What is Arthroscopic Knee Surgery?
Arthroscopic knee surgery or “knee scope” surgery is a minimally invasive knee surgery that aims to preserve tissue and in turn speed up healing time compared to an open procedure, if possible.
Orthopedic Surgeons perform millions of knee scopes each year for this reason. The rate continues to rise as more complex arthroscopic procedures become available and reduce the need for large incisions.
The operation can be exploratory in nature, but there are times when more invasive methods are necessary to perform the proper procedures and repairs (such as a ligament or cartilage repair), but that is a topic for another post.
Reasons for Needing Arthroscopic Knee Surgery
Candidates for arthroscopic surgery range from someone who has gradually worsening pain with knee “crepitus” or knee grinding — to someone with ligament or cartilage damage needing to be repaired or removed.
Common complaints from patients are “my knee hurts when I bend it and straighten it” or “I have a sharp pain in my knee”.
For the purposes of this article, we will discuss the recovery process of common and less involved surgeries of arthroscopic debridement and partial meniscectomy knee surgeries, sometimes referred to as “knee scopes”.
The goal of this article is to talk about the recovery of a routine debridement or meniscectomy, however it’s worth taking a second to explain why they differ from more involved procedures.
Why Tissue Repairs Are Different Than Removal
As previously stated, sometimes knee scopes are exploratory to assess the extent of tissue damage because physical tests and MRI results have been inconsistent or inconclusive.
It is important to distinguish the difference between the less involved debridement or loose body removal surgery, where damaged tissues are removed and articulating surfaces are cleaned up versus a REPAIR.
Once the surgeon is inside the joint to see and probe the integrity of the tissue, they can decide if just a clean up (this is the debridement) will suffice or if tissues need to be reconstructed or repaired.
The patient will consult with their Orthopedic Surgeon to discuss the benefits and risks of each procedure. Sometimes an Orthopedic surgeon recommends Physical Therapy or injections prior to choosing to perform a repair procedure.
A torn ligament such as an ACL or PCL will likely need repaired if the patient is wishing to return to higher levels of activities requiring a stable knee. The same could be said for a patient with a meniscus tear that needs to be repaired (not just just removed).
Patients with only an ACL or PCL reconstruction are likely weightbearing as tolerated with crutches immediately following surgery, whereas a meniscus repair will be non-weightbearing for 1-2 months to protect the integrity of the repair.
The surgery recovery timeline for these repairs is much longer than just a “scope” or “cleaning up” debridement procedure and will likely last 4-8 months in Physical Therapy depending on progress and goals.
Benefits and Risks of a knee scope
Time is Everything
There is a relatively quick turnaround time and positive outcomes surrounding knee scopes, pending there is no other structural damage in the knee.
One of the goals of surgery is to limit time under anesthesia and the surgery itself usually takes less than an hour, making the surgery fairly quick compared to more invasive operations.
Less invasive and fewer tissues disrupted lead to less time to recover than an open surgery. I have had a high level patient that had a knee scope performed and played a football game the following week! (Obviously you need to consult with your surgeon before returning to activities of any degree!)
Of course, those who aren’t in their last year of playing sports and in have a championship game to play usually take more time to rehab and gradually ease into higher level activities.
Preventing or Avoiding Total Knee Replacement
If injections and Physical Therapy have failed to provide pain and function improvements, a scope surgery may help put off or avoid an otherwise inevitable total knee replacement.
Knee replacement surgery is a much more involved and drastic change of structures to the knee compared to a knee scope.
This makes knee replacement recovery much longer and more difficult.
Nope, we’re not talking about the amazing board game. We’re talking about surgical risks.
With surgery, there is always an inherent risks and possibility of an unsuccessful surgery that a patient is assuming.
Infection, clots, bleeding in the joint, damaged connective tissue or nerves, etc. These are all possible poor outcomes following the surgery.
The benefits of an operation versus the risks should always be discussed between a patient and their Surgeon based on the patient’s current health and goals.
How Long Does it Take to Recover from Arthroscopic Knee Surgery?
Several factors affect the recovery following a knee scope.
- Patient prior level of activity and fitness level
- Extent of damage in the joint
- Work of surgeon
- Lack of surgical complications and post-op healing
- Patient compliance with post-op precautions
- Physical Therapist and patient progress in PT
Pending all of these go smoothly, a patient can expect to back to high levels of activity in roughly 6 weeks.
Knee Surgery Recovery Timeline
A patient will likely be sore, stiff, and feel weak in their quadriceps following surgery. Removal of the wound dressing at the surgical incision sites occurs 1-3 days after the operation.
Wound management should be pretty basic and straightforward – bandaids and keep it dry until the incisions close to prevent infection or delayed healing.
Frequent questions I receive from patients on their first day of PT are:
“Can my stitches get wet after a knee scope?”
“How long do stitches stay in?”
I always advise patients to call and ask their surgeons office regarding their wound care.
The stitches will stay in until they see the Surgeon again or some Doctors allow the Physical Therapist to remove the stitches prior to the patient’s two week follow up with the Surgeon.
Either way, usually it only takes 7-14 days for the scope holes to heal and stitches to come out.
When Can I Walk after Arthroscopic Knee Surgery?
Ah yes, back to the role of the Physical Therapist.
The Orthopedic Surgeon will determine weight bearing status and use of assistive devices. The patient is likely back to walking the same day as surgery or at least the following day pending all things go smoothly with a debridement or meniscectomy
A likely scenario is a patient is “weight bearing as tolerated with crutches as needed”, meaning the patient can put as much weight on their surgical leg as they can safely perform with as little help from crutches as possible.
Patients will need Physical Therapy for improving their knee flexibility, strength, and coordination for returning to their pre-injury level of function.
The top priority of PT following surgery is to promote a healing environment. Even though technically no “repairs” were made, there are still surgical incisions that need to heal and the affected tissue from the debridement or scope.
The goals surgical knee functioning as similar or better than their other knee
- Decrease swelling
- Regain equal extension (straight knee) and flexion (bending the knee)
- Regain quadriceps strength
They will likely to have tightness behind their knee when trying to straighten it all the way to walk evenly and a full, stiff feeling in the front of the knee when trying to bend it.
Exercises after Arthroscopic Knee Surgery
The physical therapist will prescribe exercises and functional movements as appropriate to help the patient return to higher level of function.
The American Academy of Orthopedic Surgeons give a great outline of exercises recommended after arthroscopic knee surgery.
In general exercises should include knee strengthening and stretching, but it is also important to address hip, ankle, and core flexibility and stability components as well. As you progress, the PT may include simple but important exercises like straight leg raises, seated kicking, hip presses, and exercises to recruit the quadriceps. These are important to master before progressing to advanced activities.
This means more than just walking for exercise!
You need to be strong to walk, but walking alone does not necessarily make you stronger.
More advanced single leg strengthening and dynamic stability activities can begin once full knee range of motion and strength begins to return comparably with the non-operative leg. Things such as squats, lunges, step ups, leg presses, etc. will help accelerate the strengthening phase.
The PT may introduce higher velocity and complex activities as the surgical leg flexibility, strength, and swelling normalize. The PT may initiate a gradual progression of running, hopping, lifting, cutting, etc. to prepare the patient for return to a pre-injury level of function.
When the patient demonstrates full knee ROM without pain and full strength, they may be cleared to continue performing exercises themselves and return to their activities and sport.
A Final Word…
How long to recover from arthroscopic knee debridement or meniscectomy surgery depends on a couple variables. It takes a good Orthopedic Surgeon, a devoted Physical Therapist, and a consistently committed patient working together to reach the highest possible outcome.
It’s always important to discuss the benefits, risks, and expected outcomes with your physician.
In my experience as a PT, the majority of patients have successful rehab after surgery and are able to get back to walking, running, jumping, and swinging in a couple weeks or months.