What To Expect After Arthroscopic Knee Surgery

Arthroscopic knee surgery is a procedure used to diagnose and treat joint problems related to meniscus tears, ligament injuries, and cartilage damage. While it is less invasive than other surgical interventions, it still comes with potential risks and complications, including infections and prolonged recovery periods. 

Arthroscopic knee surgery is sometimes prescribed when less invasive options may be available. For example, one study conducted on a sample of 142,275 patients found that a significant portion of patients with knee osteoarthritis received this surgery against clinical guidelines. 

Another research paper analyzed a sample of knee arthroscopies conducted in 2016. It found that 35% of them were performed without a clear medical reason. Additionally, a 2016 study shows that there is minimal difference in outcomes between surgical and conservative treatment approaches like exercise therapy. 

These findings emphasize the value of seeking a second opinion on treatment options to avoid unnecessary risks and complications often associated with surgery. 

Your Recovery Timeline After Knee Arthroscopy

Physicians may use knee arthroscopy to diagnose and treat knee joint issues. These include injuries like ligament tears and degenerative diseases like osteoarthritis. During the procedure, a small camera, called an arthroscope, is inserted into the knee through a tiny incision. 

This camera lets the surgeon view te inside of the knee joint on a screen. The surgeon can then use small tools inserted through other small incisions to fix problems like torn cartilage or ligaments. 

Recovery from knee arthroscopy varies based on the specific procedure performed and individual patient factors. For example, recovery from arthroscopy used to diagnose knee conditions can take one to eight weeks. However, if the surgeon used this surgery to remove and repair damaged tissue, recovery can take longer, up to several months. 

Generally, recovery occurs in stages, with certain milestones along the way. Below is an overview. 

Immediate Postoperative Period

Arthroscopic knee surgery generally lasts 30-45 minutes. Patients are usually given an anesthetic, which can be general, local, or spinal, where drugs are used to numb the body from the waist down. 

Generally, it takes a few hours for the effects of the anesthetic to wear off and for the patient to feel well enough to go home. At this time, the patient may experience pain, swelling, stiffness, and bruising around the knee. A physician may recommend to:

• Elevate and ice the joint to reduce pain and swelling
• Wear a compression stocking to reduce swelling
• Use painkillers to alleviate symptoms
• Use crutches if needed
• Avoid driving and operating machinery

Each of the approaches above may carry risks and downsides. Because of this it is important to follow the exact instructions provided by the physician. For example, prolonged icing can reduce blood flow to the injured area. This can slow down healing and recovery. 

Similarly, taking painkillers in the long term can have side effects like increased risk of heart attack, stroke, stomach ulcers, and kidney disease. Using crutches or compression socks incorrectly can lead to circulatory problems and muscle imbalances. 

Days 2-5 After The Procedure

In the first few days after the procedure, symptoms like pain, swelling, and stiffness are still noticeable. Icing and pain medications may be used to alleviate discomfort. The priority during this time is to protect the knee and avoid any load-bearing activity that could strain the healing joint.

Days 5-7 After The Procedure

Swelling and pain typically begin to subside, but they can persist for several more weeks. If recommended by a physician, patients may use guided physical therapy exercises to begin to move the knee as they are able. Patients may start walking short distances with minimal assistance.

Weeks 2-8 And Beyond

Pain typically subsides within two to three weeks, but it can last longer than six weeks. However, according to a 2015 study, about one-third of patients report experiencing post-surgical pain 1 year after surgery. 

Patients may also have symptoms, like tenderness, swelling, and stiffness, for around four weeks. During this period, patients typically regain some strength and mobility. Rehabilitation continues with a focus on gradually increasing activity levels. 

Most patients resume normal activities by eight weeks, though full recovery can take longer. Strength, motion, and coordination continue to improve for three to four months after the operation. 

Clinical guidelines suggest that patients in sedentary jobs can return to work one or two weeks after surgery – if they feel safe to do so. Those in more demanding roles should wait at least two weeks. In any case, the surgeon will need to give clearance for activities like working, driving, or exercising.

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What Can You Do To Encourage Healing After Knee Arthroscopy?

Following post-operative instructions after arthroscopic knee surgery is crucial for supporting recovery and minimizing complications. Guidelines may include activity restrictions, medication protocols, and physical therapy regimens. They help preserve the integrity of the surgical repair and support the healing process. Neglecting these instructions can lead to re-injury or prolonged recovery times.

Some strategies to support healing after surgery include:

Immobilization

In the first 24 hours after surgery, immobilization reduces stress on the operated joint. Patients may use crutches, but should not put weight on the leg.

After this 24-hour period, patients need to follow the instructions provided by their surgeon. Regimens include:

• Non-weight-bearing. Patients should completely avoid putting any weight on the operated leg. This regimen is recommended in ACL reconstruction or meniscus repair surgery. 
• Partial or toe-touch weight bearing. Patients are allowed to touch their toes to the ground for balance. They should not put any significant weight through the operated leg. This regimen is prescribed to protect the knee while allowing some degree of movement and balance.
• Weight bearing as tolerated (WBAT). There is no limitation on how much weight can be put on the operated leg while walking or standing. However, the amount of weight should be tolerated comfortably. Patients should also avoid strenuous activities. 

Not all arthroscopic procedures require long-term immobilization. Surgeons often allow for weight bearing as tolerated to prevent the leg muscles from weakening.

However, physicians may also recommend other instructions to protect the knee from injury. These include:

• Using crutches, a cane, or a walker
• Wearing braces
• Increasing loads on the leg progressively, as tolerated
• Avoid heavy lifting or intense exercise
• Avoid walking long distances or standing for prolonged periods 
• Begin physical therapy and rehabilitation

Return to daily activities, work, or sports should begin after obtaining clearance from the surgeon. 

Pain Management

Pain management can help alleviate symptoms after arthroscopic surgery. Common options include:

• At-home remedies. Self-care options like the RICE method help reduce swelling and pain through rest, icing, compression, and elevation. As noted above, this method may slow down healing by interfering with blood flow to the injured area. 
• NSAIDs. Non-steroidal anti-inflammatory drugs help manage pain by alleviating inflammation. They work by blocking the production of inflammatory agents, like prostaglandins. Although these are available over the counter, they should be taken as instructed. Prolonged use can lead to side effects such as an increased risk of heart attack, stroke, stomach ulcers, and kidney disease. 
• Prescription medications. Prescription drugs like opioids may be used to alleviate severe pain. It’s vital for patients to follow the instructions and dosage prescribed, as opioids carry risks like addiction and overdose. One study found that opioids are commonly overprescribed after arthroscopic surgery. 

Wound Care And Hygiene

Incision care and proper hygiene are essential steps to prevent infection and support healing. Key recommendations include:

• Keep the incision site covered, clean, and dry for five days after the operation.
• Gently clean the incision without soaking the wound.
• Change the bandages as directed by your healthcare provider. Typically, once a day or when they become wet or dirty.
• Avoid taking baths or swimming until the incision has fully healed.
• Use a plastic bag or wrap to protect the knee when showering. 
• Avoid applying lotions or ointments to the incision site.
• Monitor the wound for signs of infection, such as discharge.

Don’t remove stitches if they have been left in place. The surgeon will remove them once the wound has healed. 

Proper Diet And Nutrition

Patients should follow the diet recommended by their physician. However, generally, key lifestyle guidelines include:

• Opting for whole-grain, unprocessed foods
• Avoiding saturated fats and processed sugars
• Staying hydrated
• Ensuring adequate protein intake to support muscle strength and prevent atrophy.

Maintaining a balanced diet rich in nutrients supports tissue repair and energy production. Additionally, a diet rich in nutrients and low in calories can help maintain a healthy weight. A 2023 study suggests the importance of managing weight to reduce the risk of complications after knee surgery. Other lifestyle modifications that may support recovery include sleeping 7-9 hours each night, learning to manage stress, and making movement and exercise a daily habit.

Physical Therapy

Physical therapy is critical for regaining full knee function. The goal is to restore the range of motion, strengthen the muscles around the knee, and reduce swelling and pain. 

Therapy usually starts a few days to a week after surgery. It begins with gentle movements and progresses to more rigorous exercises. These exercises are guided by a specialist to help ensure that healing tissues regain strength and flexibility. They promote a quicker return to regular activities and reduce the risk of injury. 

Follow-Up Appointments

Regular follow-up appointments are essential to monitor healing after arthroscopic knee surgery. Visits help track progress and address concerns or unusual symptoms. Typically, the schedule involves visits two weeks after surgery, and periodically over the next few months. Key visits include:

Physical Exams

During these visits, doctors perform physical exams to assess mobility and strength. They check the knee for signs of swelling, flexibility, and pain. These exams are crucial to ensure the knee is healing as expected. Physical exams also guide adjustments to the recovery plan, if needed.

Removal Of Stitches Or Staples

Stitches or staples used to close surgical incisions are usually removed during the first or second follow-up visit. The process is quick and performed under sterile conditions to prevent infection. 

Possible Imaging Test

In some cases, follow-up appointments may include imaging tests like X-rays or MRIs. These tests help get a detailed look at the knee’s internal healing. They help ensure that there are no underlying issues, such as improper healing or new injuries. 

Long-Term Recovery

Patience and consistency with rehabilitation exercises are key to long-term recovery. Patients should wait until cleared by their physician to return to regular activities and sports. This often includes a series of phases and milestone achievements.

Common recovery miletones include:

• Return to non-demanding daily activities – three to five days after surgery
• Walking with crutches – one to two weeks after surgery
• Walking without crutches – two to four weeks after surgery 
• Return to sedentary job roles – one to two weeks after surgery 
• Return to more demanding job roles – one to two weeks after surgery or longer
• Return to sport – two to three months after surgery 

Long-term recovery timelines are unique to each patient. Influencing factors include general health, age, and type of operation. A 2013 study analyzed 61 patients who underwent knee arthroscopy for meniscus injuries. On average, those younger than 30 returned to sports within 54 days, while patients aged 30 and over took 89 days. 

Potential Risks And Post-Surgical Complications 

Arthroscopic knee surgery is generally less invasive than knee replacement procedures. However, it still comes with potential risks and complications. It is crucial for patients to be aware of the signs that may require immediate medical attention. 

These include infection, severe pain, blood clots, chest pains, or delayed healing. Recognizing these symptoms early can prevent further complications.

Common risks of surgery include:

• Arthritis. Arthritis can sometimes develop after surgery if the joint is damaged during the procedure. Changes in knee mechanics due to surgery can also alter how weight is distributed in the joint. This can place certain parts of the knee under undue pressure, causing cartilage wear. 
• Failed healing. Inadequate healing may occur if the surgical site doesn’t properly recover. It can potentially be due to infection, poor blood supply, or overuse of the knee post-surgery. This results in incomplete recovery and persistent symptoms.
• Recurrence and worsening of symptoms. Even after successful surgery, some patients may experience a return or worsening of symptoms. Risk factors include improper rehabilitation, strain on the knee, or incomplete repair during surgery. 
• Failed surgery. This refers to the surgery not achieving its intended outcomes. It can be either due to technical issues during the procedure or misdiagnosis. Consequences include continued pain and dysfunction.
• Knee ACL surgery failure. Knee arthroscopy can be used to repair torn anterior cruciate ligaments (ACL). Failure occurs when the graft is not properly placed or is rejected by the body. ACL repair can also fail due to inadequate post-surgery care. These issues necessitate additional surgeries.
• Reinjuries. Previous surgical interventions can alter or weaken the joint structure. This makes the knee more prone to future injuries requiring revision surgery.
• Cartilage damage. Surgical procedures can inadvertently damage cartilage. It can happen due to excessive manipulation or poor technique during the operation. Damaged cartilage can accelerate joint degeneration and arthritis. 

Importance of Getting A Second Opinion On Treatment Option

Seeking a second opinion before surgery is vital for making an informed decision about treatment. It allows patients to consider alternative, less invasive options more suited to their condition. 

Additionally, clinical practice guidelines published in 2018 strongly recommend against prescribing arthroscopy to the majority of patients with degenerative knee conditions, like osteoarthritis. This is because this surgery may only provide low value care and even be harmful for some patients. 

A comprehensive study published in 2017 compared the outcomes of knee arthroscopy and conservative management. It found that arthroscopy may only provide very small benefits in pain and function in the short term compared to conservative therapy, and none in the long term. 

It concluded that “patients and their healthcare providers must trade-off the marginal short-term benefits against the burden of the surgical procedure.”

Proactively seeking other opinions reduces the risk of unnecessary surgical procedures. It also helps patients consider treatments that better match personal health goals and concerns.

Is There An Alternative To Arthroscopic Knee Surgery?

The outcomes of knee surgery don’t always meet the expectations that patients have. One study found that 37.5% of patients experienced acute pain and 32.7% suffered from chronic pain one year after surgery. Additionally, 50% experienced poor surgical recovery. 

Furthermore, physical therapy may lead to the same outcomes as surgery in the treatment of knee conditions like meniscus tears, but without the risks associated with invasive procedures. 

Additionally, knee surgery is sometimes unnecessary, because certain tissues have the proven ability to heal naturally. This is the case for some types of meniscus tears and ligament injuries, which don’t have to be treated surgically. 

The Regenexx approach uses interventional orthobiologics to support this natural healing process. This proprietary method provides patients with an alternative to surgery. Customized treatment plans may include one or more of the orthobiologics below.

Regenexx-SD Injectate

Procedures using Regenexx-SD injectate include a patented protocol that utilizes Bone Marrow Concentrate (BMC) which contains the patient’s own mesenchymal stem cells. The cell processing for a Regenexx-SD injectate routinely achieves 20x concentration— above what non-Regenexx cell processing can achieve.

H3: Regenexx-SCP Injectate

Procedures using Regenexx-SCP injectate represent a supercharged version of platelet-rich plasma (PRP). In this process, blood is drawn, then processed to isolate the platelets and growth factors. The growth factors are then purified, concentrated, and injected into the knee area using imaging guidance for precision. Regenexx-SCP injectate provides a higher concentration of growth factors compared to typical PRP procedures.

Regenexx-PL Injectate

Procedures using Regenexx-PL injectate are a highly specialized derivative of platelet-rich plasma (PRP) with a faster and more concentrated release of growth factors compared to typical PRP.  The PL injectate is often combined with other orthobiologics such as PRP and bone marrow concentrate.

Explore Your Knee Treatment Options Beyond Surgery 

Surgery may not be the only option to improve knee health and function. Discover if a less invasive option is right for you by getting in touch with a physician in the licensed Regenexx network.

Find a board-certified physician in the licensed Regenexx network that may be able to help treat your knee condition without surgery on this page.

Originally published on Jan 3, 2025