- If I injure my knee, will I need an operation?
- What is an arthroscopy?
- How long does it take to recover after an arthroscopy?
- How long does it take to recover after a ligament reconstruction?
- Will I need a brace?
- When can I drive?
- What are the possible complications of surgery?
- Any other questions?
The majority of patients who are referred to me do not have an operation, and I only see those patients whose knee has failed to settle within a matter of a few days or weeks. The odds are that if you injure your knee you will avoid surgery.
If you come to surgery the most likely operation you will have is an arthroscopy (‘key hole surgery’). This involves looking into the knee with a small telescope under a general anaesthetic. Usually two or three small (5mm, ¼’’) cuts are made in the knee for the introduction of the telescope and specialised instruments. An arthroscopy can be diagnostic (i.e. finding out what is wrong) or therapeutic (i.e. dealing with problems).
Most patients having a straight forward arthroscopy go home on the day of surgery. You will walk into the hospital, and walk out afterwards. Crutches are provided if necessary, and at most are used for a few days. You should be walking comfortably after a couple of weeks, and be able to climb stairs normally within 3 – 4 weeks. Full benefit is usually 4 – 6 weeks, at which point you can start to get fit again. How much benefit you gain will depend on what is found at operation and what is done. The aim of surgery is to restore maximum function.
Most patients will either go home on the day of surgery or the following day. The recovery for day-to-day activities takes a little longer than for a routine arthroscopy, but by six weeks you should be able to walk comfortably and go up and down stairs normally. My patients undergo a six month rehabilitation programme and can then start to get sports fit with a view to returning to sport at 9 – 12 months post operation.
Most patients undergoing surgery do not need a brace. However if you have a meniscal repair, as opposed to trimming, or have a complex ligament reconstruction, then you may need a brace for a matter of a few weeks or months depending on the nature of the surgery.
This is a little dependant on which knee is operated upon, and whether you have a manual or automatic transmission car. If your left knee has undergone surgery and you have automatic transmission, you will be able to drive within a matter of days, if a manual gear box, within a matter of a couple of weeks. For a right knee, I usually advise my patients to refrain from driving until they can do an ‘emergency stop’, usually when they can come down stairs normally. If a brace is worn, then you are unlikely to be able to drive until this comes off. If you have had surgery it is as well to check with your insurance company to ensure you are covered when you return to driving.
Arthroscopic surgery is by and large very safe surgery, with minimal risk of complications. The principal ones are as follows:
- Infection: I have had one patient with a septic knee joint in 22 years of performing arthroscopies and ligament reconstructions.
- Deep Vein Thrombosis (DVT): An uncommon complication affecting less than 1% of my arthroscopy or ACL reconstruction patients.
- Nerve damage: Although the operations are through small holes, there is a small chance of cutting a small skin nerve. This may result in a numb patch about the size of a £2 coin around the cut. ACL patient may have some shin numbness, but this usually recovers in time, leaving a small numb patch adjacent to the scar in some patients.
- Vessel damage: It is impossible to perform an operation without cutting small blood vessels, so a little bruising is not uncommon. Major vessel injury is extremely rare, though patients undergoing PCL reconstruction are at greater risk of damage to the major vessels at the back of the knee.
- Graft failure: My ACL graft failure is under 10%, and the commonest cause of failure is a re-injury on returning to sport. If you injured your knee playing a given sport, and return to that sport, you can re-injure the knee. Although we can try to restore function, we can not make the joint invincible!
I am a great fan of patients writing down their questions beforehand. There is nothing more frustrating for you than to come away from a consultation thinking “I forgot to ask about……….”. If you have questions about your injury, investigations or treatment, you must ask your GP, physiotherapist or specialist. Websites such as this are useful, but are generic in outlook. Your problem is unique to you, and it is important that your mind is settled. It is after all your body, and it has to last you a lifetime!