There are many knee operations that can be performed using an arthroscope (keyhole surgery)Below are the commonest conditions requiring an arthroscopic procedure.

Torn Meniscus
There are two menisci in every knee, the medial (inside) and the lateral (outside). Menisci can be damaged acutely when the knee sustains a suddenly forced flexion and twisting strain, or chronically as part of degenerate changes within the knee ('wear & tear'). The meniscus has little blood supply, except along the periphery where it attaches to the joint capsule, and therefore unlikely to heal.

This typically causes sharp acute pain on the joint line. The knee can swell intermittently. A torn meniscus also causes mechanical interference in the knee joint. This may result in the knee 'locking', preventing full extension, or ‘giving way’. Recurrent displacement of a torn meniscus can produce damage to the smooth articular surface of the knee resulting in long-term degeneration. Torn menisci can be removed by arthroscopy leaving the undamaged, stable portion behind. Occasionally a meniscus is torn along its peripheral attachment where there is a reasonable blood supply. This type of tear can sometimes be repaired allowing the meniscus to heal.

Anterior Knee Pain
This is very common. This is normally due to pain originating from the patello-femoral joint (undersurface of knee cap & underlying femoral cartilage). There are a number of causes for this. Commonly it is due to Quadriceps weakness and/or mal-tracking of the patella. The initial treatment for this is physiotherapy, however, surgery is sometimes required to correct the patella mal-tracking.

More severe cases result in damage to the underlying cartilage. This roughened articulating area produces a painful, grinding sensation typically as the flexes leading to joint irritation and swelling. Most often patients find it painful coming down stairs, squatting and kneeling. The damaged area sometimes requires an arthroscopic chondroplasty. The arthroscopic 'shaver' removes any loose or roughened areas leaving a smooth articulating surface, thus reducing the local irritation.

All patients however will require an exercise programme of Quadriceps strengthening and Hamstring stretching to protect against further injury.

Early stages of Arthritis/Wear & Tear
Chondroplasty can also be performed in other areas of the knee to improve symptoms, especially in the early stages of arthritis. This is commonly referred to as ‘wear & tear’. In these cases, it’s important that the patient realises that this will improve symptoms but it is not a complete ‘cure’.

However, when the articular cartilage is damaged to the extent that the underlying bone is exposed, chondroplasty by itself is insufficient. In these cases, we need to promote new cartilage formation in the damaged area. This is done by breaking through the exposed bone, to the underlying blood supply (micro-fracture). The bleeding bone forms a new cartilage layer consisting of fibrocartilage. It lacks some of the special properties of the original hyaline cartilage, but it does form a new smooth surface.

Removal of Loose Bodies
A piece of bone or cartilage can be broken off during an injury or as part of a more general degeneration and form a 'loose body' within the knee. Loose bodies can remain symptomless for long periods but can cause sudden attacks of pain and locking. Loose bodies can be removed at arthroscopy although they can often be difficult to find.