Knee arthroscopy is a minimally invasive procedure that allows the surgeon to view the knee joint to diagnose and treat internal injuries. The word arthroscopy is borrowed from German arthroskopie which was introduced by the swiss surgeon and politician Eugen Bircher (1882-1956). This originally comes from the Greek words “arthro” (joint) and “scopy” (skopion – to look at, examine). Performed by Bircher, arthroscopy was purely a diagnostic procedure, with repair or removal of tissue being done by open surgery.
(“Arthroscopy” – Merriam-Webster.com Dictionary, Merriam-Webster, https://www.merriam-webster.com/dictionary/arthroscopy.)
With advances in technology, arthroscopic surgery has steadily replaced many open procedures for knee injuries. During knee arthroscopy the surgeon makes 2-3 small incisions to insert a small camera (arthroscope), into the knee joint. The high-definition camera displays images on a video monitor and the surgeon uses small miniature surgical instruments to treat and manage internal injuries such as meniscus tears. The small incisions rather than large incisions or a full open procedure result in less pain and joint stiffness for patients, and often shortens the recovery time. The procedure is done as an outpatient and people are up and around in a few days and back to their regular activities and more intense activities within a few weeks.
The knee is the largest joint in the body and is primarily a hinge type joint. The knee is comprised of the lower end of the femur (thighbone) and the upper end of the tibia (shinbone), and the patella (kneecap). The end of the bones are covered in articular cartilage, a smooth surface enabling the ends to move easily within the joint.
The menisci are two C-shaped cartilage wedges (medial meniscus & lateral meniscus) that act as “shock absorbers” to cushion the joint.
Ligaments hold the femur and tibia together to provide stability in all 3 planes. The cruciate ligaments are in the center of the knee and provide forward and backward stability while the collateral ligaments are on either side of the joint providing bending stability.
The knee is divided into three major compartments:
- Medial compartment (the inside part of the knee)
- Lateral compartment (the outside part of the knee)
- Patellofemoral compartment (the front of the knee between the kneecap and thighbone)
When is knee arthroscopy recommended?
With painful conditions within the knee joint and after failure of nonsurgical treatment, the surgeon may recommend knee arthroscopy. MRI imaging is often necessary to confirm underlying knee joint injuries prior to surgery. Common arthroscopic procedures of the knee include:
- partial meniscectomy (removal of the meniscus), repair of a torn meniscus, or meniscus transplantation
- reconstruction of a torn anterior cruciate ligament or posterior cruciate ligament
- removal of inflamed synovial tissue
- trimming or reconstruction of damaged articular cartilage
- removal of loose fragments of bone or cartilage, like those caused by synovial chondromatosis
- treatment of patella instability – medial patellofemoral ligament reconstruction
- treatment of knee sepsis (infection)
- anterior cruciate ligament reconstruction