Preparing for Surgery

How to prepare for surgery

Preoperative Testing

Before your knee arthroscopy, you will need pre-operative clearance from a healthcare provider, oftentimes from your primary care provider (PCP), to make sure that it is safe and that you are healthy enough to undergo surgery. Your pre-operative assessment will involve a physical examination from a healthcare provider within one month before your scheduled surgery to address any other medical conditions you may have and screen your heart and lung function.

If you have any other medical conditions that may increase your health risks during surgery, your healthcare provider may require certain tests in order to complete your pre-operative assessment. These tests can include things like:

• Blood tests to check your levels of blood cells, blood sugar, and indicators of kidney and liver function
• Chest x-ray to examine your lungs
• Electrocardiogram (EKG) to examine your heart function
• Urine sample to test for infections and measure your sugar and protein levels

Any other conditions that can affect how you respond to anesthesia or during the operation need to be treated and managed first before you can be cleared to undergo a knee arthroscopy.

Understanding Anesthesia Options

A knee arthroscopy can be performed using different types of anesthesia depending on what type or combination of types is considered most appropriate. Types of anesthesia used during surgery include:

• Local anesthesia: anesthesia that is injected into your knee joint to numb just your knee, allowing you to be awake for the procedure but not experience pain during the time of the operation
• Regional anesthesia: anesthesia delivered into your spine through your lower back to numb your body from the waist down, allowing you to be awake for the procedure but not experience pain during the time of the operation
• General anesthesia: anesthesia that is delivered intravenously through an IV that puts you to sleep for the operation, where you will not feel or remember anything that occurs during the operation

Oftentimes with local or regional anesthesia, sedation will be used in which you will be given medication to put you in a drowsy state to further help decrease any sensation of pain during the operation.

What to expect on the day of surgery

Pre-operative Room

Before your knee arthroscopy, you will be taken into a pre-operative room where you will change into a hospital gown and undergo a brief physical examination to clear you for the operating room. During this time, a nurse will place an IV into your arm or hand to deliver intravenous (IV) fluids and medications, while your surgical team will review your personal health information and answer any questions you may have about the procedure. From the pre-operative room, your surgical team will take you into the operating room and assist you onto the operating table.

Operating Room 

Before the Surgery

Once you are on the operating table in the operating room, you will be delivered anesthesia through an injection into your knee, spine, or IV to help numb your knee and/or put you to sleep throughout the surgery. If general anesthesia is used for your knee arthroscopy, your healthcare team will also insert a breathing tube to help you breathe during the surgery.

Following anesthesia, you will be given antibiotics through your IV and your knee will be sterilized with an antiseptic solution to kill bacteria and prevent the risk of infection at the surgical site. Your surgical team will also drape sterile linens around the rest of your leg and body so that just your knee is exposed during the operation.

During the Surgery

Rather than making a large incision down the front of your knee, your surgeon will make 3-4 small incisions called ports around your knee joint. These ports will be used for access to your knee joint to insert the arthroscope and surgical tools while leaving minimal scarring and damage to surrounding tissues. Knee arthroscopy also helps protect your knee from infection due to decreased exposure of your knee joint to the outside environment.

After making the ports around your knee joint, saline solution will be injected into your knee to expand the space around your knee joint to allow adequate space for the arthroscope and surgical tools. Your surgeon will use the camera of the arthroscope to examine the structures within your knee joint and locate areas that need treatment. Your surgeon will then use surgical tools to perform one or more of the following surgical procedures:

• Removing a torn ligament (ACL or PCL) and inserting a new reconstructed ligament from a tendon graft
• Repairing a torn meniscus by closing it back together with stitches
• Removing a portion of a torn meniscus
• Debriding and removing frayed and torn cartilage
• Removing bone spurs
• Removing inflamed folds (plica) in the synovium (joint lining)
• Cutting and releasing the patellar retinaculum to decrease tightness and pulling on the kneecap
• Implanting cartilage grafts
• Drilling tiny holes into your knee bones for microfracture surgery

Once complete, all surgical tools will be removed from your knee and any incisions will be closed with stitches or surgical tape called steri-strips.

Recovery Room 

After your knee arthroscopy is complete, you will be taken to a recovery room for a few hours to monitor your vital signs and manage your pain with medication as needed as the effects of the anesthesia wear off. Once your heart rate, breathing, and blood pressure are stable, your pain is under control, and you are able to stand up to walk or move into a chair, you will be discharged to go home.