Knee arthroscopy

If you are interested in finding out about arthroscopy knee examination surgery, and the reasons for arthroscopy knee examination, the following information will interest you.

If you are considering knee arthroscopy or have an operation planned, it is important to know all you can about it. This includes:

• why you need this operation

• what it will be like

• how it will affect you

• what risks are involved

• any alternatives.

The information here is a guide to common medical practice. Each hospital and doctor will have slightly different ways of doing things when carrying out arthroscopy knee operations, so you should follow their guidance where it is different from the information given here. Because all patients, conditions and treatments vary it cannot cover everything. Use this information when discussing the option of arthroscopy examination with your doctors. You should mention any worries you have. Remember that you can ask for more information at any time.

What is the problem?

You probably have a painful or swollen knee. It may not straighten fully. It may feel weak and unsteady. Your knee may give way or may feel that it is going to give way. This is called having an unstable knee or instability.

What is inside the knee joint?

The knee is quite a complex hinge joint. It is formed by the ends of the femur and the tibia. There are:

• The joint surfaces - The femur has 2 smooth, rounded joint surfaces. They move on the nearby flat joint surfaces on the tibia.

• The cartilages - To reduce friction, the joint surfaces are covered with cartilage. This cartilage is the smooth white layer that you see on the end of a lamb or chicken bone where it forms a joint. A “torn cartilage” does not refer to a problem with this layer.
• The meniscus - These are two half-moon shaped structures that sit on the top of the tibia. When people say that someone has a torn a cartilage in the knee they are actual­ly referring to a torn meniscus. 
• The patella - The patella is the bone at the front of the knee, commonly called the kneecap.

• Cruciate ligaments - These are two ligaments between the femur and the tibia. These ligaments make a cross, hence the name cruciate ligaments. One ligament starts at the front and is called the anterior cruciate ligament or ACL for short. The other starts at the back of the knee and is called the posterior cruciate ligament or PCL. These cruciate ligaments keep the femur and the tibia properly aligned as you bend and straighten your knee.

What has gone wrong?

There are several possible problems:

• You may have arthritis in part of your knee. The cartilage on the joint surface may be wearing away.
• You may have a tear in a meniscus from an injury.
• You may have torn one of the cruciate ligaments during an injury.
• You may have a loose piece of bone in your knee joint. This usually happens when the joint cartilage has worn away.

The aims

The aim of the arthroscopy is to look inside your knee using a tiny telescope to see what the problem is. We may be able to treat the problem at the same time using fine instruments.

If you have a torn meniscus, we will remove the torn part. If you have a loose body in the knee we will remove it. We will be able to see if you have a torn cruciate ligament. While you are under the anaesthetic, we will be able to feel how unstable your knee is with this injury. If your cruciate ligament is torn you may need another operation to replace it. It cannot be repaired. We can see if you have any arthritis and, if you do, how bad it is. In addition, having the arthroscopy may improve your symptoms due to the washing out of the joint that is part of the operation.

The benefits

If you have a problem that can be corrected, the operation should stop the pain in your knee and allow you to return to your previous activities. If you have a problem such as a torn ligament, the arthroscopy will confirm the diagnosis and allow us to plan future treatment.

Are there any alternatives?

There are many ways of investigating knee problems. Arthroscopy is the only one that gives a direct view of the inside of the joint. If you have a torn meniscus or a loose body in your knee we will be able to remove the torn meniscus or loose body straight away. 

What if you do nothing?

The condition is not dangerous in itself. However, without an operation your knee will not improve. It could get worse.

Who should have it done?

You should have the arthroscopy if one of the following applies to you:

• You have injured your knee and you cannot get it completely straight. This is usually due to a torn meniscus.
• You have injured your knee and it is swollen by blood in the joint. Bleeding into the knee joint usually causes a large swelling within an hour or so. Drawing blood from the knee joint with a needle will confirm this bleeding. This often means there is a torn ligament in the knee.
• You have had an MRI scan that shows a problem in the knee, such as a torn ligament or meniscus.
• You have mild arthritis of the knee.

Author: Mr Boyd Goldie MBBS FRCS BSC DHMSA. Consultant in Orthopaedics & Trauma.

© Dumas Ltd 2006

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