Should I have arthroscopic knee surgery?

DEAR DOCTOR K:

I’m a lifelong runner with severe knee pain. Can you tell me about knee arthroscopy? How do I know if I’m a good candidate for it?

DEAR READER:

Arthroscopy is a technique used to diagnose problems in the knees and other joints. If a problem requiring surgery is identified, arthroscopic surgery can be performed.

To appreciate how valuable arthroscopic surgery is, you have to understand what things were like back in the “old days” — as when I was in medical school.

If you had bad knee pain, the doctor might have been able to diagnose the problem by physical examination. If not, X-rays were not much help: They could spot bone problems, but most knee problems involve the “soft tissues” — tendons, ligaments, meniscuses. So the doctor might have needed to perform surgery to open up the knee joint, look around and surgically repair the problem. It took quite a while to recover from that surgery.

Arthroscopy has made much knee surgery easier — for the doctor and the patient. The arthroscope is a flexible tube with a light at its tip and a camera that flashes images on a video monitor. The doctor needs to make only a small hole to insert the arthroscope and get a good view of the inside of the knee. If surgical repair is necessary, the doctor can perform the surgery by placing tiny surgical instruments inside the knee and watching the images on the video monitor. He or she can locate and remove torn cartilage, debris and loose material from the joint. The knee does not need to be opened up.

If you do have the surgery, you probably won’t have to stay in the hospital overnight. The type of anesthesia used varies; it can be general (you go to sleep), regional (the leg is numbed) or local (just the knee area is numbed).

Recovery from arthroscopic surgery is relatively quick. You should be back to normal, day-to-day living during the first week. By the second week, you can return to work if your job is not physically taxing. By the third week, you can begin light exercise. Physical therapy is not usually needed.

Depending on the condition of your joint, you can expect mild to moderate improvement. The results may last several months or perhaps a few years. However, if you have severe osteoarthritis, arthroscopy is unlikely to help much.

Most arthroscopies are performed on patients between 20 and 60 years of age. Good candidates are active people in their 30s and 40s who are starting to have knee pain resulting from decades of running, skiing, basketball or other sports.

The majority of people who undergo arthroscopy — and who are most likely to benefit from it — include patients with knee pain caused by torn cartilage or ligaments, and those with mechanical knee problems such as locking, catching or giving out.

We have more information on treatments for knee pain in our Special Health Report, “Knees and Hips.” Learn more about this report at here.