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Arthroscopic (keyhole) knee surgery
This involves making three small incisions in the front of the knee. Fluid is pumped into the joint to expand it and allow an easier view. A tiny camera (5mm in diameter) is inserted into another hole so that the surgeon can view inside the joint on a monitor in front of them. The surgical instruments are then inserted through the third incision.
After the operation the fluid is drained out and the incisions closed with either stitches or steri-strips.
The benefits of a knee arthroscopy over open knee surgery are:
- Smaller incisions mean less muscle, tendon and ligament damage.
- Faster healing.
- Less scarring.
- A faster knee surgery recovery time.
- Often outpatient operations, meaning the patient doesn’t have to stay in hospital overnight.
Arthroscopic surgery is commonly used in the treatment of:
- ACL ruptures
- PCL ruptures
- Meniscal injuries
An arthroscopy may also be performed when an MRI scan is clear, but pain persists and is not responding to other treatments. This is called a diagnostic arthroscopy.
Knee Replacement Surgery
Knee joint replacement surgery is used in cases where the knee joint is worn out, often associated with arthritis. It is usually reserved as a last resort, once other treatments such as physiotherapy, exercises, medication and walking aids are no longer effective to control the pain and allow mobility. A knee replacement will usually last between 10 and 15 years before it needs replacing. Knee replacements can be either a partial knee replacement or full and the parts used can be either metal or plastic.
Knee replacement surgery is performed as an open joint procedure, where the surgeon makes an incision down the front of the knee. The damaged ends of the thigh and shin bones are removed so make room for the new knee joint. Patella resurfacing may also be performed if there is damage to the back of the knee cap.
To read an example of a physiotherapy pre-assessment
Techniques have improved considerably over the last decade, using improved surgical devices and smaller incisions, meaning knee replacement recovery times have also decreased.
ACL reconstruction surgery
The ACL (anterior cruciate ligament) is a very commonly ruptured ligament which is frequently reconstructed in sports people as it plays a vital role in stabilising the knee joint. The operation is done via keyhole surgery, where a graft is taken from either a hamstring tendon or the patella tendon, to replace the ruptured ligament.
The PCL (posterior cruciate ligament is far less commonly injury than the ACL and surgery is less frequent when injury does occur. It involves a similar procedure to ACL reconstruction, where a graft is taken and used to reconstruct the ligament.
In the case of a torn meniscus (cartilage), arthroscopic surgery is used to either repair or remove the torn part of the cartilage. The decision on whether to repair or remove depends on the site of the tear and also the extent of the tear.