Knee Arthroscopy

Knee arthroscopy is a minimally invasive (small-incision) procedure in which a surgeon examines, diagnoses, and often repairs the inside of the knee joint using a tiny camera called an arthroscope.

During the procedure, the surgeon inserts the arthroscope — a thin tube with a light and camera at its tip — through a small cut near the knee. The camera sends live images to a screen, allowing the surgeon to see the cartilage (the smooth cushioning tissue inside the joint), ligaments (the tough bands that hold bones together), menisci (the C-shaped shock-absorbing pads between the thigh and shin bones), and the joint lining in fine detail. If a problem is found, the surgeon can pass small tools through one or two additional cuts and fix it during the same session.

Knee arthroscopy is used both to find out what is wrong inside the knee and to treat problems that have already been identified by other tests such as MRI. It is recommended when symptoms — such as persistent pain, swelling, locking, or giving way of the knee — do not have a clear enough explanation from scans alone, or when a confirmed problem needs surgical repair.

• Torn meniscus (damaged shock-absorbing pad) — to trim or repair the tear
• Torn anterior cruciate ligament, ACL (the main stabilising ligament at the centre of the knee) — to reconstruct it
• Torn posterior cruciate ligament, PCL — to reconstruct or repair it
• Damaged articular cartilage (the smooth surface coating the ends of bones) — to smooth, repair, or stimulate regrowth
• Loose bodies (small fragments of bone or cartilage floating inside the joint) — to remove them
• Inflamed or thickened synovium (joint lining) — to trim it away
• Plica syndrome (irritated fold of joint lining) — to release the fold
• Patellofemoral problems (pain or instability involving the kneecap) — to realign or release tight tissue
• Septic arthritis (joint infection) — to wash out the joint

Knee arthroscopy is generally not suitable for everyone. Doctors will usually advise against it in some situations.

• Severe widespread osteoarthritis (advanced joint wear) where arthroscopy is unlikely to give lasting benefit
• Active skin infection or open wound around the knee
• Very poor general health that makes any anaesthesia (medication that causes loss of sensation or consciousness) too risky
• Blood-clotting disorders that cannot be safely controlled before surgery
• Significant swelling and stiffness that has not yet had a trial of physiotherapy (movement-based rehabilitation)

Knee arthroscopy is one of the safer surgical procedures, but like any operation it carries some risks, and your surgical team will discuss these with you beforehand.

• Temporary pain, swelling, or stiffness around the knee after the procedure — very common and usually settles with rest and physiotherapy
• Deep vein thrombosis, DVT (a blood clot forming in a leg vein) — the team will take steps to reduce this risk
• Infection inside the joint — uncommon but requires prompt treatment with antibiotics
• Damage to nearby nerves, causing temporary numbness or tingling around the knee or lower leg
• Damage to nearby blood vessels, causing bleeding inside the joint — rare
• Reaction to anaesthesia — the anaesthetist will review your medical history to minimise this
• Incomplete resolution of symptoms — in some cases the underlying problem cannot be fully corrected
• Need for further surgery if the repair does not heal as expected

Good preparation helps the procedure go smoothly and reduces the chance of complications. Your care team will give you personalised instructions, but the following points reflect common practice.

Before the day of surgery, patients are usually asked to: stop eating and drinking (fast) for a number of hours — typically from midnight the night before, though the exact duration depends on the type of anaesthesia planned; pause blood thinners and anti-inflammatory medicines for a period directed by the doctor; avoid smoking and alcohol for at least a few days beforehand, as both slow healing; arrange for someone to drive them home and stay with them on the night of surgery.

The following tests are commonly done in the weeks or days before the procedure to confirm the diagnosis and make sure the patient is safe for anaesthesia:

• Blood tests to check general health, kidney and liver function, and clotting ability
• X-ray of the knee to assess bone structure
• MRI of the knee to map soft-tissue injuries in detail
• EKG (electrocardiogram, a heart-tracing test) for patients over a certain age or with heart conditions
• Review of all current medications and any known allergies

On the day of the procedure, the typical sequence of events is:

• 1. Admission and identity checks — the team confirms the correct patient, knee, and planned procedure.
• 2. Anaesthesia — this is most often spinal anaesthesia (an injection into the lower back that numbs the legs) or general anaesthesia (the patient is fully asleep); the type is decided by the anaesthetist and surgeon together.
• 3. Positioning and preparation — the leg is cleaned with antiseptic (germ-killing) solution and positioned on the operating table; a tourniquet (a tight cuff) is usually placed around the upper thigh to reduce bleeding.
• 4. Portal incisions — the surgeon makes two or three very small cuts (portals) around the knee, usually less than one centimetre long.
• 5. Fluid distension — sterile saline (salt water) is gently pumped into the joint to expand it and improve visibility.
• 6. Arthroscope insertion — the camera is guided into the joint and the surgeon systematically inspects all areas inside.
• 7. Surgical repair (if needed) — small instruments are inserted through additional portals to trim, repair, reconstruct, or remove tissue as planned.
• 8. Closure — the saline is drained, the portals are closed with one or two small stitches or adhesive strips, and a dressing is applied.
• 9. Transfer to recovery — the patient moves to the recovery area where vital signs are monitored until the anaesthesia wears off.

Recovery after knee arthroscopy varies considerably depending on whether the procedure was purely diagnostic, involved a minor repair such as a meniscus trim, or involved a more complex reconstruction such as ACL repair. Your surgeon and physiotherapist will set a personalised plan, but the following points are typical.

• Monitoring: most patients are observed for a few hours in the recovery area and go home the same day; an overnight stay may be needed after more complex work.
• Pain and swelling: ice packs applied for short intervals and keeping the leg elevated help control swelling in the first few days; the doctor will advise on appropriate pain relief.
• Weight-bearing: after a simple diagnostic look or minor trim, patients can often put weight on the leg with the help of crutches soon after surgery; after ligament reconstruction, weight-bearing is reintroduced gradually over weeks.
• Wound care: the small portal dressings should be kept dry; the team will advise when showering is safe and when stitches or clips are to be removed, usually within one to two weeks.
• Physiotherapy: structured exercises are a central part of recovery — they rebuild the muscles around the knee, restore range of motion (how far the joint bends), and reduce the risk of long-term stiffness; sessions typically begin within days for minor procedures and are more intensive and prolonged after reconstruction.
• Activity restrictions: driving is usually not permitted until the knee is strong enough to brake safely — your doctor will advise on timing; return to sport depends on the type of repair and may range from a few weeks to several months.
• Blood clot prevention: the team may advise compression stockings, foot and ankle exercises, or short-term blood thinners, especially after more extensive procedures.
• Follow-up appointments: these are scheduled to check wound healing, review imaging results if taken, and assess progress; attend all planned reviews even if the knee feels fine.
• Warning signs to report promptly: increasing redness, warmth, or discharge at a wound site; sudden severe swelling or pain; calf pain or swelling (which could suggest DVT); fever.