Knee arthroscopy is a day-case surgical keyhole procedure carried out under general anaesthesia that involves placing a camera into the knee via a small incision. It’s a technique used to treat many knee conditions such as ligament and meniscal tears. It can also be used to treat damage to the articular cartilage.

What is knee arthroscopy?

Knee arthroscopy is a minimally invasive surgical procedure carried out through small incisions in the knee and under general anaesthesia. Once you are asleep, a cuff (like a blood pressure cuff) is inflated around the upper thigh to limit bleeding in the knee during the procedure. Through one of the incisions (aka ‘portals’), a thin tube called an arthroscope, which has a small camera and light attached to it, is passed into the knee. Sterile fluid is passed into the knee through another portal to distend the knee and give a clear view. The arthroscope allows me to see directly inside and around your knee joint with magnified images from the camera being transmitted to a screen in the operating theatre.

I can also insert small slender surgical instruments through the other incisions to shave or treat damaged cartilage areas or repair meniscal cartilage. At the end of the procedure, the arthroscope and instruments are withdrawn, the incisions are stitched closed, and dressings are applied.

What is knee arthroscopy used to treat?

Knee arthroscopy is both diagnostic and therapeutic. Leading up to knee arthroscopy, a patient will usually have undergone MRI imaging so we know what we are treating, but it’s only when we can directly visualize the knee at the time of surgery that we can fully appreciate the extent of the problem.

Knee arthroscopy can be used to carry out:

  • Meniscal trimming or repair
  • Microfracture and treatment of the articular cartilage
  • ACL and PCL reconstruction
  • Removal of loose bodies
  • Articular cartilage damage

Articular cartilage is the smooth, hard, glistening cartilage that covers the joint surfaces on the end of the femur and the tibia. It doesn’t have the capacity to regenerate if damaged because it doesn’t have a blood supply. Trauma and long-term adverse physical loading can damage the cartilage surface, which can cause pain in the knee, swelling, catching, locking, and stiffness. The articular cartilage consists of layers of cells, collagen, and other molecular structures that sit on top of the surface of the bone known as the subchondral bone plate. This bone has a good blood supply, which can be harnessed during a microfracture procedure.

If the damage to the articular cartilage is more superficial (known as partial thickness damage), the affected area can be smoothed and stabilized using a radiofrequency probe at the time of the arthroscopy. The probe produces electrothermal (radiofrequency) energy which smooths the articular surface and gives it mechanical stability.

If there is more severe or full-thickness cartilage loss within the joint, I may occasionally use a technique called microfracture. Where there are defects in the cartilage (e.g., down to the bone beneath), I smooth off the edges and remove any loose flaps or debris. Using a tiny metal instrument, I knock small holes into the bone plate to create a little bleeding. Because the bleeding comes directly from the bone, it’s rich in natural stem cells with great healing potential. Over time, this clotted blood matures into a scar patch filling the defect. While this scar cartilage can never be as good as the original articular cartilage, it’s better than leaving the bone exposed. Most people can expect excellent results from their microfracture for around five years, and microfracture is suitable for small articular cartilage holes (e.g., less than 2 cm in diameter).


OATS (Osteochondral Autograft Transfer System) surgery is a procedure to repair damaged articular cartilage (aka chondral defects) in the weight-bearing areas of the knee. In this procedure, I transfer one or more plugs of healthy articular cartilage and bone from the non-weight-bearing area of the patient’s knee to the damaged area. This technique is particularly beneficial for patients with a small area of cartilage damage (less than 3 cm squared in size), although not every case is suitable for this surgery.

The plugs are precisely fitted into the defect in the damaged area of the knee, creating a smooth and stable surface. Over time, the transplanted tissue integrates with the surrounding cartilage, restoring function and reducing pain.

Knee arthroscopy recovery time

After the procedure, recovery time varies from person to person and also depends on what I did during the arthroscopy. Many patients can be weight-bearing immediately, but if you’ve had an OATS procedure or extensive microfracture, you may need to be on crutches for up to six weeks with just ‘toe touch’ weight-bearing through the affected leg to protect the healing area.

You will be seen by a physio on the day of the arthroscopy who will get you started with some exercises. You must continue rehab with your physiotherapist once you’re home.

If you’ve had a simple procedure such as a meniscal trim, you can expect to begin a return to sports around 3-4 months, but after an OATS procedure, full recovery may take up to a year.

What are the risks of knee arthroscopy?

Knee arthroscopy is generally considered a safe procedure, but it carries certain risks like any surgery. Some of the potential risks and complications associated with knee arthroscopy include:

Infection: There is a small risk of infection at the surgical site or in the joint, but if this occurs, we can deal with it swiftly with antibiotics.

Blood clots: Developing a blood clot in the leg (deep vein thrombosis) or lung (pulmonary embolism) is a rare complication.

Nerve or blood vessel damage: There is a very small risk of damage to the nerves or blood vessels around the knee joint during the procedure.

Anaesthesia complications: As with any surgery involving general anaesthesia, there are risks associated with adverse reactions to anaesthetics, but it is extremely rare to have a serious adverse outcome because of undergoing general anaesthesia.

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