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Arthroscopic Knee Surgery

A Treatment Option For Some Causes of Knee Pain

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Updated May 27, 2014

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

knee arthroscopy surgery arthroscopic

Performing arthroscopic knee surgery.

Photo © Piotr Wzietek
Arthroscopic knee surgery may be a treatment option for certain types of knee pain. Arthroscopic surgery is a procedure that involves inserting a small camera inside the joint. Through other small incisions, instruments can be inserted to repair or remove damaged structures. Arthroscopic knee surgery is often called "scoping the knee" or knee arthroscopy.

Reasons to Perform Arthroscopic Knee Surgery

Not all causes of knee pain can be effectively treated with an arthroscopic procedure. Some of the reasons to perform an arthroscopic knee surgery include:
  • Torn Cartilage/Meniscus Surgery
    Meniscectomy is official name of the surgery that involves the removal of a portion of the meniscus cartilage from the knee joint. The meniscus is a shock-absorbing wedge of cartilage that sits between the bone ends to provide cushioning and support. Smaller meniscus tears can usually be trimmed to relieve the symptoms of a torn meniscus.
  • Meniscus Repair
    A meniscus repair is a surgical procedure done to repair the damaged meniscus. The meniscus repair can restore the normal anatomy of the knee, and has a better long-term prognosis when successful. However, the meniscus repair is a more significant surgery. The recovery is longer, and, because of limited blood supply to the meniscus, repair of the meniscus is not always possible.

  • ACL Reconstruction
    The anterior cruciate ligament, or ACL, is one of four major knee ligaments. The ACL is critical to knee stability, and people who injure their ACL often complain of their knee giving out from under them. Therefore, many patients who sustain an ACL tear opt to have surgical treatment of this injury. A majority of the ACL surgery is performed arthroscopically.

  • Plica Excision
    A plica is a remnant of tissue leftover from fetal development. In early development, your knee was divided into separate compartments. The dividers of the compartments are gradually lost over time, but some remnant remains. When this remnant tissue is more prominent, it is called a plica. When the plica is irritated, it is called plica syndrome. A plica resection is performed to remove this irritated tissue.

  • Lateral Release
    The kneecap moves up and down the end of the thigh bone in a groove of cartilage. The kneecap can be pulled to the outside of this groove, or may even dislocate from the groove, causing pain with bending of the knee joint. A lateral release is performed to loosen the ligaments that pull the kneecap toward the outside of the groove.

  • Microfracture
    Microfracture is a treatment used to stimulate the body to grow new cartilage in an area of damaged cartilage. In a microfracture procedure, the firm outer layer of bone is penetrated, to expose the inner layers of bone where marrow cells exist. These cells can then access the damaged area and fill in the gap of cartilage.

  • Autologous Chondrocyte Implantation
    Cartilage transfer involves moving cartilage from healthy parts of the joint to damaged areas. Small plugs of cartilage are removed, with a portion of underlying bone, and transferred to the area of damage. The plugs are taken from areas of the joint where the cartilage surface is not needed.

  • Cartilage Transfer/OATS
    Cartilage transfer involves moving cartilage from healthy parts of the joint to damaged areas. Small plugs of cartilage are removed, with a portion of underlying bone, and transferred to the area of damage. The plugs are taken from areas of the joint where the cartilage surface is not needed.

Performing Arthroscopic Knee Surgery

Knee arthroscopy can be done under general, regional, or local anesthesia. After adequate anesthesia, your surgeon will create 'portals' to gain access to the knee joint. The portals are placed in specific locations to minimize the potential for injury to surrounding nerves, blood vessels, and tendons. Through one portal, a camera is placed into the joint, and through others, small instruments can be used to address the problem. Patients who have arthroscopic knee surgery under a regional or local anesthesia can often watch their surgery on a monitor to see what is causing their problem.

The length of the knee arthroscopy procedure varies depending on what your doctor needs to accomplish. After surgery, your knee will be wrapped in a soft bandage. Depending on the type of surgery performed, your doctor may or may not allow you to place weight on the affected leg. Most patients will work with a physical therapist to regain motion and strength of the joint. The length of rehabilitation will also vary depending on what procedure is performed at the time of surgery.

Complications of Arthroscopic Knee Surgery

Complications of arthroscopic knee surgery include infection, swelling, and blood clots in the leg. Complications are unusual after knee arthroscopy, and while they are cause for concern, knee arthroscopy is considered a low-risk surgical procedure.

One interesting problem has been the use of knee arthroscopy for the treatment of early knee arthritis. There have been studies looking into the use of arthroscopic knee surgery on patients with early osteoarthritis of the knee joint. In general, patients who have osteoarthritis of the knee do well with arthroscopic surgery when their symptoms are coming primarily from loose or torn cartilage, whereas generalized discomfort is unlikely to improve with arthroscopic knee surgery. Determining the source of discomfort is critically important to predicting the outcome of surgery for this problem.

Sources:

Richmond J, et al. "Treatment of Osteoarthritis of the Knee (Nonarthroplasty)" J. Am. Acad. Ortho. Surg., September 2009; 17: 591 - 600.

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