Opinions on knee arthroscopy - good or bad?

[Phooey]

I know there's a couple of orthopaedic surgeons on here who's views are greatly appreciated, as well as a few PHers who have had knee arthroscopy so hoping for a bit of input..

Diagnosis: Right knee lateral compartment early arthritis changes.

Ok, so long story short ^^^ this is due to lack of internal rotation of my leg which is resulting in loading the lateral compartment of my knee. The only way of correcting this (internal rotation) is removing some bone of the femoral neck to allow the hip to internally rotate more. I haven't discussed this in detail with the surgeon (yet) but it doesn't sound too much of a big issue so quite tempted to explore this option later..

The bit I am currently more focussed on is the pain in the knee and the option of "keyhole or arthroscopy operation to trim back some of the cartilage and offload it. This is not going to cure the problem, but it can help with the symptoms"

I always thought knee arthroscopy to "trim" cartilage was a divided subject in the long-term health of the knee? I understand doing nothing will continue to wear the knee and eventually lead to knee replacement or partial, but I could do with some advice or guidance on the risks to knee arthroscopy

I just want to get back to riding the bike, using weights, hillwalking etc without having to ice my knee after most events.

Thanks

[The_Doc]

A lot of detail in here for your condition, but not enough to make a pronouncement or treatment plan.

I can only advise you in more detail face to face and possibly with alignment views and further imaging. Where's your Mikulicz line? Are you truely in valgus. Would a varising ostetomy at the knee be a better option, they can work really well. I do one a month.

A few pointers for nomenclature and therapies:

Femoral neck rotation problems. You are talking about cam and pincer problems and a hip arthroscopist could help, but derotation is another thing completely

Trim the cartilage, meniscal cartilage is the crescentic "shock absorber" whereas Hyaline Cartilage is the covering on the end of the bone. Trimming damaged, symptomatic and unrepairable meniscal cartilage is useful, but only when all three adjectives are met.

"keyhole or arthroscopy operation to trim back some of the cartilage and offload it. This is not going to cure the problem, but it can help with the symptoms"
- yes to some of this, but it can't offload the knee. Only offloading the knee does this with offloader braces or an offloading osteotomy.

The risk to arthrosopy are very very small. I quote a 1 in 1000 complication risk (blood clot or infection) The big risk is that is doesn't work. An experienced arthroscopist (>3000 ops is a good start) won't CAUSE damage.

Anyone with enough experience to comment on this forum, will only ask you to be seen face to face I'm afraid.

William

Edited by The_Doc on Sunday 23 February 16:09

[Phooey]

Hi Doc, thank you kindly for taking the time to reply - it is much appreciated. I also appreciate it is impossible to give any individual advice without seeing the patient, knee and images in person, so again thank you for the pointers

I guess at this stage i'm just exploring my options but I know I need to do something as the pain in my knee after exercise is becoming more of an issue.

Re Valgus - my notes say - I do not have a Valgus limb alignment. The doc wrote "Therefore, a distal femoral osteotomy would not help"

No mention of 'Mikulicz line'

Re cartilage - "There is a reduction in the thickness of the articular cartilage and the meniscus has therefore been extruded laterally. This is pressing against the soft tissue structures and correlates with the sensation of pain in that part of the knee"

The bit about the meniscus being extruded laterally is tempting me to just go ahead and have it "trimmed". I was just concerned that this could make the knee more likely to require a knee replacement in years to come(?). I *think* I also understand that unless he removes some bone from the femoral neck, the knee arthroscopy will only be a temporary fix.

Good pointer and thanks for mentioning the experience of the "experience" of the surgeon. I won't post his name on here but I can't find much info about him or his work. He did seem a particularly nice gentleman though

[The_Doc]

Perhaps I could help you find someone with more experience.
Standing full length alignment Xrays are a must for managing the younger person with lateral compartment OA.
PM me for help if your surgeon isn't inspiring confidence. I'm in North Cumbria, so I'm not touting for business.

[Phooey]

Thanks again, Doc. I shall send you a message. No rush to reply to it