Knees and arthroscopy

Our knees are particularly important as we move around every day. They provide us with mobility and stability. This key function makes them subject to many traumatic or degenerative pathologies.

Among all the existing medical conditions, osteoarthritis is the most common form of joint disease. It is characterized by the wear and tear of the cartilage that is in our body: in our hand, hip, spine, etc. Osteoarthritis can be caused by different factors (overuse of joints in athletes, obesity, age and physical activity, etc.) and occur at any age.

The knee is a two-dimensional joint that can only perform flexion and extension. Other movements are restricted by the lateral and central ligaments. It connects the thighbone (femur) and the main leg bone (tibia).

Each knee has two menisci: the lateral meniscus and the medial meniscus. These are relatively flexible and highly resistant fibrocartilage bands that separate the femur and the upper extremity of the tibia. In addition to stabilizing the knee joint, the menisci’s main function is to act as shock absorbers for the constant pressure exerted on the knee. Injuries to the meniscus can be due to trauma (traumatic injuries) or to gradual wear and tear (degenerative lesions).

The central pillar, made up of the anterior cruciate ligament and the posterior cruciate ligament, plays a key role in providing stability in the knee. The tibia cannot hold back the femur due to its flat and horizontal shape. The central pillar connects the two bones to stop the femur from slipping in front of or behind the tibia.

An arthroscopy is a type of surgery used to inspect the inside of a joint and, where necessary, treat it using a tool called an arthroscope. 

There are two types of surgical procedure practiced on the knee:

• the conventional approach, which involves open knee surgery with an incision of around ten centimeters in length,
• arthroscopy, which is a form of keyhole surgery in which the internal structures of the knee can be viewed and repaired through a fiber optic system. This procedure reduces the duration of surgery and the risk of infection.

Usually, the surgeon requires three entry points for an arthroscopy to repair a meniscal tear:

- the first is for the arthroscope, a “camera” made up of a lens and fiber optics connected to a light source, 
- two others are used to introduce small instruments to repair, cut or remove segments in the knee. 

An arthroscopy is a form of surgery. It is practiced under general anesthetic, loco-regional anesthetic (anesthesia of the knee and part of the leg) or by epidural (anesthesia of the lower part of the body). Surgery is performed in an operating theater. It lasts around 30 minutes for meniscal injuries or for diagnostic exploration, and up to 2 hours for a ligament injury.

If you choose to undergo an arthroscopy, surgery is practiced under local (on an outpatient basis) or general anesthetic depending on what was decided during your consultation with the anesthetist. This means you will not feel anything.

You might experience limited pain after surgery and the following days. However, the post-surgery treatment that was prescribed to you will ease the pain. If it is not enough and you have severe pain with other symptoms such as fever or shivers, you should contact your surgeon.

In all cases, arthroscopy is not considered a major, painful or risky surgery.

Through an arthroscopy, the orthopedic surgeon can identify the different structures that make up the knee joint and check that they are intact. The surgeon can also take direct action:

• If the meniscus is torn, a fragment may move and prevent the knee from working properly by blocking the joint. The surgeon must in this case remove the torn segment that is in the way so that the knee can once again be fully extended. 
• If the meniscus is simply injured, the surgeon may directly repair the torn cartilage. 
• If a cruciate ligament is torn, the surgeon may replace it with a tendon which, grafted between the femur and the tibia, performs the same role in stabilizing the knee. 
• If the cartilage which covers the two bones in the knee is irregular or cracked, the surgeon may rectify it by removing the damaged part of the meniscus.

Incisions are generally so small that they do not always require stitches. The knee will often be swollen for a few days. The swelling generally subsides with ice and a knee support. 
Pain may last for a few days but can generally be managed by painkillers prescribed by your surgeon. These post-operative symptoms are common and are not complications. 

Hinged or non-hinged knee braces or splints are rarely used. In all cases, patients can walk a few hours after surgery. 

An arthroscopy is a minor procedure and patients are often discharged on the same day. Rehabilitation begins the day after surgery and lasts for two to three months. Sports activities may be resumed gradually, after one to three months, depending on the type of surgery performed.

However, it is recommended to wait for your knee to recover before driving again, whether it be a car or another vehicle. Don't hesitate to ask your doctor for advice.

Even the most straightforward surgery could entail the risk of complications for the patient:

• vascular: if a blood vessel is damaged during the operation (0.003% of arthroscopies), a non-severe hemorrhage may occur. This bleeding is quickly controlled and does not leave any permanent effects.
• nervous: if a small nerve is damaged, the patient may feel numb (loss of feeling) in that area. Most of the time, such complications are temporary but in some exceptional cases may persist. 
• thromboembolic: as with any form of surgery, thrombosis is possible, despite the administration of preventive anticoagulant drugs. Cases of thrombosis remain rare (0.12%) in arthroscopies but may result in a pulmonary embolism is some exceptional cases (0.003%). 
• infections: post-operative arthritis is not likely (0.5%) but requires a new arthroscopy to be conducted to clean the joint and antibiotic treatment must be prescribed.
• complications related to the collection of fluid (blood, synovial fluid, etc.): if there is excess fluid, the surgeon may decide to leave the surgical drains in place. Very thin tubes protrude from the knee for a few days so that the fluids can escape. These tubes are easily removed without surgery.

If you suffer from acute or chronic knee pain, our medical team will recommend a specialist located near your place of residence. Our team will advise you, on the basis of treatment already begun and future treatment that is recommended.

For every knee surgery precertification request, MSH can organize a second opinion from a reputable specialist. To do so, we would ask you to send us a report from the surgeon listing prior treatment and any scan or MRI images.

We can also help you find a qualified physical therapist who will give you advice and help you get the most suitable treatment for your knee. We are also here to help you find the best treatment as well as solutions suited to your needs and requirements.
If you wish, we can arrange a visit with a specialist who will provide you with more precise diagnostic and treatment.

In all cases, if you feel pain in your joint which makes you think of osteoarthritis, or more generally if you experience unusual pain in one of your joints, our medical team is on hand to help you and recommend you the best specialists.