Arthroscopic Procedures

This is an examination of the internal structures of a joint using a 5mm scope with an attached camera and light source. The scope and a small probe are introduced via small stab wounds called “portals”. A comprehensive examination of the internal structures can be viewed on a screen and recorded by video. An arthroscopic procedure is an operation performed by arthroscopy; several varieties of instruments are used for this type of surgery (keyhole) and the recovery is usually more rapid than in “open” surgical operations.

In an arthroscopic examination, an orthopaedic surgeon makes a small incision in the patient’s skin and then inserts pencil-sized instruments that contain a small lens and lighting system to magnify and illuminate the structures inside the joint. Light is transmitted through fiber optics to the end of the arthroscope that is inserted into the joint.

If, at arthroscopy, some damage is found on the joint surface (the articular cartilage), then there are various procedures which can be done depending on the severity. Articular cartilage does not naturally repair itself and procedures carried out on more minor damaged areas are aimed at removing debris and smoothing surfaces to prevent/delay further progression. In more severe cases, advanced modern techniques aim to produce an element of healing.

If the damage is minor, the surface of the cartilage may just be shaved to remove irregularities. In this case, return to normal activity will be governed by discomfort and swelling. These are not usually severe and, if you were quite fit before surgery, you could be back to normal in a few weeks.

A plica is a fold in the membrane which lines the joint. Sometimes, for a variety of reasons, a plica can become swollen, thickened and inflamed; in this situation it may interfere with normal functioning of the knee causing symptoms such as clicking, locking, giving way and stiffness. There are two plicae which are most commonly affected – the supra-patellar plica situated just above the kneecap, and the medial plica which is usually felt just adjacent to the inner edge of the kneecap.

Often an inflamed plica will settle with rest, anti-inflammatory tablets and appropriate physiotherapy, but sometimes removal of the plica is necessary.This is a simple procedure from which recovery is usually quick and problem free. If you have a sedentary occupation you may only require a few days off work. Physiotherapy is aimed at obtaining normal movement, strength and full activity as soon as possible after any swelling has settled down. This can be as little as 2-3 weeks, but is obviously variable from patient to patient.The very nature of the “lateral release” procedure means that the knee may become quite swollen post-operatively although, with new instruments used in surgery, this is less common. Some swelling is expected and is not a problem, but does mean that you will need to curtail your activity to allow inflammation to settle. The physiotherapist will guide you on increasing exercise gradually. It may take up to four to six weeks to perform everyday activities, and three months to return to sport. Time needed off work will be dependant on your occupation – if unsure discuss this with the physiotherapist or doctor.