Arthroscopic treatment of the knee was first introduced in Australia over 30 years ago. For many years, it was the best way to see inside the knee. As instrumentation improved, it became possible for a range of conditions to be treated using this technique. It took many more years for the efficacy of these procedures to be rigorously assessed. Furthermore, with the advent of MRI scans and technological improvements in resolution and radiologists' skills studying the images, "visualisation' inside the knee no longer needs to be an invasive procedure.
The conditions in which an arthroscopy is beneficial include: a symptomatic torn meniscus (cartilage in the knee), floating cartilage or bone in the knee, severe synovitis (as may occur in rheumatoid arthritis), infection in the knee (rare) or to biopsy the synovium.
It is rare for an arthroscopy to be needed to "have a look" in the knee as MRI scans, in the right hands, are very accurate. Therefore, the diagnosis can often be established before surgery is considered.
Several studies in recent times have shown that there is little or no benefit in a "clean up" of the knee. If the knee is arthritic, it is probably best to manage it with simple analgesia and regular "knee friendly" exercise such as low resistance cycling. In some circumstances, however, an arthroscopy can be considered.
A torn meniscus (a type of cartilage in the knee) is amenable to arthroscopic treatment. However, there are no long term benefits to treating it if the symptoms are mild or non existent. Often, the symptoms will settle over a 2 months period; if they don't, then an arthroscopy can be considered.
The most important part of arthroscopic surgery is deciding whether the operation is necessary; therefore it is important to have an assessment by the surgeon and proper review of the MRI scan prior to proceeding.
