Arthroscopie du genou

The knee joint, a complex hinge joint, is composed of the femur (thighbone), tibia (shinbone), and patella (kneecap). It is supported by ligaments, tendons, and menisci, which are two C-shaped pieces of cartilage that cushion and stabilize the joint. Damage to the menisci, ligaments, or cartilage can lead to pain, swelling, and restricted movement. To visualize these tissues directly, a surgeon can insert a camera inside the knee and perform procedures to help alleviate these problems; a technique called arthroscopy.

Knee arthroscopy is a minimally invasive surgical procedure used to diagnose and treat various knee conditions, such as torn menisci, damaged cartilage, and ligament injuries. The procedure involves the use of an arthroscope, the small camera inserted into the knee joint through a tiny incision, which provides a clear view of the inside of the knee on a monitor. It is a less invasive way to access and operate on the knee joint and thus reduces the risks of complications while minimizing the size of the surgical scar.
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A surgeon can perform a knee arthroscopy with partial meniscectomy, during which the torn and damaged portion of the meniscus (cushion) causing the symptoms is removed from the inside while preserving as much healthy tissue as possible. Once the arthroscope is inside the knee, the surgeon can also inspect other aspects of the knee such as the cartilage, potential loose bone or cartilage fragments, or ligament tears, and identify if they need to be addressed.

Knee arthroscopy is generally considered safe, but as with any surgery, it comes with its risks. The potential complications of this procedure, although uncommon (0.5-1.7%), include:
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● Hemarthrosis: bleeding into the joint
● Infection of the wound or joint
● Cartilage damage
● Earlier osteoarthritis development
● Nerve or blood vessel injury
● Persistent pain or swelling
● Stiffness or limited range of motion
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General minor risks associated with surgery and anesthesia include nausea, vomiting, headaches, sore throat, and urinary retention. Major general risks include blood clots, potentially leading to heart attack or stroke, allergic reactions, and pneumonia. Your surgeon will make sure to discuss the relevant risks with you prior to your surgery and take precautions to minimize the risk of any complications.

Before the surgery, your surgeon will have a discussion with you and examine your knee before conducting a thorough presurgical workup, which may include X-rays or MRI of your knee to visualize the extent and location of joint damage, along with blood tests as needed to ensure the surgery is right for you.
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The procedure can be performed under regional anesthesia (spinal or epidural) or general anesthesia, depending on the extent of the surgery, your medical profile, and your care team’s  assessment and discussion with you.
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To manage your pain effectively after the surgery, a multimodal pain control strategy is employed, which consists of combining different modalities to treat your pain, including acetaminophen (e.g. Tylenol), NSAIDs (e.g. Advil, Aleve), opioids (e.g. oxycodone), and potentially nerve blocks, a minor procedure where a regional nerve gets frozen with the injection of a local anesthetic medication.

Recovery from knee arthroscopy is usually quicker and less painful compared to open surgery. After an outpatient knee arthroscopy, you can expect to go home the same day of the procedure, provided your surgeon determines that your recovery is on the right track. Your postoperative care will mainly consist of medications to manage the pain and starting physical therapy early to restore your knee’s strength and mobility. Additionally, your surgeon may prescribe additional medication to reduce your risk of blood clots. Your knee will be covered with a dressing during the early stages of your recovery to optimize your wound healing and avoid some complications.
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You should be able to walk right after your surgery, although you will probably need crutches or walking aids to ensure stability initially. It is important to start your physiotherapy exercises early and perform them regularly to ensure you regain your strength and mobility. You should be able to return to your functional daily activities by two weeks, and return to more demanding activities such as exercise or sports after two to three months. In the meantime, high-impact activities (such as manual labor, heavy lifting) and sports should be avoided until the knee has fully healed.
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Your follow-up visits with your surgeon will help ensure your recovery is on the right track.