With the breaking news of Roger Federer having arthroscopic knee surgery one would wonder what is so different about this type of operation vs say an open procedure and why does the recovery still take so long?
Arthroscopy is basically minimally invasive surgery performed with the assistance of small cameras. In the belly its called “endoscopy” and within a tendon its called “tendoscopy”— “arth” meaning joint , “scopic” meaning with the use of a scope/camera.
With the use of these small instruments we can get inside a joint without a large incision and use specialized equipment such a picks, awls, shavers, scoops, and others to navigate the anatomy of a joint.
When arthroscopy is performed, usually the joint needs “distracted” or “opened up”. This is done with a process called “insuflation” where sterile water is pumped into the joint to open it up like a balloon. There are usually at least 2 portals -one to pump the water in, one to suck it out.
Once you find where you want to go in the joint ( which takes a lot of practice), you are now able to do many do many different procedures. Typically an arthroscopy involves a “washing out” of the joint which is basically cleaning out scar tissue, inflammatory fluid, loose cartilage/bone. If there is nothing else wrong with the joint then your job is done.
IF there are more nefarious things going on such a torn cartilage/ ligaments/etc then the job becomes more involved. This is where longer recoveries come into play. In some procedures the joint surfaces will need to be “microfractured” which is taking a poker and hammering it through the surface to induce your body to produce new cartilage cells. This temporarily weaken the bone and requires plenty of rest and rehab after
Even if the scope is just that-a scope and wash out, there is still quite a bit of swelling and pain after. Recovery is challenging in that you are trying to get a joint which has just been beat up to move again so it takes a lot of rehab… especially for tennis.