Knee Arthroscopy
Keyhole surgery through two or three small incisions. A camera is placed inside the joint and fine instruments are used to treat the problem found — trimming or repairing a torn meniscus, removing loose fragments, or smoothing damaged cartilage. It is performed under general or spinal anaesthetic and usually takes 30–45 minutes.
Hospital stay: Day surgery — home the same day, no overnight stay in most cases.
Recovery & rehabilitation milestones
- Day 0–3: walking with crutches as comfort allows; ice and elevation to reduce swelling.
- Week 1: wound check, dressings off around day 10–14; most people are off crutches.
- Week 2–4: physiotherapy for range of motion and quadriceps strength; desk work usually possible within 1–2 weeks, manual work 3–6 weeks.
- Week 6–12: return to running and sport once strength and control are restored.
Possible complications
- Infection (uncommon in keyhole surgery, around 1 in 200) — treated with antibiotics and occasionally further washout surgery.
- Blood clots in the leg (DVT) or lung (PE) — early mobilisation reduces risk; blood thinners are used if you have additional risk factors.
- Persistent pain or swelling, particularly where cartilage wear is already present.
- Stiffness and loss of movement, reduced by early physiotherapy.
- Damage to nerves or blood vessels around the knee (rare), causing numbness or, very rarely, more serious injury.
- Ongoing symptoms requiring further surgery.
Meniscus Repair
The meniscus is the knee's shock absorber. Where the tear pattern and blood supply allow, the torn edges are stitched back together arthroscopically using sutures or small implants, preserving the meniscus rather than removing it. Preserving meniscal tissue protects the joint surface from long-term wear.
Hospital stay: Usually day surgery; an overnight stay is occasionally needed for pain control.
Recovery & rehabilitation milestones
- Week 0–6: protected weight bearing with crutches and often a brace, with limits on deep bending to protect the repair.
- Week 6–12: full weight bearing, progressive range of motion and strengthening.
- Month 3–4: jogging and straight-line running when strength is symmetrical.
- Month 5–6: return to pivoting and contact sport after clearance.
Possible complications
- Failure of the repair to heal, or re-tear of the meniscus — reported in roughly 10–25% of repairs, sometimes requiring repeat surgery or trimming.
- Infection.
- Blood clots (DVT/PE).
- Persistent pain along the joint line.
- Stiffness, especially if rehabilitation is delayed.
- Nerve or blood vessel injury, including numbness near the incisions (usually temporary).
ACL Reconstruction
A torn anterior cruciate ligament cannot heal itself. The remnant is removed and a new ligament is created from a tissue graft (commonly hamstring, quadriceps or patellar tendon), passed through tunnels drilled in the thigh and shin bone and fixed securely. The whole procedure is done arthroscopically.
Hospital stay: Usually day surgery; some patients stay one night for pain relief.
Recovery & rehabilitation milestones
- Week 0–2: full weight bearing with crutches, focus on straightening the knee fully and regaining quadriceps control.
- Week 2–6: normal walking, cycling on a stationary bike, progressive range of motion.
- Month 3: gym-based strengthening; jogging when quadriceps strength reaches roughly 70–80% of the other side.
- Month 6: agility, cutting and sport-specific drills.
- Month 9–12: return to pivoting and contact sport after functional testing — returning early increases re-rupture risk.
Possible complications
- Graft failure or re-rupture (around 5–10%, higher in young athletes returning early).
- Infection, including rare deep joint infection.
- Blood clots (DVT/PE).
- Persistent pain, including kneeling pain at the graft site.
- Stiffness or loss of full extension requiring further treatment.
- Nerve or blood vessel injury — numbness on the outer side of the shin is common and usually settles.
- Ongoing instability or associated meniscal or cartilage damage.
Patella Stabilisation (MPFL Reconstruction & Tibial Tuberosity Osteotomy)
An operation to stop the kneecap (patella) repeatedly slipping out of its groove. It usually combines two key procedures. MPFL (medial patellofemoral ligament) reconstruction rebuilds the strap that holds the kneecap against the inner side of its groove, using a tendon graft (commonly hamstring) passed through small tunnels in the kneecap and thigh bone. Tibial tuberosity osteotomy (TTO) is added where the kneecap sits high or tracks unfavourably: the bony attachment of the kneecap tendon on the shin bone is cut and shifted to improve kneecap height and tracking, then fixed with screws. The procedures are performed under general anaesthetic, often with arthroscopy first to confirm the diagnosis and treat any cartilage damage.
Hospital stay: Overnight stay usually required — typically 1–2 nights.
Recovery & rehabilitation milestones
- Week 0–2: a hinged brace locked straight (or with limited bending) for walking; crutches, ice and elevation; ankle pumps and quadriceps exercises begin immediately.
- Week 2–6: brace bending gradually increased as comfort allows; partial weight bearing on crutches, especially after an osteotomy.
- Week 6–12: brace discarded, full weight bearing, physiotherapy for range of motion and quadriceps strength; driving usually possible around 6 weeks.
- Month 3–4: progressive strengthening, cycling and straight-line running.
- Month 6–9: return to pivoting and contact sport once strength and control are restored.
Possible complications
- Recurrent instability — the kneecap can dislocate again, more commonly with severe underlying shape problems.
- Stiffness and loss of knee bending, sometimes needing prolonged physiotherapy or further treatment.
- Infection.
- Blood clots (DVT/PE) — blood-thinning medication is prescribed after surgery, particularly following an osteotomy.
- Delayed healing or non-union of the bone cut after tibial tuberosity osteotomy, sometimes requiring further surgery.
- Irritation or prominence of the screws below the kneecap when kneeling — screw removal is needed in a proportion of patients.
- Fracture through the bone cut or the kneecap tunnels (uncommon but recognised).
- Persistent kneecap pain from the cartilage wear that dislocations can cause.
- Nerve injury — numbness around the incisions is common and usually settles.
Partial or Total Knee Replacement
Worn joint surfaces are resurfaced with metal and high-grade plastic implants. A partial (unicompartmental) replacement resurfaces only the damaged compartment and preserves the ligaments and the rest of the knee; a total replacement resurfaces the whole joint. The choice depends on the pattern of arthritis, alignment and ligament condition.
Hospital stay: Overnight hospital stay required — typically 1–3 nights (often shorter for a partial replacement).
Recovery & rehabilitation milestones
- Day 0–1: standing and walking with the physiotherapist on the day of, or day after, surgery.
- Week 1–2: walking with crutches or a frame, daily exercises for bending and straightening; wound review around day 14.
- Week 6: most people walk without aids; driving usually possible at 6 weeks; blood-thinning medication is taken for 6 weeks after surgery.
- Month 3: comfortable with daily activities, golf, swimming and cycling.
- Month 6–12: continued improvement in strength and swelling; final result at about one year.
Possible complications
- Infection of the joint replacement (about 1%) — this is the most serious complication and can require further surgery and prolonged antibiotics. Risk is reduced by losing weight before surgery, good diabetes and blood sugar control, stopping smoking, treating any skin, dental or urinary infection beforehand, and washing with chlorhexidine skin preparation before knee surgery as directed.
- Blood clots — deep vein thrombosis and pulmonary embolism. Blood-thinning medication is prescribed for 6 weeks after knee replacement, along with early walking and compression stockings.
- Persistent pain — around 1 in 5 patients still notice some discomfort or a sense the knee is not entirely their own.
- Stiffness and reduced bending, occasionally needing a manipulation under anaesthetic.
- Damage to nerves or blood vessels around the knee (rare).
- Loosening, wear or failure of the implant over time, and progression of arthritis in the remaining compartments after a partial replacement, requiring revision surgery.
- Fracture around the implant, and differences in leg length or alignment.
High Tibial Osteotomy
A realignment operation for younger, active patients with arthritis limited to one side of the knee. The shin bone is cut in a controlled way and the alignment adjusted, transferring body weight away from the worn compartment onto the healthy side. The correction is held with a plate and screws, delaying or avoiding knee replacement.
Hospital stay: Overnight stay required — usually 1–2 nights.
Recovery & rehabilitation milestones
- Week 0–6: partial weight bearing on crutches while the bone heals; exercises to maintain movement and quadriceps strength.
- Week 6–12: progression to full weight bearing once X-rays confirm healing.
- Month 3–6: strengthening, cycling and swimming; return to manual work around 3–6 months.
- Month 6–12: return to higher-impact activity once the osteotomy is fully united.
Possible complications
- Delayed healing or non-union of the bone cut, sometimes requiring further surgery or bone graft.
- Infection.
- Blood clots (DVT/PE) — thromboprophylaxis is used.
- Persistent pain or progression of arthritis, eventually needing knee replacement.
- Stiffness.
- Injury to nerves or blood vessels behind the knee (uncommon but recognised).
- Irritation from the plate and screws, sometimes requiring removal.
- Over- or under-correction of alignment.
