Introduction

Arthroscopy is a surgical procedure used to look inside joints, making it possible to visually investigate symptoms such as pain and stiffness. Once the source of the symptoms has been discovered, arthroscopy can also be used to carry out treatment on joints. Arthroscopy is a form of keyhole surgery, where only small incisions (cuts) are made around the joints, and the investigation or operation is completed through these holes.¹ This can also be described as a minimally invasive procedure.  

Although arthroscopy is most commonly carried out on the knee joint, it may be used to explore joints in the arms and legs.

Purpose of arthroscopy

Diagnostic purposes

Arthroscopy can be used to assess whether there are any visible abnormalities or injuries to a joint.  The surgeon (Doctor) will look at the bone and cartilage cushions, tendons and ligaments within and around the joint. The findings can then be compared with the symptoms the patient is experiencing.  The surgeon may find problems such as loose fragments of cartilage or bone within the joint, or tears in the tendons or ligaments.³   

Therapeutic purposes

Treatment may occur when the problem is diagnosed or at a later date, using arthroscopy. The treatment given will depend on the problem found, but it may broadly include repairing cartilage inside a joint, the ligaments around a joint or removing pieces of bone or cartilage that have broken loose, causing problems with joint movement.³

Arthroscopic procedure

Patient preparation

Anaesthesia 

Anaesthetic is used to complete an arthroscopy without any pain during the procedure. The choice of anaesthetic is discussed prior to the operation and will depend on a patient’s overall health, as well as the type of arthroscopy being carried out. This is usually discussed and decided before the day of the operation.¹ The different types of anaesthetic used include:^3,4

• General anaesthetic - Medication is administered to ensure a patient is unconscious during the operation. This is the most common anaesthetic administered for arthroscopy
• Spinal anaesthetic - A patient is awake and administered medication to completely numb the lower half of the body and legs. This is sometimes used for knee arthroscopy       
• Local anaesthetic - Medication is administered by injection to numb the local area in and around a joint the patient remains awake during the procedure

If a patient is awake during arthroscopy, the area for investigation is numbed so that there is no pain, but the patient may be aware of sensations such as pulling or tugging in the joint.³

Day of surgery

Most of the decisions about the day of surgery will be individual to each patient. An arthroscopy can take between half an hour and two hours, depending on the treatment required during the procedure.³ 

Prior to the operation a patient may need a period of time without eating or drinking or be asked to stop certain medication, this will have been explained to the patient prior to attending the procedure.³ Once in hospital, the patient will need to sign a consent form, to proceed with the operation, why it is being performed and the risks and benefits of the procedure have been explained. Arthroscopy may be completed as a ‘day case’ where a patient may be able to go home the same day, or stay in hospital overnight.³

During surgery

Insertion of arthroscope

The surgery begins with cleaning of the skin over and around the joint, to ensure the area is sterile.³ The arthroscope is a small metal tube, fitted with a light source and a camera. It is two to three millimetres wide and sends live images (pictures)of the inside of the joint to a TV screen for the surgeon to view.¹ It is inserted through the skin via a small incision (cut), called a ‘portal’, which is held open by a pipe called a ‘cannula’.⁵ The location and number of portals and cannulas needed will depend on the joint being explored and treatment required, to esnure that the surgical instruments required pass safely into the joint.

Exploration and treatment

Once the arthroscope is inserted, sterile fluid is sometimes introduced to ‘wash’  the joint to improve visibility.³ The surgeon will examine the joint and carry out any repairs or removal of tissue using the portals around it. The extent of this treatment will depend on the examination findings.     

Closure of portals

Once the operation is complete, the cannulas are removed from the portals and any additional fluid that was inserted into the joint is removed. The portals are then closed with a combination of stitches and tape, and a sterile dressing applied.³

Post-surgery 

Many patients are able to go home the same day of the procedure and, in rare cases, stay overnight in hospital.¹ Either way, the patient will stay in hospital for a few hours after the operation to ensure they are well enough to go home. Pain relief is often required following arthroscopy and a review by a physiotherapist before discharge to discuss exercises to reduce any stiffness in the joint.³ The patient will receive individualised advice from the healthcare professionals looking after them regarding the operation site and post-operative recovery.¹

Common applications

Knee arthroscopy

The knee is the most common site for arthroscopy, and is used to treat the following conditions:^6,7

• Meniscus repair - Damage to the cartilage (known as the meniscus) between the femur (thigh bone) and the tibia (shin bone). This is usually caused by a sudden twisting motion and a repair involves sewing the cartilage back together
• Partial meniscectomy - A meniscus repair is not always possible, and parts of the meniscus need to be removed
• Anterior cruciate ligament (ACL) reconstruction - The ACL supports the femur and tibia, and assists movement of the lower leg. An ACL tear can be repaired using a graft of a tendon from elsewhere in the leg  

Shoulder arthroscopy

Shoulder arthroscopy uses the same techniques as a knee arthroscopy, and can be used in the following circumstances:^8,9,10

• Rotator cuff repair⁸ - The rotator cuff muscles surround the shoulder and help in a number of movements of the humerus(upper arm bone). Surgery involves the repair of the muscle and removal of inflamed tissue that could restrict movement 
• Labral tear repair⁹ - The labrum is a ring of cartilage surrounding the head of the humerus where it comes into contact with the shoulder joint. Physiotherapy can sometimes effectively treat the symptoms, however, if symptoms persist surgery may be required
• Impingement syndrome treatment¹⁰ - shoulder impingement is a condition where the tendon of the rotator cuff muscles ‘catches’ on nearby bone. If neither physiotherapy nor a steroid injection improves symptoms, a subacromial decompression procedure creates space around the rotator cuff tendon to improve symptoms 

Other joint arthroscopies

Although not as common as knee and shoulder arthroscopy, the same method can be used to investigate and treat symptoms in other joints;^3,11,12

• Hip - Used to review the hip joint before a hip replacement procedure, repair of cartilage or tendon damage and treat hip joint impingement  
• Elbow - Used to treat carpal tunnel syndrome
• Ankle - Used to repair or remove damaged joint cartilage and ligaments, remove loose bone, and complete ankle fusion surgery 

Advantages of arthroscopy

The main advantages of arthroscopy are associated with a minimally invasive procedure. The advantages over ‘open’ surgery - where an incision (cut) is made and the joint is fully exposed in the operation include;³

• Less pain postoperatively 
• Faster healing time and recovery to normal activities
• Reduced risk of infection 

Complications 

Although there are many advantages to arthroscopy, it may not be suitable for everyone and there are risks to be considered. As with most operations, there are common risks of pain, swelling and bruising postoperatively, and those specific to arthroscopy include:³

• Infection in the joint - septic arthritis, this is a serious infection that needs urgent treatment 
• Risk of developing a blood clot called a deep vein thrombosis (DVT) in a limb, requiring further treatment
• Bleeding in the joint
• Nerve damage

These potential complications should be discussed with you prior to the procedure.³

FAQs

What does arthroscopic surgery do?

Arthroscopic surgery is a minimally invasive procedure used to investigate and treat conditions relating to the joints. A small camera with a light source is passed into the joint to visualise any suspected damage or injury, and repair or remove damaged tissue without the need for an ‘open’ operation. 

Why would someone need an arthroscopy?

An arthroscopy can be used to either:

Explore and diagnose, a patient’s symptoms to the damage seen within a joint or 

Therapy, where damaged tissue is repaired or removed. Arthroscopy is unlikely to be the first diagnostic test carried out, and may be recommended based on the results of an X-ray, CT scan or MRI scan³.  

Is arthroscopy a major operation?

Arthroscopy is usually performed as day-case surgery. It carries fewer risks and reduced recovery than the ‘open’ surgical alternative, but it would not be described as major surgery.

How long does it take to fully recover from an arthroscopy?

The time taken to recover following an arthroscopy will depend on the patient’s health and mobility prior to the operation, the joint examined, and any treatment performed. Generally, a patient may need to take a couple of weeks off work and may not be able to drive for a couple of months. Recovery is based on individual circumstances and can be discussed in more detail with the surgical team.³ 

Summary

Arthroscopy is a surgical procedure used to investigate and treat symptoms relating to joints. Small incisions are made around the joint concerned, and both a camera and surgical instruments can be passed into the joint via small tubes. The most common form of arthroscopy is knee arthroscopy, however, it can be carried out in most joints and used to remove and repair cartilage, repair tendons and remove loose objects such as bone from the joint.  

Arthroscopy is described as a minimally invasive procedure. There are advantages to this approach, including reduced recovery time, risk of infection post-operatively and improved pain management. As with all surgery, there are some risks to the procedure, including bleeding in the joint, nerve damage and the potential for infection or deep vein thrombosis. These risks are common to many operations.  It takes some time to recover post-arthroscopy, but the time needed will depend on the patient’s overall health and the kind of procedure being carried out.