Arthroscopy
Surgery through keyholes: precise diagnosis and treatment in one procedure – with evidence-based indications and honest patient selection.
What is arthroscopy?
Arthroscopy is a minimally invasive surgical technique in which a thin camera (arthroscope, 2.7–4.0 mm diameter) is inserted into a joint through a small skin incision of a few millimetres. A second portal allows fine instruments to work inside the joint. The joint interior is visualised on a monitor with high-definition optics, enabling precise diagnosis and treatment in the same session – without opening the joint.
Arthroscopy is used in virtually all major joints: knee, shoulder, ankle, hip, elbow and wrist. The most common procedures include meniscus repair and partial meniscectomy, anterior cruciate ligament (ACL) reconstruction, rotator cuff repair, Bankart repair for shoulder instability, cartilage procedures, and removal of loose bodies or bone spurs (impingement).
- Most procedures are day surgery – patients go home the same day
- Smaller incisions, less pain, faster recovery than open surgery
- Not every joint problem is an indication for arthroscopy
- Degenerative meniscus tears: structured physiotherapy often equally effective (RCT evidence)
- When indicated correctly, arthroscopy has excellent outcomes across all major joints
Advantages of arthroscopy
Compared to open surgery, arthroscopy offers several well-documented advantages: smaller incisions reduce soft tissue trauma, postoperative pain and infection risk. Hospital stays are shorter – most procedures are performed as day surgery. Rehabilitation is faster because the surrounding muscles and ligaments are not disrupted. A systematic review by Salzler et al. confirmed lower complication rates for arthroscopic versus open procedures across multiple joints.
The arthroscope also provides superior visualisation of joint structures compared to open surgery: the magnified, illuminated view allows precise assessment of cartilage, ligaments, menisci and synovium that would be difficult to achieve through an open approach.
When is arthroscopy indicated – and when not?
Not every joint problem requires arthroscopy. Evidence-based patient selection is essential. The procedure is only performed when clinical findings, imaging and the individual situation clearly support it.
Degenerative meniscus tears in middle-aged patients without mechanical symptoms (locking, catching) are a prime example where arthroscopy is not the first choice: the landmark METEOR trial (Katz et al., NEJM 2013) and the FIDELITY trial (Sihvonen et al., NEJM 2013) showed that arthroscopic partial meniscectomy was not superior to sham surgery or physiotherapy for degenerative meniscus tears. Structured physiotherapy is the recommended first-line treatment.
Traumatic meniscus tears in young patients, ACL ruptures, rotator cuff tears, shoulder instability, cartilage defects and impingement syndromes that have failed conservative management are well-established indications with strong evidence for arthroscopic treatment.
The decision is always individual: age, activity level, symptom duration, imaging findings and the patient's goals are all considered. A second opinion before planned arthroscopy is always welcome.
The procedure
Arthroscopy is performed under general or regional anaesthesia (spinal or nerve block). The joint is distended with sterile saline to create working space. The arthroscope is inserted through a small portal; additional portals are created for instruments as needed. Depending on the procedure, the operation takes 20 minutes to approximately 90 minutes. Patients are typically discharged the same day or after one overnight stay.
Postoperative care includes ice, elevation, compression and early mobilisation. Physiotherapy begins within days for most procedures. The specific rehabilitation protocol depends on the procedure performed and is discussed in detail before surgery.
Frequently asked questions
How long does an arthroscopy take?
Depending on the procedure: simple diagnostic arthroscopy or partial meniscectomy takes 20–30 minutes; ACL reconstruction 45–75 minutes; rotator cuff repair 60–90 minutes. Most patients go home the same day.
How fast is the recovery?
After minor procedures (partial meniscectomy, ankle impingement): everyday activities within days, sport after 4–8 weeks. After reconstructive procedures (ACL, rotator cuff): return to sport after 6–9 months, depending on criteria-based clearance. The rehabilitation plan is discussed clearly in advance.
Is arthroscopy always the right choice?
No. For degenerative meniscus tears, uncomplicated shoulder impingement and many overuse conditions, structured physiotherapy is equally or more effective according to randomised trials. Arthroscopy is only recommended when the evidence and individual findings clearly support it.
What are the risks?
Arthroscopy is a low-risk procedure. Serious complications (infection, nerve injury, deep vein thrombosis) occur in less than 1% of cases. Specific risks depend on the procedure and are discussed individually before surgery.
References & Evidence
- Katz JN, Brophy RH, Chaisson CE, et al. Surgery versus physical therapy for a meniscal tear and osteoarthritis. N Engl J Med 2013;368:1675–1684. PMID: 23614526
- Sihvonen R, Paavola M, Malmivaara A, et al. Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear. N Engl J Med 2013;369:2515–2524. PMID: 24369076
- Moseley JB, O'Malley K, Petersen NJ, et al. A controlled trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med 2002;347:81–88. PMID: 12110735
- Abrams GD, Frank RM, Gupta AK, Harris JD, McCormick FM, Cole BJ. Trends in meniscus repair and meniscectomy in the United States, 2005–2011. Am J Sports Med 2013;41:2333–2339. PMID: 23943272
- Spindler KP, Wright RW. Anterior cruciate ligament tear. N Engl J Med 2008;359:2135–2142. PMID: 19005200
- Paavola M, Malmivaara A, Taimela S, et al. Subacromial decompression versus diagnostic arthroscopy for shoulder impingement: randomised, placebo surgery controlled clinical trial. BMJ 2018;362:k2860. PMID: 30054268
- Kirkley A, Birmingham TB, Litchfield RB, et al. A randomized trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med 2008;359:1097–1107. PMID: 18784099
Related topics
