Arthroscopic knee operations

The purpose of arthroscopic knee surgery

Interventions by arthroscopy are the most effective option for the early surgical treatment of joint injuries, abrasive and inflammatory diseases and congenital disorders. This allows the joints to be inspected from the inside through 2-3 or maybe 4 tiny, 4-5mm incisions, using a suitable minimally invasive technique, and the necessary surgical interventions can be performed with a special array of surgical instruments. The doctor follows the process through a monitor without making a major incision in the joint.

Arthroscopic knee surgery technique

The first step in arthroscopy, based on a surgical plan defined by preliminary clinical and imaging examinations, is to examine the internal structures of the joint. The joint is inspected using a palpation probe to check the integrity of the crescent-shaped cartilages (menisci), the tension of the internal ligaments of the joint and the condition of the cartilage surfaces by palpating the joint surfaces. This will help to refine the diagnosis and determine the optimal type of intervention.

For which knee conditions can the intervention be used?

• In the case of meniscus damage, the torn parts are removed or reattached, while in the case of abnormal changes to the synovial membrane, it may be removed or treated by electrocoagulation.
• A significant proportion of biomechanical damage can also be repaired by arthroscopic surgery (correction of the pressure and deformity of the joint behind the patella, replacement of the cruciate ligament, treatment of traumatic damage to certain cartilage surfaces, removal of bone growths or deposits, etc.).
• In the case of cartilage surfaces, superficial lesions can be repaired by flattening and polishing the damaged part, while deeper cartilage lesions can be treated by cartilage resurfacing (cartilage grafting, microfracture, biodegradable scaffolding and stem cell implantation, etc.).

The procedure for arthroscopic knee surgery

This orthopedic surgery is performed under general anesthesia or spinal anesthesia with the application of a tourniquet cuff.

Postoperative care

The patient may wake up a few hours after the operation. Depending on the type of surgery performed, they may be able to bear weight on the operated limb or, if a weight-relieving device is ordered, walk relieved of their bodyweight using an assistive device. The physiotherapist will help you learn to do this.

If there are no problems, the patient is discharged after one night in hospital and the sutures or surgical staples are removed between days 7 to 14. During the hospital stay, for the first few weeks the physiotherapist teaches the movement restrictions, the use of assistive devices and the initial rehabilitation exercises. At home, the exercises learned must be continued regularly. At the end of the course, a recommendation is made for home physiotherapy (as part of home care), a prescription for the necessary medication is provided and the necessary follow-up examination is scheduled. In the event of a complaint, an out-of-schedule check-up will be provided.

Postoperative rehabilitation

After discharge, replacement of the dressing applied in hospital is not usually necessary. The wound should not be exposed to water until the sutures are removed, but showering is possible if a suitable waterproof dressing is in place. Cooling of the operated joint can be carried out as advised at the time of discharge.

Instructions and restrictions on the use of the assistive device and load/movement have been learned in the hospital with the help of the physiotherapist and are valid until the next follow-up examination. If necessary, a mobility device (CPM machine) can be used at the beginning of the home period to assist with follow-up treatment, the hire of which can be arranged with the hospital.

Follow-up examinations will be scheduled according to the pace of rehabilitation, so that the check-up phases can be well defined and monitored. Medication ordered upon discharge is intended to avoid possible complications (antibiotics or prophylaxis for thrombosis) or to support rehabilitation (anti-inflammatories, analgesics).

Frequently asked questions about arthroscopic knee surgery

What movements should not be performed, and how can the knee be loaded?

In most cases, the knee joint can be moved immediately after arthroscopic surgery, and a fixed position is not usually necessary. In exceptionally rare cases (e.g. multiple ligament replacements after previous anterior cruciate ligament replacement for instability), 1-2 weeks of immobilization may be necessary. In the early period, ambulation helps the circulation of the limb, but in a passive position - prolonged sitting - it is recommended to pad the limb to avoid swelling of the knee and the development of peripheral edema. The load on the limb is essentially determined by the type of surgery. After ligament replacement, cartilage grafting or cartilage resurfacing, a 2–3-week unloaded period is usually ordered, but in the majority of arthroscopic procedures the limb can be loaded immediately.

What medical aids are needed for home physiotherapy?

In our hospital we provide all the medical aids necessary for rehabilitation that may be needed when our patients leave for home. These include elastic stockings to protect against blood clots, and walking aids (elbow crutches, underarm crutches).

In consultation with your physiotherapist or doctor, you may find it useful to hire a passive knee exerciser to supplement your home exercises in the week or two after surgery to help you regain knee function more quickly. It should be stressed that this is not a substitute for active exercise, but a complement to it. The final function of the knee joint will be determined largely by physiotherapy, active stretching and flexion exercises and muscle strengthening.

Knee braces (orthoses) are not routinely used and are only prescribed for a few weeks after surgery in selected cases.

The involvement of a physiotherapist is essential for rehabilitation. We can provide this in our hospital, in addition to our home care provision, for our inpatients. The assistance of our physiotherapists is also a priority when returning to sport.

Can I have an MRI scan with a metal implant?

Medical metals are generally MRI-compatible, so MRI scans can be performed after receiving an implant that may have been placed during arthroscopic surgery. However, as medical metals can heat up slightly in the magnetic field, we do not usually recommend an MRI scan for the first six weeks after surgery, but it can be done after this period. The implants we use are mostly made of titanium and do not heat up, so present no problem with MRI in the early post-operative period.

How does the implant behave at airport or other metal detector gates? 

The implant can be detected by the metal detector. A hospital discharge report or any other certificate does not exempt you from being screened with a handheld metal detector, as the purpose of these checkpoints is essentially to detect metal weapons.

When can I drive a car after an arthroscopy? 

Driving is usually possible after a few days. In the case of procedures that require weight bearing (cartilage grafting, ligament replacement, etc.), we usually recommend that you resume driving 4 weeks after surgery. In the case of left knee surgery or for those with an automatic car, driving can be started earlier.

What sports activities can I do after knee arthroscopy?

The aim of the operation is to relieve the patient's symptoms and to enable them to lead as full and active a life as possible with a stable knee joint, while regaining their previous mobility. The rate of gradual return to sporting activity is determined jointly by the doctor and the physiotherapist and is determined not only by the function of the operated joint but also by the patient's other parameters and general musculoskeletal condition. The surgeon's opinion is based on the joint's range of motion, stability and the amount of muscle regained, but their recommendation takes into account the physiotherapist's assessment of the functional capacity of the operated limb.

Why choose Dr. Rose Private Hospital? 

• We offer a full range of orthopedic services. We provide the necessary tests (MRI, CT, x-ray, ultrasound, laboratory tests) for an accurate diagnosis at our specialist orthopedic clinic. Arthroscopic knee surgery is performed without a waiting list. After the operation, our physiotherapists and sports rehabilitation staff will help you to regain mobility as quickly as possible.
• A highly trained team of specialists. Our specialists use state-of-the-art, minimally invasive techniques to speed recovery, complemented by our physiotherapists, physical therapists and sports rehabilitation staff. In the case of a complex problem, we decide on the appropriate course of treatment, necessary tests and therapies in a consultation.
• Exclusive environment. Our premium inpatient department has 3 operating theatres and 24 patient rooms with 33 beds to meet all your needs. The highest professional standards togehter with a unique healing environment mean you can recover in safety and with complete peace of mind.

For knee pain and complaints related to the knee joint, please contact the doctors at Dr. Rose Private Hospital.