Certain knee conditions may require surgery – especially if conservative treatment has not been successful. For example, an anterior cruciate ligament (ACL) tear often requires reconstruction to reestablish knee stability. Meniscus tears may also require surgery to remove or repair damaged tissue and prevent the knee from catching or locking.
Some knee surgeries can be done with an arthroscope, where your surgeon places surgical instruments through two small incisions to make repairs. This causes less harm to healthy tissues and greatly reduces recovery time compared to traditional surgery.
Arthroscopy can treat common knee problems like meniscus tears, cartilage damage, ligament tears, and arthritis. One arthroscopic knee surgery can often address multiple knee conditions.
Knee arthroscopy is an outpatient procedure, which means you arrive at the facility about an hour before actual surgery and don’t have to stay overnight in the hospital.
Our staff will check you in and conduct a brief health check, listening to your heart and lungs and checking your blood pressure, pulse, and temperature. We start an IV to give you fluids and medications.
The anesthesia staff will discuss your options for medications during surgery. A monitored anesthetic often lets you relax and fall asleep without the effects of a general anesthetic. At the end of your surgery, a local anesthetic is injected into the knee to help manage initial discomfort. Your surgery can last from 30 minutes to an hour, depending on how much repair needs to be done.
Once you are fast asleep in the operating room, your knee is filled with saline to expand the joint and make it easier for your surgeon to move surgical instruments and see tissues.
Your surgeon then puts an arthroscope into your knee. This tiny camera magnifies the structures in your knee and is hooked up to a large computer screen.
Once your surgeon can see into the joint, they make another incision, insert surgical instruments, and repair the damaged tissue. While in your knee, your surgeon will usually fix any repairable damage they find, even if it was unexpected. Even MRIs can miss damage, but during an arthroscopy, your surgeon can see exactly what is problematic. A Physician Assistant often helps your surgeon throughout surgery and understands what was done.
After surgery, your surgeon will explain what they found and discuss any limitations you have using your leg. You will be placed on crutches the first day and remain on crutches until you regain full sensation in your knee. Before weaning off the crutches, you should be able to bear full weight and walk comfortably. If more intensive work was done, you may need to use crutches for a few weeks and avoid placing weight on the leg.
Usually, your surgeon will ask you to just rest and recover for a few days after surgery. After that, you may take off the bulky surgical dressing from surgery and may shower. It can be hard to care for yourself after a knee arthroscopy, and you may need extra help. Your surgeon will go over any specific restrictions after surgery.
One to two weeks after an arthroscopy, patients can expect to see their surgeon or a Physician Assistant. They’ll discuss what they found, what was done, and your recovery process.
You will be asked to do ankle pumps right after surgery to help increase blood flow and prevent a blood clot from forming. This is important, since your activity level will decrease right after surgery.
On average, it takes most patients four to six weeks before they are back to daily activities; however, it can take up to six months to a year before they no longer notice any knee pain.
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Hard Cartilage Damage and Chondroplasty
Your knee joint is where the thighbone fits neatly onto the shinbone. Your patellofemoral joint is where the kneecap glides on the thighbone. These bony surfaces are covered by smooth, hard cartilage. A cartilage defect or flap can cause your knee to have a painful catch or click, which can limit knee motion and make it hard to walk.
A damaged hard-cartilage flap can catch and damage the remaining healthy tissue in your knee. If the defect is relatively small, it can sometimes be smoothed and polished with gentle motion exercises, like using an exercise bike with no resistance. For severe hard-cartilage damage, surgery may be required.
A knee chondroplasty is an arthroscopic procedure to smooth damaged hard cartilage. A surgical instrument removes fraying or flapped hard cartilage and smooths remaining tissue. You are often placed on crutches after this procedure, and can wean from them at your own pace. Your surgeon will detail your post-surgery restrictions.
ACL Tears and Autograft vs. Allograft Reconstructions
The thighbone and shinbone are stacked on top of each other and held together with tendons and ligaments. The anterior cruciate ligament (ACL) maintains knee stability by preventing the shinbone from moving forward in relation to the thighbone. Motions like cutting and twisting place big demands on the ligament, causing ACL tears. The ACL is one of a few ligaments in the body that does not repair itself; it must be surgically reconstructed for the knee to regain stability.
An ACL reconstruction is an outpatient procedure done with a general anesthetic and a nerve block. This provides more initial pain relief after surgery.
Your surgeon makes two small incisions, one on each side of your kneecap, and uses surgical instruments to go in the knee and evaluate damage.
When you tear your ACL, one or both menisci are often damaged. These tissues are evaluated and repaired or cleaned up. The ACL is evaluated and the remnants of the ligament cleaned up. The notch in the end of the thighbone is sometimes widened to allow space for the new ligament.
ACL reconstruction is done using a ligament or tendon graft. There are two types of graft: donated ACL ligament from a cadaver (allograft) or tissue from ligament or tendon from your own body (autograft). An ACL reconstruction done using an allograft involves less surgery and allows a quicker return to everyday activities. However, it takes a minimum of nine months before you can return to cutting and twisting-type activities.
If you are returning to a sport or cutting and twisting-type activities are important, an autograft is typically used to reconstruct the ACL. Tendons in your body can be used to reconstruct your ACL; however, the gold standard is to use a patellar tendon graft.
Your surgeon will harvest the middle one-third of your patellar tendon, with a small piece of bone from your shinbone and kneecap. Since an autograft involves more surgery, the initial recovery is slower and you may be on crutches a bit longer than those who use an allograft. However, with autograft ACL reconstructions you can return to cutting and twisting activities, including sports, as soon as six months after surgery.
Regardless of the graft choice for ACL reconstruction, a hole is drilled through your shinbone and thighbone and the graft is placed with a screw made of a bone-like substance. After the graft is in place, your surgeon will move your knee around to make sure the newly reconstructed ACL is in the correct location and is tight without pinching. If an autograft was used, the incision is sewn up and a local anesthetic injected for initial pain control.
After this procedure, you will be on crutches but can begin to wean off of them as you are able to tolerate weight – typically between one and three weeks. You will begin physical therapy the day or two after surgery. Your therapist will help determine when you are ready to walk without crutches. Your surgeon will detail any post-surgery restrictions.
Meniscus Tears and Debridement vs. Repairs
Between the thigh and shin bone is the meniscus – two C-shaped pillows of soft cartilage that absorb shock, increase stability, and lubricate the knee.
The meniscus is often injured by twisting movements in a squatting position, like lifting a box or misstepping on uneven ground. This can cause pain, popping, and a feeling of instability in your knee.
The meniscus can fray or completely tear, causing a flap of tissue to catch within the knee joint. Sometimes a piece of the meniscus can flip up and cause the knee to lock.
This condition can be treated with arthroscopy. A surgical instrument removes the fraying or flapped meniscus and smooths remaining tissue. After a meniscal debridement you are often placed on crutches and can wean from them at your own pace.
Your surgeon repairs a completely torn meniscus using sutures with attached anchors to fasten the meniscus to the joint capsule. The number of sutures used will depend on the size and severity of your injury.
After a meniscal repair, your surgeon will give you specific instructions, but you can expect to use crutches for about six weeks after surgery. Your surgeon will detail your post-surgery restrictions.