Arthroscopy of the knee is usually performed to diagnose and treat internal knee problems such as cartilage tears, (meniscal tears), loose bodies, arthritis and a lead up for ligament damage surgery. On occasions, arthroscopy may be used for other conditions, which will be explained to you by your surgeon, Mr Morris. Simple arthroscopy procedures are carried out in hospital as a Day Case. Occasionally you may require an overnight stay for medical reasons.
What to Expect when having a Knee Arthroscopy
The following video provides an overview of a typical patient experience having knee arthroscopic surgery as a Day Case procedure.
On the day of your surgery, you will initially meet the nursing staff in the Day Care Unit and have a brief check up by your anaesthetist. Your knee will then be prepared with hair removal and a wash. From the Day Care Unit you will be taken to the operating theatre to meet Mr Morris prior to your surgery. In most cases, the knee arthroscopic procedure will be carried out under a general anaesthetic.
Knee Arthroscopy Surgery – Outline of the Procedure
Knee Arthroscopic Surgery
Your knee will be washed with antiseptic solution and a tourniquet applied to the thigh to prevent bleeding during the operation.
The arthroscope is introduced into the knee through a small puncture wound beside the knee cap. Initially a thorough examination is made of the entire knee and then particular reference is made to the problem as discussed with you by Mr Morris.
Cartilage damage, loose bodies and arthritis are then treated with small instruments that may be introduced through a second puncture wound on the other side of the knee cap. Photos are taken of your knee during your procedure.
At the end of the operation, the small puncture wounds will be closed with steri strips (an occasionally with sutures), the knee is then wrapped up with a sterile bandage.Arthroscopic Surgery of the Knee
You will find 2-3 small puncture wounds under the compression bandage covering your knee. These are made by the surgical instruments used during the procedure and are closed by tapes called steri strips. Although these wounds are only small, the surgery inside your joint is quite significant and your joint will take time to recover. It is important that you follow the instructions on this sheet to help healing and to maintain the muscle strength and range of movement of your knee.
You will be required to rest completely for the first 2-3 days following surgery. This means Sitting in bed or on the couch, doing some light exercises and icing the knee regularly. By the 3th or 4th day you may start to walk around a little. If you work in an office you may then return to work. More active jobs may require longer periods off work e.g. up to 2-3 weeks for manual labourers.
It is very important not to push your knee too hard, as this will slow the healing.
Signs that indicate that you are doing too much include:
increase in temperature in the joint.
This area should remain dry until your surgeon removes the tapes 10-14 days after your knee arthroscopy.
The areas may be slightly tender and puffy for 1-2 months after your knee arthroscopy and will benefit from gentle massage once healed. There may be some bleeding from the portal site. This is nothing to worry about in general. Excessive bleeding may require re-bandaging. Please call your knee surgeon if this happens.
The amount of swelling following a knee arthroscopy varies with different people and tends to depend on the pre-operative state of your knee and on how much is done to your knee at the time of surgery. An increase in the amount of swelling int he first few days after your operation indicates that you are progressing your activities too quickly. It is important to decrease the amount of swelling as quickly as possible, as it will cause problems with healing, strength and range of movement.
You can decrease the swelling in your knee by:
not overdoing things
using a compressing bandage
using crutches to reduce the weight
keep the leg elevated as much as possible
using ice at regular intervals.
Ice cubes should be wrapped in a wet towel and applied to your knee for 15 minutes.
You should frequently check your leg to ensure that it is pink in colour and not white or blue, as this will result in ice burn. You may apply ice 3-4 hourly, but each application should only be of 15 minutes duration.
Ensure that you take the tablets (Panadeine or Panadeine Forte) if you have pain.
If your pain is not controlled by tablets, please call your knee surgeon.
You may commence weight bearing after 1-2 days. DO NOT DO TOO MUCH TOO SOON.
If you have pain or swelling – then rest is the best treatment early on.
You can use crutches to control the weight bearing transmitted through your knee joint.
Full Weight Bearing
This means that you may take as much weight as comfortable through your operated leg. The crutches are used in this instance to help control swelling and pain and to assist in the healing and recovery of the joint. It is important that you contract your thigh muscles each time you take weight through your operated leg and to hop over it. You may discard your crutches when you can walk without pain and the swelling around your joint has reduced.
It is extremely important to negotiate stairs slowly when you are on crutches.
Remember This Sequence:
WHEN GOING UPSTAIRS: Good leg to heaven, ie good leg bad leg, then crutches
WHEN GOING DOWNSTAIRS: Bad leg to hell, ie crutches, bad leg, good leg
Following the knee arthroscopy, your surgeon will bandage your leg. Please keep the bandage dry. It is not uncommon for the bandage to become spotted with a small amount of blood. The bandage may be removed 3-4 days after surgery and replaced with a tubigrip. 2-3 small puncture wounds will be covered with sticky-strips and dressing. Try to keep these dry until reviewed.
(eg. Panadeine or Panadeine Forte 1-2 tabs 4-6 hourly) are usually required for the first week or so.
A large ice bag applied to the knee (not directly on skin!) for 30 minutes 4-6 times per day for the 1st 2-3 days will help reduce swelling and pain. It will also help to keep your leg elevated over this time.
We recommend resting with your leg elevated for the first 2-3 days. You may place as much weight on the leg as is comfortable, unless otherwise instructed. You may need crutches initially, and you can stop using them once you are walking comfortably.
You may bend and straighten your leg within pain tolerance. Simple quadriceps and range of motion exercises are detailed below. An exercise bike on low resistance may be used after 5 days. Pain and swelling brought on by exercise should be treated with rest, ice, compression, elevation and painkillers. Ankle movements should commence immediately to help circulation in the leg.
Do not drive under the influence of pain medication. You should not drive until reviewed by your surgeon.
You may return to work as soon as your pain is tolerable. To some degree, return to work depends upon what was found and the surgery performed. Generally, if a job does not require prolonged standing and walking, you may return to work within a week. However, if your job requires prolonged standing or walking, it may be up to 2-4 weeks before you are able to return to work.
No running or impact sport until after your first review. You will be guided from there.
Follow up Visit
This has been made for you at the time of booking your knee arthroscopy and is detailed on the sheet attached to your booking information.
Should you have any problems or urgent questions about your procedure, please contact Mr Chris Kondogiannis’s rooms on (03) 9415 9272, Mr Hayden Morris’s rooms on (03) 9417 7299, Mr Nathan White’s rooms on (03) 9417 7299 if you require further information.
Preparation for Surgery
After the surgery, you will then be taken to the recovery room and eventually back to the Day Care Unit. You will be given an instruction sheet outlining your post operative care and also a photo of your knee taken during the procedure. Detailed findings of your surgery will be given to you at your post operative appointment which will be made for you approximately 10 days following the surgery.
Discharge from Hospital
You will be required to stay in hospital for at least 2-3 hours following your procedure before you will be discharged.
You must have someone available to drive you home from hospital.
You must not operate machinery or drive a car for 24 hours after your procedure.
You should have a responsible adult with you at home for at least the first 24 hours.
Post Operative Appointment
It is important that you attend this appointment usually 10 days post operative, as part of your ongoing treatment/management.