Knee
- traumatic meniscal tears and certain unstable tears;
- ligament injuries requiring reconstruction;
- focal cartilage and osteochondral injuries;
- loose bodies and certain patellofemoral disorders.
Arthroscopy
Knee, shoulder and ankle arthroscopy
Arthroscopy allows certain problems within a joint to be assessed and treated through small incisions. The decision to operate, however, does not begin with the technique but with a diagnosis supported by the clinical examination and imaging.
Clinical principle
The indication comes before the technique.
Not every painful joint requires arthroscopy. Some conditions respond to rehabilitation, activity modification, medication or injections. Others require a different type of procedure.
Arthroscopy is recommended only when there is a clearly defined problem that matches the patient's symptoms and the expected benefits justify both the procedure and the recovery period.
Areas of expertise
Conditions assessed and treated arthroscopically
Shoulder
- rotator cuff injuries;
- labral injuries and recurrent instability;
- disorders of the long head of the biceps tendon;
- persistent subacromial disorders and certain forms of stiffness.
Ankle
- osteochondral injuries of the talus;
- anterior or posterior impingement;
- loose bodies and persistent synovitis;
- injuries within the joint associated with chronic instability.
Surgical procedures
Common arthroscopic procedures
Consultation and assessment are always the first steps.
This list explains procedures that are commonly performed, but it is not a recommendation for surgery. The choice is made only after the symptoms, clinical examination findings and investigations have been considered together.
Book an assessmentMeniscal repair
A meniscal tear is repaired with sutures or fixation devices when the type of tear, its blood supply and the quality of the tissue provide a realistic chance of healing.
Rehabilitation must protect the repaired meniscus and is more cautious than after a meniscectomy.
Selective partial meniscectomy
Only the unstable, irreparable fragment is removed, preserving as much functioning meniscus as possible. The procedure is reserved for tears that cause significant mechanical symptoms and cannot be repaired.
It is not a routine treatment for knee pain caused by widespread osteoarthritis.
Anterior cruciate ligament reconstruction
The torn ligament is replaced with a graft to control knee instability. Reconstruction is considered for patients with episodes of giving way, participation in pivoting activities or associated injuries that can be repaired.
The choice of graft and treatment of any meniscal injuries are planned individually.
Treatment of cartilage injuries and loose bodies
Treatment may include stabilising the edges of a lesion, microfracture in selected cases, osteochondral fixation or reconstruction, and removal of loose bodies.
The technique depends on the size and location of the lesion, the subchondral bone and the overall condition of the joint.
Rotator cuff repair
One or more tendons are reattached to the bone using anchors. Repair is recommended selectively according to whether the tear is traumatic or degenerative, its size and retraction, muscle strength and functional goals.
Tendon healing requires protection and progressive rehabilitation.
Shoulder stabilisation and labral repair
In recurrent instability, the labrum is repaired and the capsule tightened. Assessment of glenoid bone loss and the Hill–Sachs lesion determines whether arthroscopy is sufficient or a bone procedure is required.
The aim is to reduce the risk of another dislocation without unnecessarily limiting movement.
Procedures for the biceps tendon and subacromial space
Biceps tenodesis or tenotomy, removal of the bursa or selective acromioplasty may accompany treatment of other shoulder injuries.
These are not routine add-on procedures; each must be justified by the symptoms and the clinical and intraoperative findings.
Ankle arthroscopy for impingement and loose bodies
Scar tissue, bone spurs or loose fragments that restrict movement or cause locking are removed. Persistent synovitis or injuries associated with instability may also be treated.
Correcting any associated mechanical cause is important for a lasting result.
Treatment of osteochondral injuries of the talus
Treatment may include debridement of damaged tissue and bone-marrow stimulation, fixation of the fragment or osteochondral restoration procedures. The choice depends on the size and depth of the lesion, the presence of cysts, alignment and previous procedures.
Arthroscopy is sometimes combined with correction of the limb alignment or ligament stabilisation.
Consultation and diagnosis
What the consultation establishes
An MRI report describes anatomical changes but does not always show which of them is causing the symptoms. The consultation relates the onset and location of the pain to movement, stability, strength and the available investigations.
- locking episodes, a sense of instability and functional limitation;
- whether the symptoms are related to an injury or overuse;
- previous treatments and the response obtained;
- the patient's activity level and goal.
The options discussed at the end may be to continue conservative treatment, obtain further investigations or proceed with surgery.
Choosing treatment
When arthroscopy is not the first option
In the absence of a lesion that clearly matches the symptoms, surgery is not justified solely by persistent pain or an abnormality described on MRI.
For many degenerative or overuse conditions, treatment begins conservatively. In advanced osteoarthritis, arthroscopy cannot correct widespread joint damage.
Preparing for surgery
If arthroscopy is recommended, the diagnosis, planned surgical steps, required tests, other medical conditions, medication, type of anaesthesia and any devices needed after surgery are clarified.
Medication must not be stopped on your own initiative. Instructions are agreed with the doctors involved in your care.
After treatment
Small incisions. Recovery tailored to the procedure.
The pace of recovery is determined mainly by the tissue treated. Removing a loose body, repairing a meniscus, reconstructing a ligament and repairing the rotator cuff all require different protocols.
The plan may include instructions on weight-bearing and movement, crutches, a brace or sling, rehabilitation and follow-up visits to adjust progression. Protecting the repaired tissue is more important than rushing the return to activity.
Further information
Frequently asked questions about arthroscopy
Does an abnormal MRI mean that I need surgery?
No. The decision is based on how the imaging relates to the symptoms, clinical examination and functional limitation. Some imaging findings may be incidental or suitable for conservative treatment.
Does every meniscal tear require arthroscopy?
No. The mechanism, type and stability of the tear, the condition of the cartilage, the symptoms and the response to previous treatment all matter.
Is arthroscopy appropriate for osteoarthritis?
Not as a routine treatment for pain caused by widespread joint damage. A separate associated injury needs to be assessed on its own merits.
Does arthroscopy guarantee a quick recovery?
No. The incisions are small, but healing time depends on the injury and the procedure performed. A repair or reconstruction requires more protection than a simple procedure.
When can I return to work or sport?
Return depends on the type of procedure, the demands of the activity and clinical progress. Indicative time frames are discussed before surgery and reassessed during recovery.
Appointment
Assessment begins with a clear diagnosis.
The consultation determines whether the symptoms are best managed conservatively, with an arthroscopic procedure or with another approach.
Medical emergency?
This website does not provide emergency care. In an acute or life-threatening situation, call 112 or go to the nearest emergency department.