Arthroscopic surgery is also known as “keyhole surgery” because the incisions made are very small. The camera and the instruments used inside your knee are the diameter of a pen. The camera is connected to a monitor that the surgeon watches during surgery.

Arthroscopy can be used for a wide range of knee treatments, including:

• Removing or repairing torn cartilage (meniscus tear)
• Trimming or smoothing damaged joint cartilage (articular)
• Implanting new joint cartilage (ACL)
• Removing loose fragments of bone or cartilage
• Cleaning an infected knee

Arthroscopy is also part of other knee surgeries, such as:

• ACL reconstruction
• Other ligament reconstruction (such as MCL and PCL)
• MPFL reconstruction for kneecap (patella) instability

The most important preparation for an arthroscopic surgery is to have a knee that is ‘settled’ with no effusion and to be as strong in the quadriceps (thigh muscles) as possible. The best results are achieved when working with a sports specialist physiotherapist who is in communication with your surgeon. We run clinics to prepare people for this surgery.

At MTP Health, we take your preparation for surgery very seriously in order to ensure that you get the best outcome  through being psychologically prepared, physically strong and medically safe enough to undergo this procedure.

We may need to get additional tests or specialist referrals.

Finally and importantly, we will help you to get strong:

• Our team of Physiotherapists and Exercise Physiologists can assess your level of function
• We recommend that at the time of confirming your surgical date, you book your first Physiotherapy appointment in the first 2-5 days from surgery.

The hospital will contact you in the week of surgery and they will confirm with you on the day before your surgery, the time you need to arrive and when you need to start fasting.

For our patients, if you are on a morning list you need to stop all food from midnight and stop clear fluids from 0530 or 2 hours before the planned start of the list, whichever comes first.

For afternoon lists that time is 11am.

Acceptable clear fluids include water, ‘see through’ apple juice with no bits or ‘see through’ energy drink such as gatorade. It does not include milk or cloudy juice with bits.

You will arrive at the hospital between 1 and 2 hours before your surgery. You will have your hip area  prepared by a nurse who will shave the skin over your knee and paint on a coloured antiseptic solution. You will then meet one of our anaesthetic team and they will make sure you are comfortable and safe during the procedure.

Before your anaesthetic, your surgeon will see you and ask you “Which JOINT and What SIDE?” This is critical as they will then check this matches your consent form and draw an arrow on the knee that you specify and point to. This is the most effective way of stopping ‘Wrong Side surgery.”

At the start of the procedure you are transferred from your nice warm bed to lie on your back on a hard and cold operating table - apologies in advance. The anaesthetist will then give you a general anaesthetic meaning you will be ‘asleep’ for the whole procedure. They may also put local anaesthetic around some of the nerves in your leg (nerve block) to reduce your pain after you wake up.

For the surgery you will have a tourniquet inflated around your upper thigh to reduce any blood flow and allow for a clear view inside the knee for the camera. Your surgeon will then make 2 to 3 small incisions (1cm) at the front of the knee and the knee is filled with sterile saline (salty water) to give a clear view. The telescope (arthroscope) is attached to a camera and inserted into the knee to look for damage and injured areas. These can be treated with a selection of small instruments including probes, scissors and shavers.

At the end of the procedure the incisions are injected with local anaesthetic, sutured with dissolvable sutures and then glued to provide a strong waterproof closure.

The surgery takes between 30 to 90 minutes on average with additional time before for anaesthetics and after for recovery. For the waiting relatives or partners, it is usually between 2-3 hours from leaving the admissions area to getting back to the day stay ward.

You should experience little more than mild discomfort after waking up from a knee arthroscopy. It usually involves a fast recovery needing painkillers for only a short period.

After the operation, you wake up in the recovery room, where you are monitored for approximately 1 hour and when stable, you can be transferred to the day stay ward. During this time, your surgeon will call your relative. It is important that they realise that this may be more than 4 hours from the time you were ‘taken into the operating theatres’ due to waiting and preparation times.

Walking

You will be given crutches to use before leaving hospital for your safety (If you have your own, feel free to bring them). Most patients can put all their weight through their leg immediately after arthroscopic surgery and are allowed to bend the knee as much as their pain allows.

Most patients can walk normally 7 days after surgery and can return to most activities in 6-8 weeks. Check with your surgeon before starting any impact activity such as running to avoid damaging the knee.

Bracing

A brace is used to restrict bending in some cases, but usually only after a meniscus repair or reconstruction.

Dressings

The bulky dressings can be removed the morning after surgery. You will have small, waterproof dressings underneath (insert picture) that you should leave on until your wound check at 10-14 days. It is common for some fluid to ooze out into the dressings over the first 24-48 hours and this can have a faint red colour to it. If it happens, the waterproof dressings may need changing.

You can shower with these dressings but avoid soaking in the bath, pool, or the ocean. If they come loose or get soaked, please replace them.

Game Ready

If you have been supplied with a Game Ready, please click here for information on how to set it up. We advise using it on program 2 or 3 and for up to two hours at a time. You can use it as often as you like in a day as long as you manage to complete your rehabilitation exercises. If your pain and swelling are well controlled, you don’t need to use it.

When supplied by MTP Health, you have the Game Ready for 2 weeks. At the end of this time it will be picked up by a courier unless you want to continue to rent it yourself.

Length of stay

It is safe for you to go home on the day of your surgery. Staying in the hospital overnight is uncommon and likely won’t be needed unless previously discussed with your surgeon.

Your recovery starts the minute you are awake from the anaesthetic. You start with the simple exercises including ‘Pumping’ your calf muscles to encourage blood movement through the legs and contracting your thigh muscles to squash the back of your knee into the bed. The physiotherapist will assist you in getting out of bed and walking.

It is vital to your recovery that you engage with a physiotherapist to maximize your early recovery from surgery.

At MTP Health we that you book your first post operative appointment with a physio as soon as we have a confirmed surgical date. This should be between 2 and 5 days from the surgery and we will have communicated the rehab plan with your treating Physio whether that is one of our team or your own Physio. They will help you manage swelling and stiffness before working on your leg strength and function. Finally they will look to improve your level of function for your chosen sport or activity and develop your program to reduce the risk of further injury.

Recommended Rehab/Recovery visits -

• First 6 weeks - twice a week Physio
• Second 6 weeks - once a week Exercise Physiology
• Ongoing - as directed by Surgeon, Physio and/or Exercise Physiologist

Returning to driving takes a minimum of two weeks for right knee arthroscopy and two days for left knee surgery in an automatic car. You must be able to safely perform an “emergency stop” and you must have stopped all painkillers other than over-the-counter medications (such as Panadol or Nurofen). There is no specific documentation on this by licencing authorities, but checking with your car insurance company is recommended.

If the surgery was for meniscal trimming, removal of a loose body, or cartilage smoothing:

• Most office workers can return to work after 2 to 5 days
• Heavy manual workers may need up to 2 weeks before resuming full duties
• Full recovery takes between 4 to 6 weeks
• There is usually no restriction placed on the amount of bending in the knee
• Resistance work and non-impact exercise (such as swimming and cycling) is usually unrestricted from 2 weeks

We advise against running for the first 6 weeks due to the risk of insufficiency fracture which can prolong recovery. We happily work with athletes who need to manage their training load.

The knee may remain swollen for up to 6 weeks and the incision sites are often puffy and firm for up to 3 months.

If the surgery was for meniscal repair or root repair:

• Most office workers can return to work after 1 week
• Heavy manual workers may need up to 3 months before resuming full duties
• Depending on the size of the repair, you may need to use crutches for 6-8 weeks
• The knee is kept in a brace to restrict bending beyond 90 degrees for 6 weeks
• The brace is removed at 6 weeks but there is to be no squatting beyond 90 degrees for 3 months after surgery.
• Resistance work and non-impact exercise (such as cycling) is usually unrestricted from 2 weeks. The only limit is the brace’s range of motion.

Running and impact training is restricted for 3-4 months. We happily work with athletes who need to manage their training load.

The knee may remain swollen and the incision sites are often puffy and firm for up to 3 months. Full recovery takes between 4 to 6 months

Knee arthroscopy is a very safe procedure but there are always some general risks with joint surgery. The most common side effect is temporary pain and bruising. Other complications can include -

Blood clots in the leg 

These are uncommon after knee arthroscopy but can cause severe swelling and pain. Clots that develop in the calf are called Deep Vein Thrombosis (DVT) and these can travel to the lungs Pulmonary Embolus (PE). If a clot develops you may need to take “blood thinner” medications for several months

Infection

This is very uncommon after knee arthroscopy. If it is just a wound infection then antibiotic tablets or sometimes IV through a drip are needed. If the infection gets into the knee joint, it may require further surgery to wash the joint out.

Skin numbness

There are very small nerve fibres in the skin around the knee that are always cut during the surgery and this leaves a small numb patch on the outer aspect of the leg past the scar. This numb patch tends to shrink over time. Permanent nerve damage is rare, especially to the larger nerves that supply muscles that could cause weakness.

The risks specific to meniscal trimming include:

• Ongoing pain, especially if there is any pre-existing arthritis
• Further tears – more likely in a degenerate meniscus

The risks specific to meniscal repair include:

• 1 in 5 people have ongoing pain around the site of the repair for several months
• Approximately 25-35% of meniscal repairs don’t heal needing further surgery in the first year.

Other uncommon complications include anaesthetic risks of allergic reaction to medications, heart damage, lung damage, stroke and death.

As always with the health system, the answer is ‘it depends.’

At MTP Health, our aim is to simplify healthcare through a better understanding of the system upfront. Therefore, while you can discuss the options specific to you with the team when you see your specialist -

If you are having surgery using your private health cover, the standard fees for the surgeon, anaesthetist, and assistant usually lead to a total out-of-pocket payment of around $2,500. This is the ‘gap’ that is left after Medicare and your insurance company have given you back their rebates.

Note that the anaesthetist is an independent practitioner and can charge a different gap which could affect this figure. We always provide you with their details and recommend you check their quote before committing to surgery.

The surgeons at MTP Orthopaedics participate in the various reduced gap schemes run by different health insurance providers. However, please check for the availability of surgical time slots first as there is often a wait of many months for this option.

Your insurance may also have an excess to pay, so please check. This is usually $500.

If you are having the operation through the public system, there is no out-of-pocket cost. Unfortunately, you are likely to have to wait up to a year for surgery.