17153 Knee Arthroscopy

Overview

A knee arthroscopy is a type of keyhole surgery. It lets a surgeon look inside your knee joint and fix certain problems, without making a large cut. The surgeon makes two or three tiny openings, each about the width of a pencil, and puts in a slim tube with a camera on the end. The camera sends pictures to a screen, so the surgeon can see your knee in detail. Thin instruments are passed through the other small openings to do the repair work. Because the cuts are so small, most people go home the same day and recover faster than with open surgery.

Yes. Knee arthroscopy is one of the most common orthopaedic (bone and joint) operations worldwide. Millions are done each year.

It can be done at almost any age, but it is most often used for adults with knee injuries from sport or everyday twisting, people with a torn meniscus (the knee's shock-absorbing cartilage), and people with loose fragments or cartilage damage. It is used less often in children, and more careful thought is needed in older adults with widespread wear-and-tear arthritis, where surgery may help less.

Symptoms

Common symptoms

• Knee pain that comes on gradually or after an injury and does not settle with rest
• Swelling of the knee, sometimes coming and going
• The knee locking, catching or clicking when you move it
• The knee giving way or feeling unstable when you walk or turn
• Stiffness, especially first thing in the morning or after sitting
• Trouble kneeling, squatting, going up and down stairs, or playing sport

Symptoms in children

• Knee pain after sport or a fall, sometimes with swelling
• A knee that locks or clicks — in children this can be caused by a differently shaped meniscus (a condition present from birth)
• Limping or avoiding activities they used to enjoy
• Children often describe pain vaguely, and hip problems can show up as knee pain, so a proper check is important

Symptoms in older adults

• Grinding, aching pain linked to wear-and-tear arthritis (osteoarthritis)
• A degenerate meniscal tear — a frayed cartilage that tears with a minor twist
• Stiffness and swelling after activity
• Note: in older adults with widespread arthritis, keyhole surgery often helps less than physiotherapy and staying active, so the decision needs careful discussion with your doctor

Causes

Main causes

• A torn meniscus — the rubbery pad inside the knee can tear with a twist while the foot is planted
• Loose bodies — small fragments of bone or cartilage floating in the joint that cause locking or catching
• Cartilage (joint surface) damage from injury or wear-and-tear
• Ligament injuries, such as a torn anterior cruciate ligament, which may be repaired or rebuilt using keyhole techniques
• Problems with the kneecap, such as it not tracking smoothly
• Sometimes arthroscopy is used to find the cause of knee pain when scans and tests have not given a clear answer

Risk factors

• Playing sports that involve twisting, pivoting or sudden stops, such as football, rugby, netball, basketball and skiing
• A previous knee injury or knee surgery
• Being overweight, which puts extra load on the knee joint
• A job that involves lots of kneeling, squatting, climbing or heavy lifting
• Getting older, as cartilage becomes more worn and tears more easily
• Weak thigh muscles, which give the knee less support

When to see a doctor

See a doctor urgently if:

• You have a hot, red, very swollen knee with a fever — seek same-day medical advice
• There is pus or spreading redness around a surgical wound
• You have severe calf pain or swelling, or any breathlessness or chest pain
• Your knee is locked and you cannot straighten it
• You cannot put weight on the leg at all after an injury

Book a routine appointment if:

• Knee pain or swelling that has lasted more than a few weeks
• Your knee catches, clicks, locks or gives way
• Pain is stopping you from doing sport, work or everyday activities
• You have been offered a knee arthroscopy and want to talk through the benefits and risks
• You are not recovering as expected after knee surgery

Diagnosis

Your doctor will start by asking about your knee — when the pain began, what makes it better or worse, and whether it locks or gives way. They will examine the knee, checking how it moves, how stable it feels and where it hurts. Often this is enough to plan the next step. If an operation seems possible, imaging scans help show what is going on inside. The arthroscopy itself can also be a way of confirming the diagnosis, because the surgeon can see the joint directly.

Tests that may be done

• A physical examination of the knee, including moving and gently stressing it
• X-rays to look at the bones and the space between them
• An MRI scan (a detailed picture using magnets, not radiation) to show cartilage, ligaments and meniscus
• An ultrasound scan for some soft-tissue problems
• Blood tests if infection or inflammation is a concern
• Sometimes a small sample of joint fluid is taken with a needle to check for infection or crystals

What to expect at your appointment

Before surgery you will usually have a pre-assessment appointment. This may be in person or by phone, and covers your general health, any medicines you take, and whether you need any tests such as a blood test or heart tracing. You will be asked not to eat or drink for a set time before the operation. The operation itself usually takes about 30 to 45 minutes. It is normally done under a general anaesthetic (you are asleep) or a spinal anaesthetic (you are numb from the waist down and can stay awake). You can often go home the same day once you have recovered from the anaesthetic and seen a physiotherapist.

Treatment

Knee arthroscopy is only one option, and it is usually considered after simpler approaches have been tried. Many knee problems improve with physiotherapy, activity changes and time. Your doctor will help you weigh up whether surgery is likely to help your particular knee, because the benefits vary depending on the problem — for example, removing a loose fragment or trimming a clear tear often helps a lot, while surgery for general wear-and-tear arthritis often helps less than exercise and physiotherapy.

Self-care at home

• Follow the RICE approach after a flare-up: Rest, Ice (a wrapped cold pack for up to 20 minutes), Compression (a supportive bandage if advised) and Elevation (raise the leg on cushions)
• Keep gently moving the knee — complete rest makes it stiffer
• Build up the muscles around the knee with simple exercises given by a physiotherapist
• Adjust activities rather than stopping them — swap high-impact sport for swimming, cycling or walking for a while
• If you are above a healthy weight, losing even a small amount can noticeably reduce knee pain
• Wear supportive, well-cushioned footwear
• Follow your surgeon's and physiotherapist's instructions carefully after any operation, including wound care and when to return to activity

Medical treatments

Non-surgical treatment usually starts with physiotherapy to strengthen the thigh and hip muscles and improve how the knee moves. Your doctor or pharmacist can advise on pain relief that is suitable for you — always ask them rather than self-selecting, especially if you have other health conditions or take other medicines. Injections into the knee of anti-inflammatory or lubricating medicine are sometimes offered for certain knee problems. Supports, braces and insoles help some people. Weight management and activity coaching can make a real difference. If these steps do not control your symptoms, surgery may be discussed.

When is surgery considered?

A knee arthroscopy may be suggested if: a clear mechanical problem is found, such as a torn meniscus that keeps locking the knee, a loose fragment, or a flap of cartilage catching in the joint; knee pain and catching continue despite a good course of physiotherapy; or the diagnosis is genuinely unclear and needs to be seen directly. It is usually not the first choice for general wear-and-tear arthritis. Your surgeon should explain what they expect to find, what they can fix, and what the realistic chances of improvement are for you.

Living with this condition

For the first few days after surgery, expect some swelling, stiffness and soreness — this is normal. Most people use crutches for a short time and can put some weight on the leg, depending on what was repaired. Keep the knee raised when sitting, use ice packs as advised, and keep the wounds clean and dry until they have healed. Small paper strips or stitches usually come off or dissolve within one to two weeks. You will be given exercises to do at home; these are the single most important thing you can do for your recovery. Driving, work, sport and lifting all have their own timelines, so ask your surgical team what applies to you.

Lifestyle tips

• Build a simple routine of daily knee exercises, even on days when it feels good
• Return to activity gradually — increasing too fast is the most common cause of setbacks
• Choose low-impact exercise such as swimming, cycling and walking as you recover
• Keep to a healthy weight to reduce load on the knee
• Warm up before sport and avoid sudden jumps in training volume
• Use a stool or cushion for kneeling tasks if kneeling is uncomfortable

Diet and exercise

There is no special diet for knee problems, but eating well supports healing and helps keep your weight in a healthy range. Include plenty of vegetables, fruit, whole grains, beans and lean protein, and drink enough water. Gentle movement is good for knees — cartilage likes being used. Aim for a mix of strengthening exercises for the thigh and hip muscles, plus low-impact aerobic activity. A physiotherapist can give you a plan that suits your knee, your age and what you want to get back to.

Mental health and emotional wellbeing

Knee pain and surgery can be frustrating. Being unable to do the things you enjoy, relying on others, or feeling anxious about whether you will recover can all affect your mood. This is very common and worth mentioning. Tell your doctor, physiotherapist or nurse if you are feeling low, worried or overwhelmed — support is available, and talking about it usually helps. If you ever have thoughts of harming yourself, contact your local emergency number or a crisis line in your country straight away.

Prevention

You cannot prevent every knee injury, but you can lower your risk. Strong thigh and hip muscles protect the knee. Warm up before sport, wear suitable shoes, and increase training gradually rather than in sudden bursts. Learn safe landing and turning techniques if you play pivoting sports. Keeping to a healthy weight reduces daily load on the joint. If you have had a knee injury, a structured physiotherapy programme helps prevent repeat problems.

Vaccines

There is no vaccine that prevents knee problems. Keeping up with routine vaccinations is still good general health practice, and your doctor may advise on specific vaccines before surgery.

Screening programmes

There is no national screening test for knee problems. If you have ongoing knee pain, stiffness or instability, see your doctor for an assessment rather than waiting for a screening programme.

Complications

If left untreated

• Ongoing pain, swelling and stiffness that limit walking, work and sport
• A knee that keeps locking or giving way, which can lead to falls
• Weakening of the thigh muscles from disuse, which makes the knee feel less stable
• Further damage to cartilage or joint surfaces over time, especially if the knee keeps catching
• Strain on other joints and on your general activity levels and mood

Long-term outlook

Most people do well after a knee arthroscopy, and many get worthwhile relief from locking, catching or pain caused by a clear mechanical problem. Recovery is a gradual process — it usually takes a few weeks to feel comfortable and several months to reach your best result, and physiotherapy makes a real difference. Some people still have some aching, especially if there is underlying wear-and-tear, and a small number need further treatment. Your surgical team can tell you what is realistic for your knee, and there is support at every stage.

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