An arthroscopy is a procedure used to diagnose and treat some joint problems.

When you have an arthroscopy, an instrument called an arthroscope is used to look inside your joint. An arthroscope is a small, fibre-optic video camera attached to a narrow tube.

An arthroscopy can be done to help diagnose a problem in a joint. It can also help guide surgical repair of a joint problem.

This type of ‘keyhole surgery’ is done with narrow, pencil-shaped surgical instruments.

Arthroscopy can be done on many parts of your body:

• knee arthroscopy
• shoulder arthroscopy
• elbow arthroscopy
• ankle arthroscopy
• hip arthroscopy
• wrist arthroscopy

In the knee, arthroscopy may be used for conditions such as:

• some meniscal (cartilage) tears
• some ligament injuries
• loose bodies of bone and cartilage inside the joint

Before an arthroscopy, your doctor will ask about your symptoms and examine your joint. They may also ask for:

• x-rays
• MRI scans
• other scans
• blood tests

Talk with your doctor about the benefits and risks of arthroscopy for your condition.

Before agreeing to arthroscopic surgery, ask if there are other suitable treatment options, such as:

• losing weight
• pain relief medicines
• exercise
• physiotherapy

An arthroscopy is often done as day surgery. Depending on the joint involved and your health, you may have a:

• local anaesthetic
• spinal anaesthetic
• general anaesthetic

Your surgeon will make a tiny cut near your joint and insert the arthroscope. The images from inside your joint will be shown on a video monitor. The surgeon might be able to see what is causing your problem.

If surgery is needed, your surgeon may make a few more narrow cuts and insert surgical instruments.

Examples of arthroscopic surgery include:

• reconstructing a torn ligament in the knee
• treating carpal tunnel syndrome in the wrist
• fixing a recurring shoulder dislocation

After surgery, your wounds will be stitched or closed with special tape and then bandaged.

Injuries to the knee are common. Since this joint is primarily supported by muscles and ligaments, injuries to any of these structures will result in pain or knee instability. Injury to the posterior cruciate ligament occurs when the knee is flexed and the tibia is driven posteriorly, such as falling and landing on the tibial tuberosity or hitting the tibia on the dashboard when not wearing a seatbelt during an automobile accident. More commonly, injuries occur when forces are applied to the extended knee, particularly when the foot is planted and unable to move. Anterior cruciate ligament injuries can result with a forceful blow to the anterior knee, producing hyperextension, or when a runner makes a quick change of direction that produces both twisting and hyperextension of the knee.

A worse combination of injuries can occur with a hit to the lateral side of the extended knee (Figure 9.20). A moderate blow to the lateral knee will cause the medial side of the joint to open, resulting in stretching or damage to the tibial collateral ligament. Because the medial meniscus is attached to the tibial collateral ligament, a stronger blow can tear the ligament and also damage the medial meniscus. This is one reason that the medial meniscus is 20 times more likely to be injured than the lateral meniscus. A powerful blow to the lateral knee produces a “terrible triad” injury, in which there is a sequential injury to the tibial collateral ligament, medial meniscus, and anterior cruciate ligament.

Arthroscopic surgery has greatly improved the surgical treatment of knee injuries and reduced subsequent recovery times. This procedure involves a small incision and the insertion into the joint of an arthroscope, a pencil-thin instrument that allows for visualization of the joint interior. Small surgical instruments are also inserted via additional incisions. These tools allow a surgeon to remove or repair a torn meniscus or to reconstruct a ruptured cruciate ligament. The current method for anterior cruciate ligament replacement involves using a portion of the patellar ligament. Holes are drilled into the cruciate ligament attachment points on the tibia and femur, and the patellar ligament graft, with small areas of attached bone still intact at each end, is inserted into these holes. The bone-to-bone sites at each end of the graft heal rapidly and strongly, thus enabling a rapid recovery.

Recovery from arthroscopic surgery is usually faster than open surgery.

You may have some pain, swelling, bruising and stiffness after the surgery. You can take pain-relief medicines to help ease pain and discomfort.

You might also be advised to:

• keep the affected joint raised
• apply ice packs to reduce swelling
• wear a pressure stocking
• use a splint, supportive brace or crutches
• do special exercises or physiotherapy to strengthen your muscles and prevent joint stiffness

You might need to have a few days or a week off before returning to work or school. Your doctor will talk with you about managing your wound dressings.

Recovery will depend on your condition and the procedure performed. Ask your doctor about what to expect in your situation.

Any type of surgery has some risks. While most arthroscopies go smoothly, possible complications can include:

• infection
• a deep vein thrombosis (blood clot), usually in the leg
• bleeding inside your joint
• nerve damage or numbness
• ongoing pain

Contact your doctor immediately if you have:

• high fever
• severe pain
• redness or excess swelling around the wounds
• numbness
• bad smelling fluid leaking from the incisions