Yasmin Dhar, M.D.
Orthopedic Surgeon and Sports Medicine Specialist
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Arthroscopic Knee Surgery
What is a knee arthroscopic surgery?
The arthroscope is a fiber optic instrument slightly narrower than a pen. It is placed into the knee through a tiny incision (called a portal). Attaching a small camera to the arthroscope, the surgeon is able to view the internal knee structures as they are projected onto a monitor. Using additional portals (usually 1 to 2), small instruments ranging in size from 3-5 millimeters are inserted into the knee. These instruments allow the surgeon to inspect and feel the joint structures, more accurately diagnose the injury, and then repair, reconstruct, or remove the damaged structures.
In the past, many orthopaedic injuries required complicated operations with large incisions, long hospital stays, and extensive physical therapy. Today, many procedures are done entirely or in combination with the arthroscope, allowing for more accurate diagnosis, less invasive surgical intervention and an accelerated rehabilitation process. It must be kept in mind that not all surgery can be done through the arthroscope and standard surgery is still the best way to treat some sports injuries.
What type of procedures can be done with arthroscopy?
Some of the more common arthroscopic procedures in the knee are:
Partial menisectomy (removal of torn knee cartilage)
Removal of loose fragments/cartilage
Synovectomy (removal of inflamed joint lining)
Meniscal repair (stitching torn knee cartilage)
Smoothing of joint surfaces
Lateral release of the patella (re-align patella)
Assisted ACL/PCL reconstruction
What type of anesthesia is used?
Local anesthesia with sedation or general anesthesia can be used. An anesthesiologist is always present if there is a need for further sedation or pain control. Prior to surgery, an anesthesiologist will discuss with you the various options and answer your questions.
How long will I be in the hospital?
Most people go home the same day. Several factors, including your age, health status, other damage to the knee and the side effects of anesthesia, may affect your ability to go home the same day of surgery.
What happens the day of surgery?
The day before surgery you will be told what time to report to the hospital on the day of your procedure. It is very important to arrive on time. You will be taken to a pre-operative area where you will be prepared for your surgery. You will see your surgeon, and meet the nurses and anesthesiologist the day of surgery. Then, you will be taken to the operating room. After the operation, you will be taken to the recovery room. Here the staff will monitor that the effects of anesthesia are wearing off properly and they will provide you with medication for any pain you are experiencing. You will be given post-surgery instructions to follow at home and then discharged after you have adequately recovered.
How should I care for my knee after surgery?
Prior to your discharge from the hospital you will be given specific instructions on how to care for your knee. It is important to follow these instructions. In general, you can expect the following:
Diet: Resume your regular diet as soon as possible.
Medication: You will be given medication for pain. Most other home medication can be restarted.
Bandage: You will have a bulky dressing and elastic bandage on the knee for 2-3 days after the surgery unless instructed otherwise. Under these dressings you will have several small incisions with stitches. You may cover the stitches with Band-Aids after you remove your dressing.
Bathing: You may shower after your dressings are removed, unless otherwise instructed. To give your wound time to heal, do not soak your knee under water (bathtub, pool, or whirlpool) for at least 2 weeks. Soaking the leg in water prior to this will increase the chance of infection.
Brace: In most cases, you will not have a brace on your knee. In some cases you may have a brace on your leg; you should leave it on unless you are instructed to take it off by our office.
Walking: You will have crutches or a cane for walking. You may put weight on your foot as tolerated as soon as possible after the surgery, unless instructed otherwise. Most people are able to get rid of their crutches or cane in a few days but initially the thigh muscles get weak after surgery and the leg can give out. The crutches or cane help protect you during this time.
Ice: You may apply ice to the knee for 15-20 minutes, 3-4 times per day. Initially, you can apply this right over the dressing. Later you can apply it directly to the knee or with a cloth between the ice and your knee. DO NOT put any heat on your knee. You may also obtain a ice and compression machine depending on your insurance coverage.
Exercise: If there are any exercises you should be doing at home, you will be instructed in them. At your first post-operative visit, approximately 5-7 days after your surgery, you will be given a prescription for formal rehabilitation to do with a physical therapist.
Follow-up Office Visit: You will be instructed to follow-up at our office after surgery. You will be instructed in making further post-operative appointments at this time.
When can I return to my previous activities?
Most people are able to return to their job or school within 1 week. The exception to this is for people who have a strenuous job that requires them to be on their feet a lot, lift objects, climbing or driving. These patients will return to more strenuous jobs approximately 4-6 weeks after surgery. You will typically be able to begin driving about 1 week after your operation unless you are told otherwise.
Most people can return to sports activities in 4-6 weeks. It should be noted that every case is different and the rate of recovery depends on the extent of the damage in your knee, the exact surgical procedure performed, and how well you recover. It is essential that the motion in your knee and the strength of your thigh muscles return before participating in sports activities.