Knee Arthroscopy: What to Expect Before and After

What is knee arthroscopy and what can it treat?

Arthroscopy means looking inside a joint with a small camera (arthroscope). In the knee, two or three small incisions about a centimeter long allow the surgeon to view the entire interior of the joint on a screen and pass thin instruments to perform repairs.

Conditions appropriately treated with knee arthroscopy include: - Meniscus tears: Trimming (partial meniscectomy) for certain tear patterns, or repair of reparable tears - ACL or PCL reconstruction: Using a graft to replace torn ligaments - Loose bodies: Removing fragments of cartilage or bone floating in the joint - Cartilage repair procedures: Microfracture or other focal cartilage treatments - Synovitis: Removing inflamed joint lining in inflammatory arthritis cases

Importantly, arthroscopy is not recommended for the treatment of diffuse knee osteoarthritis. Studies comparing arthroscopic cleaning (debridement) in arthritic knees to sham procedures showed no meaningful difference in pain or function 1Ref 1Sihvonen R, Paavola M, Malmivaara A, Itälä A, Joukainen A, Nurmi H, Kalske J, Järvinen TLN; FIDELITY Group (2013).Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear.Arthroscopic partial meniscectomy not superior to sham for degenerative meniscal tears — basis for recommending against arthroscopy in OA2Ref 2Thorlund JB, Juhl CB, Roos EM, Lohmander LS (2015).Arthroscopic surgery for degenerative knee: systematic review and meta-analysis of benefits and harms.Arthroscopic surgery provides no meaningful benefit for degenerative knee conditions. Major guidelines do not support this use.

What happens on the day of surgery?

Knee arthroscopy is almost always performed as an outpatient (same-day) procedure under general, spinal, or regional anesthesia. The procedure itself typically takes 30–90 minutes depending on what is being done.

Before surgery: You will fast from midnight the night before. A pre-operative assessment checks your general health and any medications that need to be paused (particularly blood thinners).

During surgery: You are positioned on the operating table; the knee is cleaned and draped. The surgeon makes two or three small incisions, inserts the arthroscope, fills the joint with saline to improve visualization, and performs the planned procedure.

After surgery: You wake in the recovery room. Once stable, you are given pain medication, and a physical therapist or nurse reviews your home instructions. Most patients go home within two to four hours. You will need someone to drive you.

What is recovery like after knee arthroscopy?

Recovery depends heavily on the procedure performed:

Partial meniscectomy (trimming): - Crutches for a few days if needed; many people don't need them after 48 hours - Light walking within a week - Return to low-impact activity in two to four weeks - Return to sport (non-contact) in four to six weeks on average

Meniscus repair: - Protected weight-bearing with crutches for four to six weeks to allow the repair to heal - Return to sport: three to six months depending on the sport and repair type

ACL reconstruction: - Crutches initially; progressive weight-bearing over the first two weeks - Full return to cutting and pivoting sport: nine months to over a year in many programs — following criteria-based return-to-sport protocols 3Ref 3Grindem H, Snyder-Mackler L, Moksnes H, Engebretsen L, Risberg MA (2016).Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: the Delaware-Oslo ACL cohort study.Criteria-based return-to-sport protocols after ACL reconstruction reduce reinjury risk

Microfracture for cartilage: - Protected weight-bearing for six to eight weeks - Return to impact sports: nine to twelve months

Physical therapy is critical after all of these procedures. Early exercises focus on swelling control, range of motion, and quadriceps activation; later phases address strength, balance, and sport-specific movements.

What are the risks of knee arthroscopy?

Knee arthroscopy has a generally favorable safety profile as surgical procedures go, but complications can occur:

• Infection (rare, less than 1% for most procedures)
• Blood clot (deep vein thrombosis) — more common with longer procedures and prolonged immobility; blood clot prevention measures are routinely used
• Stiffness (arthrofibrosis) — can occur if early mobilization and PT are not done consistently
• Re-tear or failed repair — particularly relevant for meniscus repairs and cartilage work
• Anesthesia risks — standard for any surgical procedure

Discuss your individual risk factors with your surgeon before deciding on surgery.

Is knee arthroscopy always the right answer?

Not always. For acute ligament tears or mechanical problems (locking from a displaced meniscus fragment), surgery is often necessary. For degenerative conditions or osteoarthritis, evidence consistently shows that arthroscopy does not help and is not recommended by major guidelines 1Ref 1Sihvonen R, Paavola M, Malmivaara A, Itälä A, Joukainen A, Nurmi H, Kalske J, Järvinen TLN; FIDELITY Group (2013).Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear.Arthroscopic partial meniscectomy not superior to sham for degenerative meniscal tears — basis for recommending against arthroscopy in OA2Ref 2Thorlund JB, Juhl CB, Roos EM, Lohmander LS (2015).Arthroscopic surgery for degenerative knee: systematic review and meta-analysis of benefits and harms.Arthroscopic surgery provides no meaningful benefit for degenerative knee conditions.

For moderate meniscus tears without clear mechanical symptoms, the decision between surgery and a structured physical therapy program should involve a careful shared discussion with your orthopedic surgeon about your specific tear type, age, activity goals, and prior treatment history.

An orthopedic surgeon is the specialist who performs and evaluates for knee arthroscopy. Gale can help you prepare questions and find a specialist.