Knee arthroscopy
The surgeon inserts a camera into the knee through small incisions to visualize the inside. Depending on the injury, they may perform a procedure on the meniscus, cartilage, or certain ligament structures.
The indication depends on the discomfort, the clinical examination, the observed lesions, the treatments already tried, and the patient's goals. An abnormality visible on an image is not, in itself, sufficient to justify surgery.
UNDERSTANDING ANTERIOR CRUCIATE LIGAMENT SURGERY
WHEN TO CONSIDER KNEE ARTHROSCOPY?
Arthroscopy may be considered when the examination and symptoms correspond to a lesion that could benefit from an arthroscopic procedure.
- Some meniscal tears are repairable: Suturing may be considered depending on the location and shape of the tear, and the quality of the tissue. When possible, preserving the meniscus is preferred.
- An unstable and irreparable meniscal tear: A limited resection may be offered when the fragment responsible for the symptoms cannot be repaired.
- Certain localized cartilage lesions: An arthroscopic procedure may be considered in selected situations, depending on the size, location and depth of the lesion.
- Certain ligament injuries or loose bodies in the joints — Arthroscopy can be used to perform or to support a procedure adapted to the lesion and the surgical plan.
Functional impairment, symptom duration, clinical examination, observed lesions, previously tried treatments, functional age, activity level, and patient goals are all taken into account. Arthroscopy is not automatically indicated, particularly for pain related to diffuse wear and tear of the knee. An abnormal image alone is not sufficient to warrant surgery.
PREPARE FOR THE INTERVENTION
The preparation allows you to confirm the planned procedure, to organize the follow-up, and to receive instructions tailored to your situation.
PRE-OPERATIVE ASSESSMENT
The consultation will review your symptoms, the clinical examination, and any available imaging studies. Additional tests or analyses may be requested. An anesthesia consultation will be scheduled according to the planned pathway.
INTERVENTION PLANNING
The surgeon specifies the planned procedure: meniscal repair, limited resection, or another appropriate intervention. The technique depends on the lesion and the goals of joint preservation.
PHYSICAL PREPARATION AND PRACTICE
Rehabilitation can be arranged in advance, especially if meniscus repair is planned. Plan for your return home and arrange for assistance with mobility if needed. Crutches may be helpful.
INSTRUCTIONS BEFORE THE OPERATION
The team will provide you with instructions regarding fasting, hygiene, arrival, and return home. Do not change or stop any medication without consulting the medical team.
HOW IS KNEE ARTHROSCOPY PERFORMED?
The procedure varies depending on the planned intervention. Here are the main steps, which will be explained in detail during your consultation.
INSTALLATION AND ANESTHESIA
You will be positioned to allow access to your knee. General or regional anesthesia may be offered depending on the procedure and your medical condition. The team will prepare the area according to aseptic techniques and perform checks before the incision.
ACCESS TO THE TREATED AREA
The surgeon makes small incisions, called portals, around the knee. The camera is inserted through one of them; the instruments are passed through the others. The images allow the joint structures to be viewed on a screen.
MAIN SURGICAL PROCEDURE
The surgeon examines the structures and performs the planned procedure. For a repairable meniscal tear, the edges of the tear are brought together and held in place with appropriate sutures. If a fragment is unstable and cannot be repaired, a limited resection may be performed: only the affected portion is removed as much as possible. Other procedures may be used for localized cartilage damage, a loose body, or to support ligament reconstruction. The choice depends on the anatomy, the nature of the injury, and the surgical findings.
RESULT CONTROL
The surgeon checks the procedure performed and the condition of the visible structures. After suturing, they check the stability of the repair and the knee's mobility according to the appropriate procedures. For other procedures, the checks focus on the treated area and the preservation of surrounding structures.
CLOSURE AND END OF THE PROCEDURE
The instruments are removed, the small incisions are closed or covered with dressings, and then the patient is transferred to the recovery room. A splint is not always necessary; it depends on the procedure performed and the prescribed protocol.
The procedure performed and the instructions after the operation depend on the lesion being treated, not solely on the fact that the intervention is arthroscopic.
The anesthesia, approximate duration, and hospitalization details will be specified according to your surgical plan. Some arthroscopies are performed on an outpatient basis. Meniscal repair may require different postoperative precautions than partial resection.
THE DIFFERENT POSSIBLE TECHNIQUES
Arthroscopy allows access to the inside of the knee, but the procedure varies depending on the nature and location of the lesion.
For a meniscal tear, the surgeon aims to preserve the tissue whenever repair is possible. Partial meniscectomy is reserved for fragments deemed irreparable or in certain situations following a failed repair.
MENISCAL REPAIR
The tear is sutured when its shape, location, and the quality of the tissue make repair feasible. This preserves the meniscus but requires specific healing and recovery instructions.
PARTIAL MENISCECTOMY
The surgeon removes only the unstable and irreparable portion responsible for the symptoms. Resection is limited as much as possible. This technique is not suitable for all tears and does not replace repair when appropriate.
GESTURE ON THE CARTILAGE OR FREE BODY
In certain specific cases, arthroscopy can be used to treat a localized cartilage lesion or to remove a loose fragment within the joint. The procedure depends on the size, location, and overall condition of the knee.
ARTHROSCOPY COMBINED WITH ANOTHER SURGERY
Arthroscopy may be part of a ligament surgery or other knee procedure. The fixation technique, instruments, and monitoring are then determined by the primary surgery.
The choice of technique is discussed according to the assessment, the expected benefits, the limitations and the patient's objectives.
AFTER THE PROCEDURE: THE FIRST STEPS
After the procedure, the team monitors the patient's awakening, pain level, and overall condition. Pain management, dressing changes, and initial mobilization are tailored to the specific procedure performed.
Walking can resume quickly after certain procedures. Following meniscal repair or a related intervention, weight-bearing and mobility may be managed differently. Follow the instructions you are given.
WAKE-UP AND PAIN ROOM
The team monitors your awakening and adjusts pain management accordingly. Instructions regarding prescribed medications and care are explained to you before discharge.
SUPPORT, WALKING AND SPLINTING
Weight-bearing may be immediate or protected depending on the procedure. Crutches may be necessary; a splint is prescribed only if the intervention and protocol warrant it.
RETURN HOME AND MONITORING
Outpatient discharge or length of hospital stay depends on the procedure and your overall condition. Keep the dressing on as instructed. Contact the team if you develop a fever, experience significantly worsening pain, drainage, or significant redness around the incisions.
REHABILITATION AND RESUMPTION OF ACTIVITIES AFTER KNEE ARTHROSCOPY
The initial objectives The goals are to manage pain and swelling, monitor healing, gradually regain mobility, and reactivate muscles according to instructions. The exercises depend on the specific movement performed.
Rehabilitation then progresses towards work on mobility, strength, balance and movement control. After meniscal repair, the program may include different restrictions than those prescribed after a partial resection.
Walking, stairs, driving and work Activities are resumed based on permitted weight-bearing, mobility, and activity requirements. Resumption of driving should be discussed with the team, particularly if the operated knee is involved in driving.
Sport is gradually resuming, Depending on healing, mobility, strength, and functional control of the knee, resumption of activity must be medically validated, provided there are no complications; the time frame varies depending on the procedure and the patient's progress.
The rehabilitation program is tailored to the intervention and your progress.
EXPECTED RESULTS, LIMITATIONS AND RISKS
The decision weighs the expected stability, the constraints of recovery, and the risks specific to the patient's situation.
The expected benefit, limitations and risks are assessed together before deciding on the intervention.
OBJECTIVES AND EXPECTED RESULTS
The procedure aims to treat the targeted lesion and improve symptoms or function when this lesion is responsible for the discomfort. For meniscal repair, the goal is also to preserve tissue when conditions allow. No complete result can be guaranteed.
Boundaries
Arthroscopy does not necessarily treat all causes of pain. Diffuse cartilage damage, another injury, or stiffness can limit improvement. Recovery depends on the procedure, healing, and rehabilitation.
Risks and complications
Like any surgical procedure, arthroscopy carries risks, including infection, hematoma, phlebitis, stiffness, or persistent pain. After a repair, healing may be insufficient or the injury may recur; further surgery may then be considered.
AN INTERVENTION TAILORED TO EACH PATIENT
Two patients with a meniscal tear that appears similar on imaging do not necessarily require the same treatment. Symptoms, clinical examination, and functional goals all contribute to the decision.
Dr. Benoît Coulin takes into account functional age, anatomy, tissue quality, the importance and location of the lesion, level of activity, occupation, associated injuries, treatments already tried, and personal goals.
«"Movement is life. Every patient deserves to regain their freedom to move."»
FREQUENTLY ASKED QUESTIONS
Would you like to discuss knee arthroscopy?
A clinical examination and analysis of imaging can confirm whether arthroscopy can be considered and choose the appropriate procedure.
