Knee Arthroscopy

Overview

Knee arthroscopy may be used as a minimally invasive surgical procedure that uses a small camera (arthroscope) to view the inside of the knee joint and to help diagnose or treat certain knee problems. It can often be considered for conditions such as meniscal tears, loose bodies, selected cartilage injuries, and some ligament-related problems, depending on symptoms and imaging findings. The procedure typically uses small incisions and specialized instruments, which can generally reduce soft-tissue disruption compared with open surgery. Outcomes can vary based on the underlying diagnosis, the extent of joint damage (including arthritis), and the specific procedure performed during arthroscopy.

Indications

This procedure may be considered when:

• •Suspected meniscal tear associated with mechanical symptoms (such as catching or locking) that may persist despite initial nonoperative care, depending on tear type and patient factors
• •Loose bodies within the knee joint that can cause intermittent locking, swelling, or sharp pain
• •Selected cartilage injuries (chondral flaps or focal defects) where arthroscopic stabilization or cartilage procedures may be considered
• •Persistent knee swelling or synovitis where arthroscopic evaluation and synovial tissue sampling or debridement may be considered in selected cases
• •Septic arthritis evaluation and arthroscopic irrigation and debridement when infection is suspected, depending on clinical urgency and local practice
• •Assessment and treatment of certain ligament-related problems (for example, evaluation of ACL injury-associated meniscal or cartilage damage, or arthroscopic assistance during reconstruction planning)
• •Unexplained knee pain with inconclusive imaging where diagnostic arthroscopy may be considered after other evaluations, recognizing that yield can vary

How It Works

The procedure typically involves several coordinated steps:

• •A pre-procedure assessment can generally include review of symptoms, physical examination findings, and imaging (often X-ray and MRI) to clarify suspected intra-articular pathology.
• •After anesthesia, the knee may be positioned to allow controlled flexion and extension, which can help open different compartments for inspection.
• •Standard arthroscopy portals (often anterolateral and anteromedial) may be created with small skin incisions, and a trocar/cannula system can be introduced into the joint.
• •Sterile saline irrigation can be used to distend the joint, clear blood or debris, and improve visualization; inflow and outflow may be adjusted to manage clarity and pressure.
• •A systematic diagnostic arthroscopy may be performed, typically surveying the suprapatellar pouch, patellofemoral joint, medial compartment (including medial meniscus), intercondylar notch (ACL/PCL), and lateral compartment (including lateral meniscus).
• •Meniscal pathology may be addressed by partial meniscectomy (trimming unstable fragments) or meniscal repair (suturing), with the choice often depending on tear pattern, location (vascular zone), tissue quality, and patient factors.
• •Cartilage lesions may be treated with debridement/chondroplasty to stabilize frayed cartilage edges; selected focal full-thickness defects may be addressed with marrow stimulation techniques such as microfracture in appropriate candidates.
• •Loose bodies can be retrieved using graspers, and associated chondral or meniscal sources may be evaluated to reduce recurrence risk.
• •Synovitis may be treated with arthroscopic synovectomy or targeted debridement, and tissue samples may be obtained for laboratory evaluation when clinically indicated.
• •At completion, the joint can be irrigated, instruments removed, and portals closed; a compressive dressing may be applied to help limit swelling.
• •Post-procedure protocols can generally vary by the procedure performed (for example, meniscal repair may require different weight-bearing and motion limits than partial meniscectomy).

Risks

As with any surgical procedure, potential risks include:

• •Infection (superficial portal infection or deeper septic arthritis), which may present with increasing pain, swelling, warmth, fever, or drainage and may require additional treatment
• •Bleeding into the joint (hemarthrosis) or persistent swelling, which can contribute to stiffness and discomfort
• •Blood clots (deep vein thrombosis or pulmonary embolism), with risk influenced by patient factors, procedure duration, and mobility limitations
• •Damage to cartilage, meniscus, or ligaments from instruments or fluid pressure, which can potentially worsen symptoms or accelerate degenerative changes
• •Nerve or blood vessel injury near portal sites (for example, saphenous nerve irritation), which may cause numbness, tingling, or vascular complications
• •Stiffness or loss of motion (arthrofibrosis), which can be more likely after extensive procedures or prolonged swelling
• •Persistent pain or limited functional improvement, particularly when symptoms are related to osteoarthritis or diffuse cartilage loss rather than a discrete mechanical lesion
• •Anesthesia-related complications (such as nausea, sore throat with general anesthesia, allergic reactions, or cardiopulmonary events), with likelihood varying by health status and anesthetic type
• •Fluid extravasation into surrounding soft tissues, which can cause temporary swelling and discomfort and is generally monitored during the procedure
• •Need for additional surgery if the underlying condition progresses, if repair fails, or if new intra-articular pathology develops

Recovery Expectations

Recovery follows a gradual progression:

• •First 24–72 hours: Pain and swelling can often be most noticeable; elevation, icing strategies, and limited activity may be used as part of typical post-op care plans.
• •First 1–2 weeks: Portal sites can generally heal; follow-up may include dressing changes and suture removal timing depending on closure method and local protocol.
• •First 1–2 weeks: Walking may often resume with gradual increase in weight-bearing as tolerated after simple procedures, while repairs (such as meniscal repair) may require a longer protected phase.
• •Weeks 2–6: Range-of-motion and strengthening work can generally progress; return to desk-based work may often span several days to a couple of weeks depending on pain and mobility demands.
• •Weeks 4–12: Higher-demand activities may gradually resume; timelines can vary widely based on whether trimming, repair, cartilage procedures, or ligament-related work was performed.
• •Months 3–6: Return to pivoting sports can often require this span after more complex procedures (for example, meniscal repair or cartilage restoration steps), with progression typically guided by functional milestones.
• •Up to several months: Swelling with activity can sometimes persist intermittently, particularly after more extensive intra-articular work or in the presence of arthritis.

Alternatives

Depending on individual circumstances, alternatives may include:

• •Activity modification and structured physical therapy focused on strength, flexibility, and neuromuscular control
• •Oral or topical pain-relieving medications that may be used for symptom control, depending on individual risk factors and clinician guidance
• •Injections (such as corticosteroid injections for inflammation or hyaluronic acid in selected cases), with variable effectiveness depending on diagnosis
• •Bracing or assistive devices that can sometimes help with stability or unloading in selected patterns of symptoms
• •Image-guided aspiration of joint effusion and diagnostic evaluation when swelling is prominent, depending on suspected cause
• •Open surgical procedures (such as open meniscal repair in selected cases) when arthroscopy may not be appropriate or sufficient
• •Nonoperative monitoring (watchful waiting) when symptoms are mild or improving and imaging suggests degenerative rather than mechanical pathology

Sources

• AAOS OrthoInfo - Knee Arthroscopy
• MedlinePlus (NIH) - Knee Arthroscopy
• Mayo Clinic - Arthroscopy (Overview and Risks)