Arthroscopy (Knee and Shoulder)

Some joint problems are mechanical. The knee locks halfway through standing up or catches on the stairs. The shoulder aches every time you reach for the seat belt and hasn't had its old strength since a fall. X-rays often look normal, because the damage is in soft tissue.

Arthroscopy is keyhole surgery on a joint. The surgeon makes two or three cuts of about 1 cm and passes in a thin camera (the arthroscope), which shows the inside of the joint on a screen. The joint is filled with sterile fluid for a clear view, and slim instruments passed through the other cuts trim, stitch or remove damaged tissue. In the knee that is usually the meniscus (the C-shaped cartilage cushions); in the shoulder, the rotator cuff tendons or the labrum (the rim of cartilage around the socket).

It works well for clearly mechanical problems: a meniscus flap that catches, a loose fragment, a cuff tear after an injury, or a shoulder that keeps dislocating. It doesn't help worn-out arthritis. Trials have shown that washing out or trimming an arthritic knee works no better than physiotherapy.

Our operation theatres have arthroscopy towers, and our orthopaedics team does meniscus repair and rotator cuff surgery this way. Where physiotherapy and medicines are likely to work, we try them first.

Arthroscopy is mostly used on the knee and shoulder, and occasionally the ankle, hip, wrist or elbow. An MRI usually shows the problem first; the camera confirms it, and it's treated in the same sitting.

Recovery depends far more on what was done inside the joint than on the size of the cuts. Trimming a meniscus and stitching one are very different recoveries.