Arthroscopy

Arthroscopy (also called arthroscopic or keyhole surgery) is a minimally invasive surgical procedure on a joint in which an examination and sometimes treatment of damage is performed using an arthroscope, an endoscope that is inserted into the joint through a small incision. Arthroscopic procedures can be performed during ACL reconstruction. The advantage over traditional open surgery is that the joint does not have to be opened up fully. For knee arthroscopy only two small incisions are made, one for the arthroscope and one for the surgical instruments to be used in the knee cavity. This reduces recovery time and may increase the rate of success due to less trauma to the connective tissue. It has gained popularity due to evidence of faster recovery times with less scarring, because of the smaller incisions. Irrigation fluid (most commonly ‘normal’ saline) is used to distend the joint and make a surgical space. The surgical instruments are smaller than traditional instruments. Surgeons view the joint area on a video monitor, and can diagnose and repair torn joint tissue, such as ligaments. It is technically possible to do an arthroscopic examination of almost every joint, but is most commonly used for the knee, shoulder, elbow, wrist, ankle, foot, and hip.

Why it’s doneDoctors use arthroscopy to help diagnose and treat a variety of joint conditions, most commonly those affecting the:

  • Knee

  • Shoulder

  • Elbow

  • Ankle

  • Hip

Diagnostic procedures

Doctors often turn to arthroscopy if X-rays and other imaging studies have left some diagnostic questions unanswered.

Surgical procedures

Conditions treated with arthroscopy include:

  • Loose bone fragments
  • Damaged or torn cartilage
  • Inflamed joint linings
  • Torn ligaments
  • Scarring within joints

Risks

Arthroscopy is a very safe procedure and complications are uncommon. Problems may include:

  • Tissue or nerve damage. The placement and movement of the instruments within the joint can damage the joint’s structures.

  • Infection. Any type of invasive surgery carries a risk of infection.
  • Blood clots. Rarely, procedures that last longer than an hour can increase the risk of blood clots developing in your legs or lungs.

How you prepare

Exact preparations depend on which of your joints the surgeon is examining or repairing. In general, you should:

  • Avoid certain medications. Your doctor may want you to avoid taking medications or dietary supplements that can increase your risk of bleeding.
  • Fast beforehand. Depending on the type of anesthesia you’ll have, your doctor may want you to avoid eating solid foods eight hours before your procedure.
  • Arrange for a ride. You won’t be allowed to drive yourself home after the procedure, so make sure someone will be available to pick you up. If you live alone, ask someone to check on you that evening or, ideally, stay with you the rest of the day.
  • Choose loose clothing. Wear loose, comfortable clothing — baggy gym shorts, for example, if you’re having knee arthroscopy — so you can dress easily after the procedure.

What you can expect

Although the experience varies depending on why you’re having the procedure and which joint is involved, some aspects of arthroscopy are fairly standard.

  • You’ll remove your street clothes and jewelry and put on a hospital gown or shorts.
  • A nurse will place an intravenous catheter in your hand or forearm and inject a mild sedative.

During the procedure

The type of anesthesia used varies by procedure.

  • Local anesthesia. Numbing agents are injected below the skin to block sensation in a limited area, such as your knee. You’ll be awake during your arthroscopy, but the most you’ll feel is pressure or a sensation of movement within the joint.
  • Regional anesthesia. The most common form of regional anesthesia is delivered through a small needle placed between two of your spine’s lumbar vertebrae. This numbs the bottom half of your body, but you remain awake.
  • General anesthesia. Depending on the length of the operation, it may be better for you to be unconscious during the procedure. General anesthesia is delivered through a vein (intravenously).

You’ll be placed in the best position for the procedure you’re having. This may be on your back or on your side. The limb being worked on will be placed in a positioning device, and a tourniquet might be used to decrease blood loss and enhance visibility inside the joint.

Another technique to improve the view inside your joint involves filling the joint with a sterile fluid. This expands the area around the joint.

One small incision is made for the viewing device. Additional small incisions at different points around the joint allow the surgeon to insert surgical tools to grasp, cut, grind and provide suction as needed for joint repair.

Incisions will be small enough to be closed with one or two stitches, or with narrow strips of sterile adhesive tape.

After the procedure

Arthroscopic surgery usually doesn’t take long. For example, arthroscopy of the knee takes about an hour. After that, you’ll be taken to a separate room to recover for a few hours before going home.

Your aftercare may include:

  • Medications. Your doctor may prescribe medication to relieve pain and inflammation.
  • R.I.C.E. At home, may find it helpful to rest, ice, compress and elevate the joint for several days to reduce swelling and pain.
  • Exercises. Your doctor might prescribe physical therapy and rehabilitation to help strengthen your muscles and improve the function of your joint.

Call your surgeon if you develop:

  • A fever
  • Pain not helped by medication

  • Drainage from your incision

  • Redness or swelling
  • New numbness or tingling

Results

In general, you should be able to resume desk work and light activity in a few days. You’ll likely be able to drive again in one to three weeks, and engage in more strenuous activity a few weeks after that.

However, not everyone’s recovery is the same. Your situation might dictate a longer recovery period and rehabilitation.

Your surgeon will review the findings of the arthroscopy with you as soon as possible and may send a written report. Your surgeon will continue to monitor your progress in follow-up visits and address problems.