Arthroscopic Knee Surgery: Common Questions & Post-Operative Instructions

What is arthroscopy?

Arthroscopy is a surgical procedure that orthopaedic surgeons use to visualize, diagnose, and treat problems inside of a joint. The word arthroscopy comes from the Greek words, “arthro” (joint) and “skopein” (to look). The term literally means to look within the joint.” During the knee arthroscopy, the surgeon will make 2-3 tiny incisions to insert the pencil-sized instruments. These instruments contain a small lens and lighting system to magnify and illuminate the structures inside the joint. By attaching the arthroscope to a miniature camera, the surgeon can visualize and examine the inside the joint. They can examine the bones, cartilage, and ligaments of the knee and repair or correct various problems or injuries.

Why is arthroscopy necessary?

Diagnosing a joint injury will always begin with a thorough medical history, physical examination, and radiographic studies (x-rays, MRI, CT scan, etc.). Through the arthroscope, a final diagnosis is made which is often more accurate than through traditional “open”surgery, x-ray studies, or MRI alone.

Some of the more common reasons that knee arthroscopy is done in pediatric orthopaedics include:

• Torn meniscus (cartilage inside your knee)
• Discoid lateral meniscus (abnormally formed meniscus)
• Loose bodies in knee joint
• Fractures in or near knee joint (although these will often require an “open” approach)
• Repair of torn ligaments (can require open surgery)
• Persistent knee pain with failure of conservative therapy (diagnostic knee arthroscopy)
• Removal of inflamed lining (synovium) in the knee

How is the arthroscopy performed?

Arthroscopic surgery is done in the operating room or surgical suite under a general anesthetic. Although the procedure can be done under a local block (regional anesthesia), it is usually done with general anesthesia in the pediatric population. A small incision (about the size of a buttonhole) will be made to insert the arthroscope into the knee joint. 2-3 additional buttonhole incisions are often needed to examine other parts of the joint or to insert other instruments. When indicated, corrective surgery is performed with specially designed instruments that are inserted into the joint through the accessory incisions. Many common knee injuries can now be treated arthroscopically.

What happens after knee arthroscopy?

After arthroscopic surgery, the small incisions will be covered with a bulky dressing and knee immobilizer. You will be moved from the operating room into the recovery room. Some patients will need little or no pain medication, although it is not uncommon to have pain if an injury was treated. The surgeon will usually put novocaine in the knee at the time of surgery for pain relief after surgery. This will often last for about six-eight hours after surgery. Pain medication should be used as needed for the first few days after surgery. After the novocaine wears off, it is not uncommon to have discomfort in the knee. The pain should be well controlled with Ibuprofen (Motrin) and/or Tylenol with Codeine (tablets or liquid). The dose will depend on weight of the patient. A prescription will be given and should be filled prior to going home from the hospital.

Once you are awake, tolerating drinking and eating, and pain is well controlled, you will be discharged home.

General Post-Op Instructions:

• To reduce pain and swelling, you should use ice and elevate the leg. A pillow can be placed under the knee for the first few days. Ice can be used 20 minutes on/20 minutes off for the first few days as well.
• You should place a towel or cloth between the skin and ice to prevent skin injury.
• The bandages on the knee can be removed after 2 days. The tiny incisions are usually closed with absorbable sutures (will not need to be removed). If there are steri-strips (small pieces of tape) covering the incisions, they will fall off on their own in about 7-10 days.
• If there is fever >100.4, redness, or drainage from the incisions, please call our office 617-726-8523.
• You can bear full weight and walk on the leg unless instructed otherwise by the surgeon. Crutches are usually needed for several days after arthroscopic surgery.
• Sometimes the knee remains slightly painful and swollen for several days or weeks after a knee arthroscopy (depending on the particular procedure done).
• Patients can usually return to school when they are comfortable. Most patients will return after 3-4 days following a knee arthroscopy.
• Sports, including gym, should be avoided until you are seen for your post-operative evaluation.
• Your surgeon will determine when you should start physical therapy to rebuild the strength in your leg and knee. This could be immediately after surgery or several weeks later. We will provide you with a prescription with specific instructions.
• You will need to schedule a post-operative clinic visit with your surgeon about 10-14 days after surgery.
• If you have any questions or concerns, please contact our office at 617-726-8523.