The knee joint has two meniscal cartilages, one on the inner side and one on the outer side of the joint. They function as shock absorbers and are important to help prevent arthritis in the long term. Unfortunately, the meniscus is prone to tearing, especially with sudden twisting movements. Likewise, the meniscal tissue can become more brittle as we get older and again tear quite easily (“a degenerate tear”). Torn tissues need a blood supply to heal themselves – but the meniscus typically has a very poor blood supply and therefore does not usually heal itself. Patients with meniscal tears tend to have prolonged symptoms which do not improve with time. These include a darting, clicking pain which is intermittent and unpredictable in nature.
After the initial traumatic event, it is best to see if the intermittent pain settles itself over a number of weeks. A physiotherapist may be helpful in the acute phase. If the darting pain persists for more than 6 weeks, surgery may become necessary.
1. Knee Arthroscopy
If the pain persists, a knee arthroscopy may be necessary. This is a simple day case procedure, performed under general anaesthetic, where two small incisions (keyhole surgery) are used to introduce a camera and a shaving device into the knee. The articular cartilage and the meniscal cartilage can be clearly inspected and probed. Unstable segments of the torn meniscus are removed and the meniscus is shaved back to a stable margin. This prevents the intermittent catching, clicking and darting pain. Only the unstable segment is removed and as much meniscal cartilage as possible is preserved.
Following surgery, we will show you photographs of the inside of your knee to explain what happened during the operation. You can go home a number of hours after your surgery, with two crutches. You will be fully mobile and should have mild discomfort only. Most people can return to more sedentary jobs and driving within a number of days. I will ask your GP to remove your stitches after about 10 days and I usually see you again after 6 to 8 weeks with the Physiotherapy Team in the Rehabilitation Suite weeks to ensure you are happy with the outcome of your surgery.
Surgery – What to expect?
Knee arthroscopy is performed as a day-case procedure. After your surgery, our physiotherapy and nursing teams get you up out of bed, with the use of crutches. You can full weight bear through your leg and if comfortable, you do not need to use the crutches. Our physio team show you photos from inside your knee and give you an exercise programme for the next 6 weeks. I chat with you prior to your departure.
You can drive 24 hours after your anaesthetic. You can drop the crutches, once you are comfortable (typically day 2 or 3). We ask your GP to remove your two stitches after 7 – 10 days. Approximately 10% of patients can have residual stiffness and discomfort after the scope, especially if your knee was tight, meaning more loading during your surgery. If your knee is sore, I recommend your take some ‘over the counter’ anti-inflammatories for 1 to 2 weeks.
Thankfully complications after knee arthroscopy are very unusual. If you develop pain, temperatures, heat, swelling or stiffness in your knee, this could mean you are developing an infection, so please contact us immediately if this is the case. Other complications include residual pain, leg cots that can travel to the lungs, ligament tears during the surgery, incomplete resection of the torn meniscal cartilage and wound discomfort.
I review you with the physiotherapy team in the Rehabilitation Suite at 6 weeks following the surgery, to ensure all is well. Most patients have returned to work and all activities by that stage.