is extremely experienced, the operation can be performed rather quickly.  The shorter amount of surgical time decreases the amount of anesthesia and limits the side effects of the anesthesia.

What happens the day of surgery?

The day before surgery you will be told what time to report to the hospital the next day.  It is very important to arrive on time.  You will be admitted to the hospital and taken to a pre-operative area where you will be prepared for your surgery and then taken to the operating room.

Note:  You may not eat or drink anything after midnight the night before your surgery.  If you must take medicine then you will be permitted to do so with just a sip of water.

After the operation, you will be taken to the recovery room to be monitored.  Here the staff will check that the effects of the anesthesia are wearing off properly and they will provide you with medication for any pain you are having.  Almost all patients go home the same day.  You will be given specific instructions to follow at home and discharged after you have adequately recovered.  If you have any questions about your operation or recovery, give Dr. Wilson’s office a call at (334) 749-8303.