Knee arthroscopy - acute knee injury

The knee joint acts like a hinge to let you bend, straighten and move the leg. It is made up of three bones:

  • Thigh bone (femur)
  • Shin bone (tibia)
  • Kneecap (patella).

Ligaments

Ligaments are tough bands of connective tissue in the knee which join the thigh bone to the shin bone at the knee joint. They help keep the knee steady and balanced.

Menisci

The meniscus is a piece of cartilage – firm rubbery material. It covers the ends of the bones in the knee and helps to provide a cushion between your thighbone and shinbone. There are two menisci in each knee joint which help to:

  • Absorb impact from body weight
  • Improve movement
  • Support the stability of the knee.

Acute knee injury:

An acute knee injury is usually the result of a sudden twist, sprain, fall, force or direct bang to the knee. Common sports injuries can tear, damage or bruise the knee cartilage or ligaments. When they become damaged this can limit the knee’s normal movement and cause pain.

Treatment:

Treatment for acute knee injuries is generally conservative management, such as the PRICE protocol, medicines and physiotherapy.

PRICE stands for Protection, Rest, Ice, Compression and Elevation which is effective pain andsymptom management for most sports-related injuries.

  • Protection – protect the affected area from further injury – for example, by using a support.
  • Rest – avoid exercise and reduce your daily physical activity. Using crutches or a walking stick may help if you can't put weight on your knee.
  • Ice – apply an ice pack to the affected area for 15-20 minutes every two to three hours. A bag of frozen peas, or similar, will work well. Wrap the ice pack in a towel so that it doesn't directly touch your skin and cause an ice burn.
  • Compression – use elastic compression bandages during the day to limit swelling.
  • Elevation – keep the injured body part raised above the level of your heart whenever possible. This may also help reduce swelling.

Non-steroidal anti-inflammatory medicines like aspirin and ibuprofen can be used under medical guidance to reduce pain and swelling.

Physiotherapy is offered to patients whose symptoms have not resolved after PRICE and taking medicines.

Knee arthroscopy:

A knee arthroscopy is a type of keyhole surgery which may be used to treat problems in the knee. A very small cut is made on the knee joint to insert a tiny camera (an arthroscope) so the inside of your knee can be seen on a monitor screen. This allows the surgeon to repair or trim any damage using small surgical tools.

Meniscectomy

This procedure involves removing some or all of the damaged or torn tissue.

Reconstructive ligament surgery

A torn ligament cannot be repaired by stitching it back together. However, it can be rebuilt by attaching new tissue from other areas of the leg.

Risks

There is a small risk of infection, worse pain, stiffness and damage to the nerves and blood vessels around the shoulder. In some cases, the surgery may need to be done again.

Eligibility criteria:

A knee arthroscopy for acute knee injury is a restricted surgical procedure. It is considered when other forms of treatment such as PRICE (Protection, Rest, Ice, Compression and Elevation), physiotherapy and painkillers after three months have not enabled knee function to be restored.

The treatment will only be funded if a patient is under 35-years-old and:

  • Does not already have a degenerative knee disorder such as osteoarthritis

AND

  • Continues to experience locking, clicking, popping or giving way of the knee

AND

  • Has difficulties carrying out daily activities such as walking, sleeping or eating.

This means the patient’s NHS commissioning organisation (CCG), who is responsible forbuying healthcare services on behalf of patients, will only fund the treatment if the patient meets the eligibility criteria above or an Individual Funding Request (IFR) application hasshown exceptional clinical need and the CCG supports this.

Further guidance:

Treatment policy for patients covered by NHS Birmingham and Solihull CCG

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