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Knee Arthroscopy: Procedure, Indications, and Recovery

Knee arthroscopy is a minimally invasive orthopedic surgery using a 4 mm camera (arthroscope) and instruments through 2–3 small portals to diagnose and treat intra-articular pathology.

Common Indications

  • Meniscal tears (repair or partial meniscectomy).
  • ACL/PCL reconstruction (graft passage, tunnel drilling).
  • Chondral lesions (microfracture, OATS, MACI).
  • Loose body removal.
  • Synovitis (rheumatoid, PVNS) – synovectomy.
  • Plica resection, lateral release, septic arthritis washout.

Procedure Steps

  1. Anesthesia: General, spinal, or femoral/sciatic block + sedation.
  2. Portals: Anterolateral (viewing), anteromedial (working), ± superolateral/patellar.
  3. Diagnostic arthroscopy: Systematic 12-point inspection (patellofemoral, medial/lateral gutters, gutters, intercondylar notch, medial/lateral compartments).
  4. Therapeutic intervention per findings.
  5. Irrigation, hemostasis, portal closure (sutures/steri-strips).

Recovery

ProcedureWeight-BearingReturn to Work (sedentary)Return to Sport
MeniscectomyWBAT immediately3–7 days4–6 weeks
Meniscus repairNWB/PWB 4–6 wks2–4 weeks4–6 months
ACL reconPWB 2–4 wks2–4 weeks9–12 months
Chondral (microfracture)NWB 6–8 wks4–6 weeks6–12 months

Rehab Principles

  • Early ROM (CPM optional), quad activation (NMES), patellar mobility.
  • Progressive strengthening (closed then open chain).
  • Neuromuscular/proprioceptive training.
  • Criteria-based progression (not time-based alone).

Risks

  • Infection (<0.5%), DVT (1–5%), stiffness, saphenous nerve injury, instrument breakage.

Arthroscopy is powerful but not for everyone (e.g., advanced OA without mechanical symptoms). Shared decision-making essential.

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