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.
Before your surgery is even scheduled you will meet with your orthopedic surgeon to talk over the surgical procedure, its risks and benefits, and any questions or concerns you may have.
Knee arthroscopy is an outpatient procedure, which means you arrive at the facility about an hour before surgery, have a procedure that lasts 30 minutes to one hour, and are discharged without an overnight hospital stay.
Our staff will check you in, have you change into a surgical gown, listen to your heart and lungs, and check your blood pressure, pulse, and temperature. We’ll start an IV to give you fluids and medications and prep the skin around the surgery area.
The anesthesia staff will meet with you and review your health history, past surgeries, and current medications, and discuss your anesthesia options.
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.
A surgeon and a physician’s assistant (PA) will lead your surgical team in the operating room.
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. MRIs can miss damage, but during an arthroscopy, your surgeon can see exactly what is problematic.
After surgery, your surgeon will explain what they found, any specific post-surgery restrictions, and any limitations you’ll have using your leg.
You’ll be placed on crutches the first day and will remain on crutches until you regain full sensation in your knee. Before weaning off 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 can take off the bulky surgical dressing from surgery and shower.
Caring for yourself after a knee arthroscopy can be easier if you have extra help. Don’t be afraid to ask for help if you need it.
Patients generally see their surgeon or a PA one to two weeks after an arthroscopy. 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.
It takes most patients four to six weeks before they’re 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 and patellofemoral joints are covered by smooth, hard cartilage. A cartilage defect or flap can cause a painful catch or click, limiting knee motion and making it hard to walk.
A damaged hard-cartilage flap can catch and damage remaining healthy knee tissue. Relatively small defects can sometimes be smoothed and polished with gentle motion exercises, like using an exercise bike with no resistance. Surgery may be required for severe hard-cartilage damage, .
A knee chondroplasty uses an arthroscope to remove fraying or flapped hard cartilage and smooth 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. 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.
Before your surgery is even scheduled you will meet with your surgeon to talk over the procedure, its risks and benefits, and your questions or concerns.
To start the 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, along with the ACL, are evaluated and repaired or 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: a 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’re returning to a sport or cutting and twisting-type activities are important, an autograft is typically used to reconstruct the ACL. Many tendons in your body can be used to reconstruct your ACL; however, the gold standard is to use a patellar tendon graft.
To do this, your surgeon harvests 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 allograft surgery. 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 wean off of them as you are able to tolerate weight – typically between one and three weeks. You will begin physical therapy a day or two after surgery. Your therapist will help determine when you are ready to walk without crutches.
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.
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, or cause pain, popping, and a feeling of instability in your knee.
This condition can be treated by removing the fraying or flapped meniscus arthroscopically and smoothing 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 depends on the size and severity of your injury.
After a meniscal repair, your surgeon will give you specific instructions and detail your post-surgery restrictions, but expect to use crutches for about six weeks after surgery.