Knee arthroscopy is a minimally invasive method of treating knee joint conditions and has been one of the most commonly performed procedures in orthopaedic trauma surgery for many years. Through small incisions, the surgeon can visualise the interior of the knee joint, assess the articular cartilage, menisci, cruciate ligaments and synovial membrane, and — where necessary — carry out treatment immediately.
It is precisely this minimally invasive approach, and the ability to respond immediately to any damage encountered, that make knee arthroscopy effective in shortening recovery time, reducing the risk of complications and allowing a faster return to full physical activity.
Arthroscopy is a surgical procedure during which numerous joint procedures are carried out without the need for a full surgical opening of the joint. A specialist camera introduced into the joint cavity transmits a real-time image to a monitor, giving the operating surgeon an excellent view of all intra-articular structures.
During knee arthroscopy, two arthroscopic portals are typically made — approximately 1 cm each. Through one, the orthopaedic surgeon operates the camera; through the other, the necessary instruments are introduced. Additional portals may be created if the clinical situation requires it.
The most common problems for which patients present — and are subsequently qualified for knee arthroscopy — are joint effusion, pain and restricted range of motion. It is important to remember, however, that these are symptoms only, and their cause may be multifactorial, requiring thorough diagnostics before any surgical procedure is undertaken.
The most common indications include:
- meniscal damage (one or both menisci)
- cruciate ligament injuries
- intra-articular fractures
- patellar dislocation
- loose bodies within the joint
- inflammatory synovial hypertrophy
- articular cartilage damage
- restricted range of motion following previous procedures or knee joint injuries
The menisci function as shock absorbers, significantly reducing the forces transmitted through the articular cartilage. They also play an important role in knee joint stability. Damage to the menisci causes a range of symptoms — joint locking, pain and recurrent effusions — but the most significant problem is progressive articular cartilage damage resulting from increased forces acting on the joint surfaces.
Knee arthroscopy not only allows the degree of damage to be accurately assessed, but also enables immediate meniscal repair or partial resection.
Another common indication for arthroscopic treatment is ligament damage — particularly of the anterior and posterior cruciate ligaments. Arthroscopy enables minimally invasive reconstruction of the damaged ligaments, resulting in a significantly faster and more comfortable recovery for the patient.
Articular cartilage is a delicate structure with an exceptionally low friction coefficient, responsible for smooth and painless movement of the knee joint. Due to its specialised function, articular cartilage has no blood supply or nerve endings, which adversely affects its healing potential following damage. Arthroscopic techniques enable articular cartilage repair using a variety of implants and instruments.
The most common changes found inside the joint include:
- articular cartilage degeneration
- articular surface damage
- loose bodies
- synovial hypertrophy
In conventional knee surgery, the entire joint is opened — a considerably more burdensome procedure with a greater risk of complications. Arthroscopy reduces the risk of complications, causes less post-operative pain, promotes faster tissue regeneration and results in smaller scars.
In orthopaedic trauma surgery, arthroscopy is considered the gold standard for the treatment of many knee joint conditions.
Knee arthroscopy is not performed in the presence of:
- blood clotting disorders
- active skin infection
- medical contraindications to surgical treatment, such as uncontrolled diabetes or arterial hypertension
- active systemic infection
- advanced degenerative changes of the knee joint
The physician also assesses the possibility of discontinuing anticoagulant medication before the procedure.
Before knee arthroscopy, a clinical examination and imaging study — most commonly MRI — are required. This investigation assesses the condition of both intra- and extra-articular tissues. Correlation between imaging results and the clinical examination performed by the physician is essential, since the principle remains: we treat people, not test results. Not every patient will require the same treatment in a similar clinical situation.
Preparation for knee arthroscopy begins several days before the procedure. The patient must inform the doctor of all medications being taken — particularly anticoagulants, which may need to be temporarily discontinued in accordance with the treating physician’s instructions. It is equally important to disclose the use of immunosuppressive medications such as corticosteroids or other immunosuppressants. Basic blood tests and an anaesthetic risk assessment are carried out before the procedure, allowing the appropriate type of general or regional anaesthesia to be selected.
It is also important to ensure adequate hydration, disclose any allergies and comorbidities, and confirm that there are no contraindications to knee arthroscopy. The patient must follow fasting instructions before anaesthesia as specified by the anaesthesiologist. This approach minimises the risk of complications and ensures the procedure is carried out safely.
After knee arthroscopy, following the doctor’s instructions closely is essential to accelerate healing and reduce the risk of complications. The operated knee should be kept in a slightly elevated position to limit swelling and aid circulation. In the first few days, regular icing of the joint area is necessary, and prolonged walking or standing should be avoided so as not to stress structures that require regeneration.
The doctor determines when it is safe to begin bearing weight on the leg and to progress to the next stages of activity. If the patient is taking anticoagulants, the dosage must be adjusted to the post-operative period. Following the doctor’s instructions and taking care of the operated knee significantly influence the course of recovery.
