Follow up consultation £150
Surgery Cost £3,500 - £4,000
Depending on location and procedure, inclusive of follow up consultation, surgery, follow up and physio/after care)
Most knee arthroscopies are done as a day-case procedure. You will have very little to show for your surgery except for 2 small incisions on the front of the knee. Under a general anaesthetic a special camera is inserted into the knee joint through one of the small holes. The whole of the knee joint is inspected for damage to the joint surfaces, meniscus and ligaments. Treatment is carried out as necessary. The surgery takes 20-40 minutes on average. Local anaesthetic is injected into the joint and therefore most patients are comfortable when they wake up from the anaesthetic and this continues for a few hours.
Recovery time does depend entirely on what surgery is carried out. Most patients will be able to mobilise and drive within a few days and should only need 2 weeks off work on average. If there is significant wear & tear inside the knee, it typically takes longer for the knee to settle down, up to 8-12 weeks in some cases. Mr Simon Garrett will give you an idea of the expected recovery time following the operation.
Following surgery, the crepe bandage should stay in place for 48 hours and the tape sutures (steristrips) can be left to fall off by themselves.
Knee arthroscopy is a safe procedure. There is a very minor risk of infection and Blood Clots, and of course on-going symptoms depending on the condition of the knee.
There are many knee operations that can be performed using an arthroscope (keyhole surgery)Below are the commonest conditions requiring an arthroscopic procedure.
There are two menisci in every knee, the medial (inside) and the lateral (outside). Menisci can be damaged acutely when the knee sustains a sudden forced flexion and twisting strain, or chronically as part of degenerate changes within the knee ('wear & tear'). The meniscus has little blood supply, except along the periphery where it attaches to the joint capsule, and therefore unlikely to heal.
This typically causes a sharp acute pain on the joint line. The knee can swell intermittently. A torn meniscus also causes mechanical interference in the knee joint. This may result in the knee 'locking', preventing full extension, or ‘giving way’. Recurrent displacement of a torn meniscus can produce damage to the smooth articular surface of the knee resulting in long-term degeneration. Torn menisci can be removed by arthroscopy leaving the undamaged, stable portion behind. Occasionally a meniscus is torn along its peripheral attachment where there is a reasonable blood supply. This type of tear can sometimes be repaired allowing the meniscus to heal.
Anterior Knee Pain
This is very common. This is normally due to pain originating from the patello-femoral joint (undersurface of knee cap & underlying femoral cartilage). There are a number of causes of this. Commonly it is due to Quadriceps weakness and/or mal-tracking of the patella. The initial treatment for this is physiotherapy, however, surgery is sometimes required to correct the patella mal-tracking.
More severe cases result in damage to the underlying cartilage. This roughened articulating area produces a painful, grinding sensation typically as the flexes leading to joint irritation and swelling. Most often patients find it painful coming down stairs, squatting and kneeling. The damaged area sometimes requires an arthroscopic chondroplasty. The arthroscopic 'shaver' removes any loose or roughened areas leaving a smooth articulating surface, thus reducing the local irritation.
All patients however will require an exercise programme of Quadriceps strengthening and Hamstring stretching to protect against further injury.
Early stages of Arthritis/Wear & Tear
Chondroplasty can also be performed in other areas of the knee to improve symptoms, especially in the early stages of arthritis. This is commonly referred to as ‘wear & tear’. In these cases it’s important that the patient realises that this will improve symptoms but it is not a complete ‘cure’.
However, when the articular cartilage is damaged to the extent that the underlying bone is exposed, chondroplasty by itself is insufficient. In these cases we need to promote new cartilage formation in the damaged area. This is done by breaking through the exposed bone, to the underlying blood supply (micro-fracture). The bleeding bone forms a new cartilage layer consisting of fibrocartilage. It lacks some of the special properties of the original hyaline cartilage, but it does form a new smooth surface.
Removal of Loose Bodies
A piece of bone or cartilage can be broken off during an injury or as part of a more general degeneration and form a 'loose body' within the knee. Loose bodies can remain symptomless for long periods but can cause sudden attacks of pain and locking. Loose bodies can be removed at arthroscopy although they can often be difficult to find.