Knee arthroscopy is a minimally invasive technique that allows orthopaedic surgeons to assess – and in most cases, treat – a range of conditions affecting the knee joint. During the procedure, we make small incisions or portals in the affected joint, and then inserts a tiny camera and fiber optics to light the interior space. Pictures obtained with the camera are then projected onto a screen in the operating suite. The primary advantage afforded by arthroscopy is the ability to gain multiple views inside the joint. In the past, gaining access to some of these areas required an arthrotomy – a surgery in which an open incision was made – and dislocation of the patella, or “knee cap”. That procedure required additional trauma to the knee and carried the risk of additional injury to the joint. In contrast, arthroscopic examination of the knee joint usually does little damage to surrounding soft tissues. While most orthopedic surgeons continue to rely on radiographs (x-rays) and MRI to provide important preliminary information, many agree that arthroscopy is the best diagnostic tool available.Arthroscopy offers pieces of information that the other tests don’t including that which is derived by probing the affected tissue.
MRI is a wonderful tool to evaluate the structure of the soft tissues, but does not provide the tactile information acquired by probing the soft tissues and evaluating them with direct visual observation. Here at Hospital, general anaesthesia is rarely indicated for arthroscopic surgery of the knee which is generally performed with regional or occasionally local anaesthesia. Reconstruction of the ACL (anterior cruciate ligament) and repair of a torn meniscus are among the most commonly performed arthroscopic surgeries. Within the knee, these structures perform distinct functions. The ACL helps stabilize and support the joint. There are two menisci in the knee. These c-shaped “cushions” of cartilage help protect the articular cartilage, the lining of the bones that allows them to glide smoothly against one another during motion. (Injury or loss of articular cartilage results in arthritis.) These structures also act as shock absorbers, distributing load across the knee. Injuries to both the ACL and the menisci are common, particularly in athletes. Moreover, surgeons often see them in conjunction with one another. This may be the result of injuries suffered at the same time, or in sequence; that is, a person with a torn ACL is at greater risk of injuring the menisci. Statistics show that more than 60% of patients diagnosed with an ACL tear also have a torn meniscus. Some ACL and meniscus injuries can be treated non-surgically with rest, physical therapy, and activity modification. However, in a young active person, choosing to forgo ACL reconstruction or meniscus repair is likely to result in persistent instability and pain in the knee, as well as setting the stage for degenerative arthritis if they are unwilling to modify their sport-related activities significantly. Arthroscopic surgery takes place only after the immediate post-injury swelling and inflammation has diminished, and the patient has recovered almost complete range of motion.