Degenerative knee conditions such as osteoarthritis can often lead to the obliteration of the joint lining and associated menisci. This causes individuals to experience symptoms that are highly uncomfortable and may have a negative effect on their quality of life. (1) Keyhole Knee Surgery, which is also known as Knee Arthroscopy, is one of the treatments suggested for such knee disorders. In fact, it is amongst the most common orthopedic ambulatory procedures conducted in the United Kingdom for the treatment of degenerative knee conditions. Studies conducted in Uk have shown the results of Arthroscopic Knee Surgery to vary depending on factors like age, sex, income, and diagnosis. (2)
What is knee keyhole surgery?
Knee Arthroscopy, also known as Keyhole Surgery, is a minimally invasive surgical procedure that allows the surgeon to evaluate the inside of the Knee. It is usually performed by making small puncture holes on both sides of the knee cap, through which the procedure can be performed. While one puncture hole is used to insert surgical instruments inside the knee structures, the other is used for the insertion of the arthroscope. The arthroscopy is a small flexible tube connected with a light and camera that allows the orthopedic surgeon to see a clear image of the inside of the knee joint. This is made possible by connecting the arthroscope to a monitor screen, which can be viewed by the surgeon as they perform the procedure.
Indications For Knee Keyhole Surgery
The health professional may recommend undergoing knee arthroscopy if an individual has been experiencing knee problems for a while and more conservative approaches have not been successful. This is usually recommended after the doctor has already diagnosed the root cause behind the knee problem or they want to use knee arthroscopy as a diagnostic tool to reach a definitive diagnosis. Hence, whether it is to be used for treatment purposes or diagnostic purposes, Knee arthroscopy is considered an effective tool for both. (3)
The common indication for Knee Arthroscopy include:
- Tearing of Anterior Cruciate Ligament (ACL)
- Tearing of Posterior Cruciate Ligament (PCL)
- Tearing of the Meniscus, which is the cartilage present between the bones of the Knee (4)
- Dislocation of the Patella
- Loose pieces of Cartilage and damaged tissue in the Knee joint
- Removal and Diagnosis of Bakers Cyst
- Mild Fractures of the Knee Bones, since severe fractures may require knee replacement
- Swelling of the lining of the knee joint, known as Synovium
- Knee Arthritis – however, it may not always be effective for this
- Irrigation and Debridement inside the joint
How Should The Patient Prepare for Knee Keyhole Surgery?
The doctor may first start by taking a detailed history of the patient, where they may be asked about their health and any medication they currently take. These may include prescription medications, over-the-counter pain relief tablets, or even nutritional supplements. The patient may also be required to stop taking certain medications like Aspirin and Ibuprofen days to weeks before the procedure as they interfere with post-operative healing. The patient may also be asked to refrain from eating or taking any drinks at least 12 hours before the surgery. They may also be prescribed painkillers before the surgery, which can then be taken to manage the post-operative pain.
How is Knee Keyhole Surgery Performed?
What to Expect Before The Procedure?
Before the start of the procedure, the orthopedic surgeon may once again take a history from the patient to double-check the previous records about their general health. This may be followed by evaluation and examination of the knees and identification of any problems that may complicate the procedure. If the patient has been diagnosed with any health conditions or is at an increased risk for health risks, they have to undergo more extensive evaluation and preoperative tests. These may include blood tests, EKGs, and X-rays. (5)
If the patient is considered healthy, their knee arthroscopy surgery will most likely be conducted in an outpatient procedure. Hence, it is usually a day case, and they will not be required to get admitted or stay overnight.
Before the start of the procedure, the anaesthetist will evaluate the patient and discuss the anesthesia options with them. They may either choose to go with a local anesthetic, region anesthetic, or even a general anaesthetic. The local anaesthetic may only be applied to the Knee and will help numb this area. On the other hand, the regional anaesthetic will help numb the area below the waist, while the general anaesthetic will put the patient to sleep.
What to Expect During the Keyhole Surgery?
During the procedure, the patient has first positioned appropriately, which will allow the doctor to have the maximum accessibility. They are usually positioned with their heels to be at the end of the table. This is followed by positioning the pelvis at the edge of the table so that the leg can be easily placed against the leg holder. After appropriate positioning of the patient, a safety belt is applied around their waist to keep them stable throughout the procedure. This is followed by the placement of the tourniquet, after which a cotton padding is wrapped around the thigh carefully to prevent any wrinkling. The pressure of the tourniquet is usually up to 350 mm Hg in healthy adults, and it is placed high enough to allow good access to the Knee. After this, a plastic drape may also be applied to the patient thigh so that the solution used during surgery does not drip out of the tourniquet. The surgical draping will only allow exposure of the incision site. Sometimes a positioning device may also be used to stabilize the Knee as the surgeon starts the arthroscopic procedure. (6)
After the patient is in the correct position and ready for the surgery, the orthopedic surgeon starts by making small incisions in the Knee. Once the incisions are made, the Knee joint may be filled up with a sterile solution which helps rinse away any cloudy fluid present. This washing away helps allows the surgeon greater visibility and allows them to diagnose and manage any abnormalities.
Before treating the problem, it is first important to diagnose it. When the arthroscope is inserted into the Knee joint, it helps the surgeon see the structure present inside and guide it according to the images being produced on the projector. If there is a need for surgical treatment, the appropriate instruments can be then inserted through the small cuts made previously. The instruments used during arthroscopy are specialized for cutting, grasping, shaving, and allowing meniscal repairs. Some procedures may also require the anchoring of special devices like those allowing anchoring of stitches to the bone.
The overall length of the procedure varies from case to case and depends on the findings from the arthroscopy and the extent of treatment required. However, it generally lasts for less than an hour. After the procedure is completed, the surgeon closes every incision made with a stitch or adhesive strips. These stitches are then covered with an additional soft bandage to protect the treatment sites.
What to Expect After the Procedure?
After the completion of the procedure, the patient is moved to a recovery room. The average recovery time after knee arthroscopy is one to two hours. The patients may also be advised about the aftercare during their time in the recovery room. Even though the recovery through knee arthroscopy seems much simpler and faster than other knee surgeries, it is necessary to follow the doctor’s advice carefully after returning home to prevent complications. (7)
What are the Possible Complications of Knee Keyhole Surgery?
Every type of surgery has its own risks and complications; however, these are generally rare. The possible complication associated with Keyhole Surgery include:
- Infection inside of Your Knee
- Excessive bleeding from the treatment area
- Shortness of breath due to Anesthesia (8)
- Allergy to any anesthesia or any medication given during surgery
- Blood Clot formation and Deep Vein Thrombosis (DVT) during the recovery period (9)
- Bleeding in the Knee Joint
- Stiffness and mobility issues in the Knee
- Damage to the joint surfaces, ligaments, meniscus, Cartilage, and nerves around the Knee (10)
Recovery At Home
The recovery at home is almost as important as the procedure itself. The patient is recommended to have someone at home to take care of them the first day after the surgery. They are advised to keep their legs elevated as much as they can and put on ice and cold packs to reduce the swelling and pain at the treatment site. The patient is also required to change their dressing from time to time, as instructed by the doctor. They may also be required to see the doctor for a follow-up appointment after the procedure.
It is recommended to start light exercises and return to normal activity slowly. The patient may also be instructed to visit a physiotherapist until the patient is able to use their Knee like before. Regular exercise and physiotherapy are recommended to help the patient restore their normal knee function and range of movement. This will also allow the strengthening of their muscles over time to better support their Knee.
Alternatives to keyhole surgery
Structures in and around the knee have a poor blood supply, which is why they can struggle to heal on their own. It is the oxygen and nutrients in our blood supply that helps to heal these structures.
Prolotherapy involves the injection of a regenerative solution into these structures to provide a direct supply of what is required to heal and repair.
As the treatment is helping to treat the root cause of the problem, it is deemed to be a permanent fix.
Frequently Asked Questions
What happens after keyhole surgery on the knee?
On the knee, after keyhole surgery, patients may feel some swelling and pain around the knee. Swelling or pain is not long-lasting, maybe for a week. After that patient becomes normal, some patients also feel more tired than usual. With time, It becomes fine.
How long is recovery from keyhole surgery on the knee?
A person will recover completely within 5 to 7 days if keyhole surgery has been used to diagnose a condition. But to treat a condition will take 2 to 12 weeks. Recovery time may increase if the doctor repairs damaged tissue. It is necessary to limit your activities until your knee movement and endurability are back to normal. You can also concern with physical rehabilitation centers.
Can you walk right after arthroscopic knee surgery?
Right after the arthroscopic knee surgery, the patients can bear weight with the help of a brace. It is expected that patients can walk with crutches after 4 to 6 weeks of surgery. However, it is beneficial to avoid walking long distances after surgery. Physical rehabilitation is designated to manage swelling and pain, acquire a maximum range of movement, and full load walking.
Is knee arthroscopy major surgery?
No, knee arthroscopy is not major surgery. It’s a minor one and is done on an outpatient basis (means that patients receive medical treatment without being admitted to a hospital).doctors suggest this surgery if you have an injured joint, inflammation in the joint, or have damaged joint over time.
Is a knee scope painful?
So many doctors and patients opt for knee scoping over other treatments. Because the orthopedic surgeons are only required to make a small incision (a surgical cut made in skin or flesh) to use the arthroscope. In knee scoping, there is usually not too much pain and stiffness. Furthermore, recovery is also faster than other treatments.
What is the fastest way to recover from arthroscopic knee surgery?
The fastest recovery tips are:
- Take complete rest
- Keeping the leg elevated for so many days after surgery
- To lessen the swelling and pain, apply ice packs to the dressing and surrounding areas of the knee
- Follow the doctor’s suggestions regarding weight on the knee
- Also, use crutches
- Change the dressing regularly
- Alkan, B. M., Fidan, F., Tosun, A., & Ardıçoğlu, O. (2014). Quality of life and self-reported disability in patients with knee osteoarthritis. Modern rheumatology, 24(1), 166–171. https://doi.org/10.3109/14397595.2013.854046
- Hawker, G., Guan, J., Judge, A., & Dieppe, P. (2008). Knee arthroscopy in England and Ontario: patterns of use, changes over time, and relationship to total knee replacement. The Journal of bone and joint surgery. American volume, 90(11), 2337–2345. https://doi.org/10.2106/JBJS.G.01671
- Mayr HO, Rueschenschmidt M, Seil R, et al. Indications for and results of arthroscopy in the arthritic Knee: a European survey. Int Orthop. 2013;37(7):1263-1271. doi:10.1007/s00264-013-1896-3
- Bhattacharyya R, Davidson DJ, Sugand K, et al. Knee Arthroscopy: A Simulation Demonstrating the Imperial Knee Arthroscopy Cognitive Task Analysis (IKACTA) Tool. JBJS Essent Surg Tech. 2018;8(4):e32. Published 2018 Dec 26. doi:10.2106/JBJS.ST.18.00017
- Ward BD, Lubowitz JH. Basic knee arthroscopy part 1: patient positioning. Arthrosc Tech. 2013;2(4):e497-e499. Published 2013 Nov 22. doi:10.1016/j.eats.2013.07.010
- Royse, C. F., Williams, Z., Ye, G., Wilkinson, D., De Steiger, R., Richardson, M., & Newman, S. (2014). Knee surgery recovery: Post-operative Quality of Recovery Scale comparison of age and complexity of surgery. Acta anaesthesiologica Scandinavica, 58(6), 660–667. https://doi.org/10.1111/aas.12273