samsani

Mr Srinivas Samsani

MS Orth PGI, FRCS, FRCS, FRCS Tr & Orth.
MSc Trauma, Dip Orth London.
Hip and Knee Fellow, Melbourne Australia.

Consultant Orthopaedic Surgeon
Specialisation: Knee and Hip Surgery

Knee Arthroscopy

Arthroscopy, also popularly known as keyhole surgery, is a procedure in which a small camera is introduced through a small incision (keyhole) to examine the inside of your joint. It is one of the most commonly performed orthopaedic surgical procedures and helps patients recover quicker than the traditional open operations. More than 80% of patients return to walking and light activities within a week after operation. Around 4 million knee arthroscopies are performed around the world each year.

Mr Samsani has extensive experience in arthroscopic surgery and has performed hundreds of knee arthroscopies to treat various conditions of the knee joint since his appointment as substantive Consultant Orthopaedic Surgeon at Medway NHS Foundation Hospital Trust in 2006.

Basic anatomy of knee joint

The knee is the largest joint in the body. It is formed by the lower end of the thigh bone (femur), upper end of shin bone (tibia) and the kneecap (patella). The ends of these bones are lined with articular cartilage to allow smooth gliding low friction movement of the knee. Between the tibia and femur lie two half-moon shaped floating cartilages called menisci. One cartilage lies on the inner side of the knee joint (medial meniscus) and second cartilage lies on the outer side (lateral meniscus). These cartilages act as shock absorbers and stabilisers of the knee joint. The knee joint is stabilised by strong ligaments that lie inside and outside the joint. Medial and lateral collateral ligaments lie outside the knee joint and supports the knee from excessive side to side movements. Anterior and posterior cruciate ligaments lie inside the knee joint and supports knee from buckling and giving way. The knee joint is lined by a synovial tissue (lining of knee joint) which produces lubricating fluid (synovial fluid) to help smooth movement of knee. Thigh muscles and strong tendons surround the knee joint and acts as secondary stabilisers.

What is Knee Arthroscopy?

Knee arthroscopy is an operation in which a small fibre-optic telescope (arthroscope) and special instruments are introduced through small incisions-less than 1cm (keyholes) on either side of kneecap (patella) to diagnose and treat certain conditions of the knee joint. A camera is attached to the arthroscope and the picture is visualised on the monitor (TV).

This is minor surgical procedure and usually carried out as day case operation.

Which knee conditions are treated with knee arthroscopy?

Knee arthroscopy is used to diagnose and treat certain conditions of the knee joint. It is commonly used to treat the following conditions:

  • Torn floating cartilage (meniscus). The tear of the cartilage is removed or occasionally repaired.
  • Torn surface (articular) cartilage.
  • Removal of loose bodies (broken bits of cartilage and bone).
  • Reconstruction of anterior cruciate ligament.
  • Removal of inflamed synovial tissue (lining of knee joint).
  • Certain problems of knee cap (patella).
  • Cleaning of infected knee joints
  • Diagnosis of certain knee conditions.

What happens before knee arthroscopy?

Clinical Assessment: Mr Samsani will conduct a physical examination including a detailed history of your problem, clinical examination of the knee and obtain routine x-rays of the knee. To confirm the diagnosis you may also need to have special scans such as MRI and CT scan. After confirming the nature of the problem, Mr Samsani will also discuss with you  the various treatment options available to treat the condition including non-operative and operative options. Usually a course of non-operative treatment is considered first and knee arthroscopy is considered when the non-operative treatment has been ineffective.

Tests: Once you have decided to proceed with the operation it is important to make sure that you are fit to undergo the operation. As part of the pre-operative assessment, you may have some or all of the following tests depending on your medical condition:

  • Blood tests
  • Urine tests
  • X-ray of knee
  • X-ray of chest
  • ECG

You may also require a medical examination by a medical doctor to make sure you are fit for surgery and identify any medical problems that could interfere with your surgery.

Inform Mr Samsani or his team all the medication you take regularly. You may be informed to stop taking certain medication before surgery.

A Physiotherapist will see you and advise you about exercises that will keep the knee in best possible condition before surgery and help to recover quickly after the operation.

The knee arthroscopy operation

You are likely to be admitted on the day of operation. Sometimes you may be admitted one night before the operation. You will be given instructions not to eat or drink for 6 hours before surgery.

Majority of  knee arthroscopies are performed as day case operations. The operation usually takes 30 minutes to more than an hour depending on the findings and the treatment required.

A member of the anaesthetic team will see you before the operation and discuss the anaesthetic options. Knee arthroscopy is usually performed under general anaesthesia. Mr Samsani will also see you before the operation. Your knee will be identified and marked prior to anaesthetic being administered.

Once you are under anaesthetic, a tight band (tourniquet) is placed around the upper leg to allow a blood less operation and knee is prepared in a sterile fashion.

The telescope (arthroscope) is introduced into the knee through a small incision (less than 1cm) on the outer side of kneecap. Another small incision (less than 1cm) is placed on the inner side of kneecap to introduce special instruments (such as probe, shavers, scissors or lasers) that allow examination and treatment of knee problems. A sterile solution will be used to distend the knee and wash out the debris.

Knee arthroscopy is commonly used to treat the following conditions:

  • Torn floating cartilage (meniscus). The tear of the cartilage is removed or occasionally repaired.
  • Torn surface (articular) cartilage.
  • Removal of loose bodies (broken bits of cartilage and bone).
  • Reconstruction of anterior cruciate ligament.
  • Removal of inflamed synovial tissue (lining of knee joint).
  • Certain problems of knee cap (patella).
  • Cleaning of infected knee joints
  • Diagnosis of certain knee conditions.

After completion of the procedure, the small incisions are closed either with a stitch or steri-strips (small sterile tapes). At the end of the procedure a local anaesthetic solution is injected into knee for pain relief. A bandage is placed around the knee.

After operation you will be moved to recovery and later to a ward. You should be able to go home 2 to 4 hours after surgery. Someone should accompany you for 24 hours after surgery.

Recovery after knee arthroscopy

Recovery after knee arthroscopy is much quicker than tradition open knee surgery.

You may have some discomfort for few days and pain killers will be prescribed to control the discomfort. You may also be prescribed medication to minimise the risk of blood clots.

A Physiotherapist will see you and demonstrate a number of exercises for you to do at home. These exercises are important to restore the knee movement and strengthen muscles of knee and leg.

You will need crutches or other walking aides for while after the operation. Mr Samasani or his team will tell you when you can safely weight bear on your leg.

You can remove the bandage in 48 hours leaving the waterproof dressings on the wounds untouched. Mr Samsani’s team will tell you when you can have a bath or shower and when you should change the dressing.

You will be assessed in few weeks after surgery by Mr Samsani to monitor your progress and discuss the operative findings.

Some amount of swelling and bruising of the knee is common. Elevation of the leg when seated and application of ice packs on the knee helps to reduce swelling and bruising (place ice packs on the knee for 15 minutes 3 to 4 times a day).

You will be able to resume driving when comfortable from 1 to 3 weeks after surgery

Complications of knee arthroscopy

Knee arthroscopy is a commonly performed minor operation. Risk of complications following this procedure is very low.

  • Bleeding: Bleeding into the knee joint after arthroscopy can occur but very rare.
  • Thrombosis: Risk of blood clots formation after knee arthroscopy is very rare.
  • Stiffness: Usually this is temporary and movement will come back with exercises and time.
  • Infection: Infection following knee arthroscopy is very rare
  • Failure to improve: Occasionally pain or other knee symptoms may continue to persist after operation despite the surgeon’s best effort. This is usually due to advanced arthritic changes already present in the knee joint.
  • Numbness around scar: Very rare.
  • Damage to nerves and vessels: Very rare.

Warning Signs: please contact Mr Samsani or his team immediately if you experience any of the following:

  • Chills
  • Fever
  • Redness or warmth around knee
  • Persistent or increasing pain in the knee or calf
  • Marked swelling of knee or calf

Outcomes after knee arthroscopy

Currant data shows that, after knee arthroscopy, 82% of the patients return to walking and 94% of patients resume light activities in two weeks. You will be able to return to most  activities in 6 to 8 weeks or sooner. If your job involves heavy work, it may be longer before you can return to your work.

However following a major ligament reconstruction, the recovery may be slow and prolonged. Discuss with Mr Samsani or his team regarding timing of return to high impact activities.

Sometimes your knee pain and other symptoms may not improve even after physiotherapy. This is usually due to the fact that your articular cartilage has worn out completely and the arthritis is well advanced. If this is the case, Mr Samsani will discuss various other treatment options that may benefit you.

Follow up after Knee Arthroscopy

Arthroscopy of the knee is a relatively small operation and you will usually go home on the day of the operation. After your operation you will be reviewed in the clinic by Mr Samsani or his team in two to three weeks’ time to make sure you are recovering well. Subsequent follow ups then depend on the nature and complexity of surgery and the rate of recovery after surgery.

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