Arthroscopy

Arthroscopy is a procedure in which a surgeon uses a small camera to look inside a joint — and, when needed, to repair problems found there — without making a large cut.

The surgeon makes one or two tiny openings near the joint. Through one opening, a thin tube holding a miniature camera (called an arthroscope) is inserted. The camera sends live pictures to a screen, so the surgeon can see the cartilage (the smooth cushioning tissue), ligaments (the tough bands connecting bones), and other structures clearly. If a repair is needed, small surgical tools are passed through another opening to fix the problem — all without opening the joint fully.

Arthroscopy is used when a doctor needs a clear view of the inside of a joint, or when a known problem inside the joint needs to be treated. It is most often performed on the knee, shoulder, ankle, hip, wrist, or elbow.

• Torn meniscus (the C-shaped cushioning pad inside the knee) — trimming or repairing the tear
• Torn or damaged ligaments — such as a torn anterior cruciate ligament (ACL, the main stabilising band in the knee)
• Inflamed or damaged cartilage — smoothing rough surfaces or removing loose fragments
• Shoulder impingement (pinching of soft tissue in the shoulder) or a torn rotator cuff (the group of muscles and tendons that hold the shoulder joint together)
• Loose bodies — small pieces of bone or cartilage floating freely inside the joint
• Synovitis (inflammation of the joint lining) that has not responded to other treatments
• Recurrent joint dislocation — the joint repeatedly slipping out of place
• Unexplained joint pain, swelling, or stiffness when scans have not given a clear answer

Arthroscopy is usually not suitable in certain situations. Your doctor will assess your individual case before recommending it.

• Active skin or joint infection at the site, which raises the risk of spreading infection
• Severe joint damage where full joint replacement is the more appropriate solution
• Blood-clotting disorders that cannot be safely managed before surgery
• General health conditions that make any anaesthesia (medication that prevents pain and keeps the patient comfortable during the procedure) unsafe

Arthroscopy is considered a low-risk procedure compared with open joint surgery, but, like any surgical procedure, it does carry some recognised risks.

• Temporary pain, swelling, and stiffness around the joint after the procedure — the most common experience
• Infection inside the joint (septic arthritis) — uncommon but serious if it occurs
• Deep vein thrombosis or DVT (a blood clot forming in a deep vein, usually in the leg) — risk is higher after knee procedures
• Damage to nearby nerves or blood vessels, which can cause numbness, tingling, or weakness around the joint
• Haemarthrosis (bleeding into the joint space), causing increased swelling and pain
• Instrument breakage — a very rare event where a small tool tip breaks off inside the joint
• Reactions to anaesthesia — your anaesthetist (the doctor who manages pain and sedation) will review your health before choosing the most suitable approach
• Need for further surgery if the repair is not complete or if the joint does not heal as expected

Preparation for arthroscopy usually begins several days before the scheduled date. Your medical team will give you specific instructions based on which joint is involved and what type of anaesthesia is planned.

Before the procedure, patients are typically asked to:

• Fast (have nothing to eat or drink) for a period of hours before the procedure — your team will tell you exactly when to stop eating and drinking
• Temporarily stop taking blood thinners, anti-inflammatory medicines, or certain supplements — your doctor will advise which ones and for how long
• Stop smoking and avoid alcohol in the days leading up to surgery, as both can slow healing and affect how anaesthesia works
• Arrange for someone to drive you home and stay with you the first night, since you will not be able to drive after anaesthesia

Pre-operative tests (tests done before surgery) are usually ordered to make sure the procedure is safe. These commonly include:

• Blood tests to check general health, clotting ability, and kidney or liver function
• An EKG (electrocardiogram — a recording of the heart's electrical activity) for older patients or those with heart concerns
• Imaging such as X-ray, MRI, or USG of the affected joint to help plan the procedure
• A review of current medications and any known allergies

On the day of the procedure, the typical sequence of steps is as follows — though the exact number and order of steps may vary between hospitals and surgeons:

• 1. You arrive at the hospital and complete admission paperwork.
• 2. A nurse checks your vital signs (blood pressure, heart rate, temperature) and confirms your identity and the joint to be treated.
• 3. You change into a hospital gown and an intravenous (IV) line is placed in your arm to deliver fluids and medication.
• 4. The anaesthetist meets you, explains the anaesthesia plan, and administers the chosen form — this may be general anaesthesia (you are fully asleep), regional anaesthesia (only the limb is numbed), or sometimes local anaesthesia with sedation (you are drowsy but not fully asleep).
• 5. The joint area is cleaned and draped with sterile coverings to prevent infection.
• 6. The surgeon makes small incisions (cuts) and inserts the arthroscope and any necessary instruments.
• 7. The joint is filled with a sterile fluid to expand the space and improve visibility.
• 8. The surgeon examines the joint on the screen and carries out any planned repair.
• 9. The fluid is drained, instruments are removed, and the small incisions are closed with stitches or small adhesive strips.
• 10. A dressing or bandage is applied, and you are moved to a recovery area.

After arthroscopy, most patients are monitored in a recovery area until the effects of anaesthesia wear off, and many are able to go home the same day. Recovery time varies considerably depending on which joint was treated, how much repair was done, and the individual patient's health — your surgeon and physiotherapist (a specialist who helps restore movement and strength) will guide your specific plan.

• Keep the joint elevated (raised above heart level) and apply ice packs as directed in the first day or two to help reduce swelling
• Keep the wound dry and clean; dressings are usually changed at a follow-up appointment, and stitches — if not dissolvable — are typically removed within one to two weeks
• Use any prescribed pain relief and complete any antibiotic course as directed by your medical team
• Avoid bearing full weight on the joint or using it fully until cleared by your surgeon — crutches or a sling may be needed for a period
• Attend physiotherapy sessions as recommended; guided exercises are important for regaining strength and range of motion (the full movement the joint can make)
• Watch for warning signs that need prompt attention: increasing redness, warmth, or discharge from the wound; fever; sudden severe pain; or significant new swelling — contact your medical team if any of these occur
• Avoid driving until your surgeon confirms it is safe — this depends on which joint was treated and what was done
• Return to sport or heavy physical work only when your surgeon gives approval, which may take weeks to several months depending on the repair
• Attend all scheduled follow-up appointments so that healing can be checked and the rehabilitation (recovery and strengthening) programme can be adjusted