Should I have arthroscopic knee surgery?


I’m a lifelong runner with severe knee pain. I hate the thought of surgery, but hear it’s not such a big deal these days, using arthroscopy. How do I know if I’m a good candidate for it?


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” — like 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. X-rays don’t take very good pictures of soft tissues. 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 first advantage of arthroscopy is that the doctor needs to make only a small hole to insert the arthroscope and get a good view of the inside of the knee. In the past, a much larger cut was needed for the surgeon to see what was wrong.

The second advantage of arthroscopy is that 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. This all involves much less cutting than traditional surgery.

A third advantage: With arthroscopic 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).

A fourth advantage: 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.

Unfortunately, if you have severe osteoarthritis of your knees, arthroscopy is unlikely to help much. Indeed, you may need joint replacement surgery — a “bigger” operation than arthroscopic surgery.

Good candidates are active people in their 30s and 40s who have knee pain caused by torn cartilage or ligaments, and those with mechanical knee problems such as locking, catching or giving out. If you’re one of those, you’ll do well.

(This column is an update of one that ran originally in October 2012.)