Knee Arthroscopy in Sydney

Arthroscopic surgery is also known as keyhole surgery because the incisions are very small. The camera and the instruments used inside your knee are about 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, such as a meniscus tear
• Trimming or smoothing damaged joint cartilage
• Removing loose fragments of bone or cartilage
• Cleaning an infected knee
• Assessing and treating selected injuries inside the knee joint

Arthroscopy is also part of other knee surgeries, such as ACL reconstruction, other ligament reconstruction such as MCL or PCL reconstruction, and MPFL reconstruction for kneecap, or patella, instability.

The most important preparation for knee arthroscopy is to have a knee that is settled, with minimal swelling, and to be as strong as possible through the quadriceps, or thigh muscles. The best results are achieved when you work with a sports-focused physiotherapist who is in communication with your surgeon.

At MTP Health, we take your preparation for surgery seriously. We aim to make sure you are psychologically prepared, physically strong and medically safe enough to undergo the procedure.

We may need to organise additional tests or specialist referrals depending on your medical history.

Finally and importantly, we will help you get strong. Our physiotherapists and exercise physiologists can assess your level of function, and we recommend booking your first post-operative physiotherapy appointment for two to five days after surgery when your surgical date is confirmed.

The hospital will contact you in the week of surgery and confirm your arrival time and fasting instructions, usually the day before your procedure.

For our patients, if you are on a morning list you usually need to stop all food from midnight and stop clear fluids from 5:30am or two hours before the planned start of the list, whichever comes first.

For afternoon lists, the food fasting time is usually 11am.

Acceptable clear fluids include water, see-through apple juice with no bits, or see-through sports drink such as Gatorade. Clear fluids do not include milk or cloudy juice with bits.

You will arrive at hospital between one and two hours before surgery. A nurse will prepare the skin over your knee and apply a coloured antiseptic solution. You will then meet the anaesthetic team, who will make sure you are comfortable and safe during the procedure.

Before your anaesthetic, your surgeon will ask you which joint and which side are being treated. This is critical. Your surgeon will check this against your consent form and draw an arrow on the knee you specify.

At the start of the procedure, you are transferred onto the operating table. The anaesthetist will give you a general anaesthetic, meaning you will be asleep for the whole procedure. They may also use local anaesthetic around some of the nerves in your leg to reduce pain after you wake up.

A tourniquet may be inflated around your upper thigh to reduce blood flow and allow a clear view inside the knee. Your surgeon then makes two to three small incisions at the front of the knee and fills the joint with sterile saline.

The arthroscope is inserted into the knee and attached to a camera. Your surgeon uses the camera to look for damaged or injured areas, which can be treated with small instruments such as probes, scissors and shavers.

At the end of the procedure, the incisions are injected with local anaesthetic, closed with dissolvable sutures and glued or dressed to provide a strong waterproof closure. The surgery usually takes 30 to 90 minutes, with additional time before for anaesthetic and after for recovery.

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

After the operation, you wake in the recovery room, where you are monitored for approximately one hour. Once stable, you are transferred to the day stay ward. Your surgeon will usually contact your relative or support person, although they should understand this may be several hours after you were taken into theatre because of preparation and recovery time.

Walking — You will be given crutches before leaving hospital for safety. Most patients can put all their weight through the leg immediately after arthroscopic surgery and bend the knee as pain allows.

Most patients can walk normally within about seven days after simple arthroscopy and can return to most activities within six to eight weeks. Check with your surgeon before starting impact activity such as running.

Bracing — A brace is used to restrict bending in some cases, usually after a meniscus repair, root repair or reconstruction.

Dressings — The bulky dressings can usually be removed the morning after surgery. Small waterproof dressings underneath should stay on until your wound check at 10 to 14 days. Some fluid may ooze into the dressings over the first 24 to 48 hours and may have a faint red colour.

You can shower with waterproof dressings, but avoid soaking in the bath, pool or ocean. If dressings come loose or become soaked, replace them.

Length of stay — It is usually safe to go home on the day of surgery. Staying overnight is uncommon and is usually only needed if discussed with your surgeon beforehand.

Your recovery starts the minute you are awake from the anaesthetic. Early exercises include pumping your calf muscles to encourage blood movement through the legs and contracting your thigh muscles to press the back of your knee into the bed. The physiotherapist will assist you with getting out of bed and walking.

It is vital to your recovery that you engage with physiotherapy to maximise your early recovery from surgery.

At MTP Health, we recommend booking your first post-operative appointment with a physiotherapist as soon as your surgical date is confirmed. This should usually be between two and five days after surgery. We will communicate the rehabilitation plan with your treating physiotherapist, whether that is one of our team or your own physio.

Your physiotherapist will help you manage swelling and stiffness before working on leg strength and function. Later, the program will focus on your chosen sport or activity and help reduce the risk of further injury.

As a guide, recommended rehabilitation visits may include physiotherapy twice weekly for the first six weeks, exercise physiology once weekly for the second six weeks, and ongoing review as directed by your surgeon, physiotherapist or exercise physiologist.

Returning to driving usually takes a minimum of two weeks for right knee arthroscopy and around two days for left knee surgery in an automatic car. You must be able to safely perform an emergency stop and must have stopped all painkillers other than over-the-counter medications such as Panadol or Nurofen. There is no specific documentation from licensing authorities, so checking with your car insurance company is recommended.

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

• Most office workers can return to work after two to five days
• Heavy manual workers may need up to two weeks before resuming full duties
• Full recovery usually takes four to six weeks
• There is usually no restriction on knee bending
• Resistance work and non-impact exercise, such as swimming and cycling, are often introduced from around two weeks
• Running is usually avoided for the first six weeks to reduce overload and prolonged recovery

The knee may remain swollen for up to six weeks, and the incision sites are often puffy and firm for up to three months.

If the surgery was for meniscal repair or root repair:

• Most office workers can return to work after about one week
• Heavy manual workers may need up to three months before resuming full duties
• Depending on the repair, crutches may be needed for six to eight weeks
• The knee may be kept in a brace to restrict bending beyond 90 degrees for six weeks
• The brace may be removed at six weeks, but deep squatting beyond 90 degrees is usually avoided for three months
• Non-impact exercise may be introduced within the limits of the brace and repair
• Running and impact training are usually restricted for three to four months
• Full recovery may take four to six months

Knee arthroscopy is generally a safe procedure, but there are always some general risks with joint surgery. The most common side effects are temporary pain, bruising, swelling and stiffness.

Blood clots — Blood clots are uncommon after knee arthroscopy but can cause severe swelling and pain. Clots in the calf are called deep vein thrombosis, or DVT. Rarely, these can travel to the lungs and cause a pulmonary embolus, or PE. If a clot develops, you may need blood-thinning medication for several months.

Infection — Infection is very uncommon after knee arthroscopy. A wound infection may require antibiotic tablets or antibiotics through a drip. If infection gets into the knee joint, further surgery may be needed to wash out the joint.

Skin numbness — Very small nerve fibres in the skin around the knee are often cut during surgery, leaving a small numb patch near the scar or outer part of the leg. This usually shrinks over time. Permanent damage to larger nerves that supply muscles is rare.

Risks specific to meniscal trimming include ongoing pain, especially if there is pre-existing arthritis, and further tears, which are more likely in a degenerate meniscus.

Risks specific to meniscal repair include ongoing pain around the repair site for several months and failure of the repair to heal, which may require further surgery.

Other uncommon complications include anaesthetic risks, 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. You can discuss the options specific to you with the team when you see your specialist.

If you are having surgery using 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 left after Medicare and your health fund have paid their rebates.

The anaesthetist is an independent practitioner and can charge a different gap, which may affect the final figure. We always provide their details and recommend checking their quote before committing to surgery.

The surgeons at MTP Health participate in various reduced-gap schemes run by different health insurance providers. Please check availability of surgical time slots first, as there may be a longer wait for this option.

Your insurance may also have an excess to pay, commonly around $500. If you are having the operation through the public system, there is no out-of-pocket surgical cost, but you may need to wait up to a year depending on hospital availability and urgency category.

Knee arthroscopy is not usually recommended for arthritis alone. If pain is mainly caused by osteoarthritis or general wear and tear, the best first steps are usually physiotherapy, strength training, weight management, activity modification and appropriate pain relief.

Arthroscopy may still be considered in selected cases where there is a clear mechanical problem, such as a loose body or a meniscus tear causing true locking. Your surgeon will explain whether your symptoms and imaging fit a problem that keyhole surgery is likely to improve.

An MRI is often useful before knee arthroscopy because it can show meniscus tears, cartilage damage, ligament injuries and other problems inside the knee. X-rays may also be needed, especially if arthritis is suspected.

However, surgery is not recommended based on an MRI alone. The scan needs to match your symptoms, examination and goals. Many people have meniscus changes on MRI that are not the main cause of pain.