Knee Arthroscopy
Knee arthroscopy is the most frequently used closed surgical technique for meniscus tears, cruciate ligament injuries and cartilage problems. The structures inside the joint are assessed in detail with a camera and the problem identified can be treated in the same session.
The Structure of the Knee Joint
The knee is a large weight-bearing joint formed by the thigh bone, the shin bone and the kneecap. Two menisci distribute load and absorb impact; the anterior and posterior cruciate ligaments together with the collateral ligaments provide front-to-back and side-to-side stability. The cartilage covering the joint surfaces allows movement without friction.
In Which Conditions Is It Considered?
- Meniscus tears — repair with sutures in suitable cases, partial resection where repair is not suitable
- Anterior cruciate ligament (ACL) injuries — ligament reconstruction
- Assessment of posterior cruciate and collateral ligament injuries
- Cartilage (osteochondral) lesions
- Kneecap (patellar) instability and alignment problems
- Removal of loose bodies from within the joint
- Removal of inflamed joint lining (synovitis)
- Assessment of adhesions and restricted movement within the knee
Meniscus: Repair or Partial Resection?
This distinction matters because it determines the whole of the postoperative period. The blood supply of the meniscus is better in its outer part; for suitable tears in this zone, repair with sutures may be preferred and preservation of the tissue is the aim. For some tears in the inner zone, where the blood supply is poor, sutures may not heal; in that case limited resection of the torn portion is considered.
Where a repair is carried out the protection period is longer and knee flexion may be restricted for a time. After partial resection, weight-bearing is generally permitted earlier. Always ask your physician which group you are in; your postoperative instructions depend on it.
Diagnosis and Assessment
- History: the moment of injury (twisting, pivoting, contact), locking, catching, a sense of giving way, and the timing of swelling.
- Physical examination: joint line tenderness, meniscal tests, ligament stability tests, range of movement.
- Imaging: X-ray for the bone and joint space; MRI for meniscus, ligament and cartilage tissue.
- Decision: an MRI finding alone is not a reason to operate; it is interpreted together with symptoms and examination.
Related article: Knee Pain: When Should It Be Taken Seriously?
Conservative Treatment First
Particularly in degenerative (age-related) meniscus tears and early-stage cartilage problems, the first approach is generally not surgical. Activity modification, weight control, a quadriceps strengthening programme and pain management are considered first. Tears causing locking, marked instability, and ligament injuries in young and active patients may require earlier surgical assessment.
How Is the Procedure Performed?
In knee arthroscopy, small portals on either side of the kneecap are generally used. The joint is distended with fluid, the camera is introduced and all compartments are assessed systematically. In procedures such as anterior cruciate ligament reconstruction, a graft (a tendon taken from your own tissue) is prepared, passed through bone tunnels and fixed. Graft choice is planned according to age, activity and any accompanying injuries.
Preparing for the Procedure
- Prepare an up-to-date list of every medication you take, including herbal supplements.
- If you take blood thinners, be sure to say so; your physician decides when they are stopped.
- Bring any previous MRI, X-ray and operation reports with you.
- Follow the fasting instructions; this is critical for the safety of anaesthesia.
- Arrange your transport home and someone to accompany you in advance.
For detailed preparation headings, see the Preparing for Orthopaedic Surgery page.
The Postoperative Period
In the first days, elevating the leg, applying ice and performing ankle pump exercises are recommended to reduce swelling. Permission to bear weight varies with the procedure performed. Early activation of the quadriceps is decisive in preventing muscle wasting and restricted movement later on.
For detailed headings see the Knee Arthroscopy Aftercare Guide.
Risks and What You Should Know
Although arthroscopy is a closed technique, it is still a surgical procedure and every surgical procedure carries risks. The headings below are for general information; your individual risk assessment is made by your physician after examination and investigations.
- Infection — a risk present in every operation, despite the small portals.
- Bleeding or swelling within the joint
- Involvement of nerve and vessel structures (rare)
- Risk of clot formation (deep vein thrombosis), particularly in lower limb procedures
- General risks related to anaesthesia
- Failure to achieve the expected improvement, or persistence of symptoms
- Stiffness and restricted movement in the knee
- Failure of a repaired meniscus to heal, or re-tearing
- Re-injury of a reconstructed ligament
The decision to operate is made by weighing together the duration and severity of symptoms, examination findings, imaging results, age, occupation, activity level and any accompanying conditions. Outcomes vary from person to person.
When Should You Seek Assessment?
- If the knee locks, catches or does not straighten fully
- If there is a sense of giving way or insecurity in the knee
- If swelling developed rapidly after an injury
- If you cannot bear weight or walk because of pain
- If symptoms persist despite physiotherapy
Frequently Asked Questions
When can you walk after meniscus surgery?
Permission to walk depends on the procedure performed: weight-bearing is generally allowed early after partial resection, whereas the protection period is longer after a meniscus repair (suture). See our related article for detail; your physician determines the exact timeframe.
Does every meniscus tear require surgery?
No. Good results can be obtained with exercise and pain management, particularly in age-related degenerative tears. Surgery is considered more often in tears that cause locking or mechanical symptoms, and in traumatic tears in young and active patients.
If my anterior cruciate ligament is torn, must I have surgery?
The decision is made according to your age, activity level, whether the knee gives way, and any accompanying meniscal or cartilage injury. In some patients adequate stability can be achieved with a strengthening programme, while reconstruction may be recommended in sporting and physically active patients.
Does arthroscopy cure knee osteoarthritis?
No. Arthroscopy does not treat osteoarthritis itself. It does not provide the expected benefit in advanced osteoarthritis; in these cases weight control, exercise, pain management and, where appropriate, joint replacement surgery are considered.
Is swelling in my knee after the operation normal?
Some swelling in the early period is expected and settles with elevation, ice and gradual movement. However, increasing redness, warmth, fever or uncontrolled pain are not expected findings; in that case you should seek assessment without delay.
Academic Work
Assoc. Prof. Bertan Cengiz, MD has scientific work published in national and international peer-reviewed journals in the field of knee arthroscopy and sports injury surgery and related areas of arthroscopic surgery. The publication list and verifiable academic sources are available on the Publications page.
Related Pages
- Arthroscopic Surgery (Keyhole Joint Surgery)
- Knee and Hip Problems
- Meniscus Tear
- Knee Cartilage Injuries
- Knee Arthroscopy Aftercare Guide
The information on this page is for general guidance and does not replace an in-person medical examination. Diagnosis and treatment require a physician’s clinical assessment. Outcomes of any surgical or medical intervention may vary from person to person; no guarantee of a specific result or timeframe is given on this page.