Keyhole arthroscopy or open surgery: why do some knee operations need a bigger cut?

The short verdict

The size of the cut follows the job, not the other way around. Arthroscopy uses a small camera and instruments through a few cuts of around a centimetre, which is ideal for work inside the joint. When a surgeon needs to cut bone, insert plates or implants, or reach structures outside the joint, a larger incision is safer and more accurate. Many operations combine both, for example an arthroscopy followed by a small open step.

How they compare

• Incision: arthroscopy uses small portals; open surgery uses one longer incision
• Typical operations: arthroscopy for meniscus repair or trimming, ACL and PCL reconstruction, loose body removal and cartilage procedures; open surgery for knee replacement, high tibial osteotomy, tibial tubercle osteotomy, many fractures and some tendon repairs
• Early pain and stay: arthroscopy is often a day case; open surgery more often means one or more nights in hospital
• Recovery: arthroscopic recovery may still take months if a structure was repaired; open surgery recovery depends on the bone healing or implant
• Risks: both carry small risks of infection, blood clots and stiffness; open surgery has a larger wound to heal
• Scar: arthroscopy leaves a few small marks; open surgery leaves a longer scar that usually fades over time

Who each approach tends to suit

Arthroscopy tends to suit younger and active people with sports injuries, torn meniscus or ligaments, and mechanical symptoms such as locking. Open surgery tends to suit advanced arthritis needing replacement, bow legs or knock knees needing realignment, displaced fractures, ruptured tendons and kneecap alignment surgery. It is also important to know that arthroscopy is not a treatment for arthritis on its own.

When to see a knee surgeon in Doha

If you have been advised to have knee surgery and want to understand why a particular approach was chosen, ask. Dr. Gelber at Aman Hospital will examine your knee, review your scans, and explain what needs to be done inside or around the joint, which approach fits that task, and what recovery and time off work to expect.