What Is Arthroscopy? A Complete Guide to Keyhole Orthopedic Surgery

When a doctor says "we can look inside your knee with a camera" or "it's a keyhole surgery," they're describing arthroscopy — one of the most commonly performed orthopedic procedures in India.

Most patients who are told they need arthroscopy have a reasonable amount of anxiety about it and very little actual information. What goes in? What does the surgeon see? What can be done through such small openings? Is it really as minor as it sounds?

This guide answers all of those questions.

What Arthroscopy Actually Is

Arthroscopy (from the Greek: arthron = joint, skopein = to look) is a procedure in which a surgeon inserts a thin telescope-like instrument — the arthroscope — through a small incision (called a portal) into a joint. The arthroscope contains a camera and a fibre-optic light source. The image is projected onto a screen in the operating room, giving the surgeon a clear, magnified, real-time view of the inside of the joint.

Through one or two additional small portals, the surgeon can insert precision instruments — scissors, shavers, burrs, probes, suturing devices — and perform a wide range of diagnostic and therapeutic procedures without opening the joint at all.

The entire procedure is performed through incisions of 5–10 mm. No large incision. No major muscle cutting. No wide exposure of the joint.

Arthroscopy is not a single operation — it's a surgical approach that can be used for dozens of different procedures across multiple joints: knee, shoulder, hip, ankle, elbow, and wrist.

Why Arthroscopy Instead of Open Surgery?

Open surgery — where a large incision is made and the joint is fully exposed — was the only option for joint surgery until arthroscopy developed in the 1960s and became widespread from the 1980s onward.

The advantages of arthroscopy over open surgery for the same procedure are significant:

Less tissue damage: The joint capsule, surrounding muscles, and tendons are largely undisturbed. Only the specific area being treated is accessed.

Less post-operative pain: Smaller incisions mean far less pain from the surgical approach itself — the patient's discomfort comes from the joint work, not from a 15-cm wound.

Faster recovery: Most arthroscopic procedures allow weight-bearing on the day of surgery or the next day. Return to daily activity is typically within days to weeks rather than months.

Lower infection risk: The small portal sites heal faster and have lower surface area for contamination.

Day-care surgery: Many arthroscopic procedures are done without an overnight hospital stay.

Diagnostic accuracy: The magnified, direct view inside the joint is often far more accurate than any pre-operative imaging.

Knee Arthroscopy: The Most Common Application

The knee is the most frequently arthroscoped joint in orthopedic practice. Conditions treated include:

1. Meniscal Tears

The menisci are two C-shaped cartilage pads between the femur and tibia that act as shock absorbers and stabilisers. When they tear — from a twisting injury in sport, or in older patients from degenerative wear — arthroscopy allows the surgeon to:

• Repair the tear: Placing sutures to hold the torn edges together, preserving the meniscus. This is preferred when the tear is in the vascular (blood-supplied) zone and the patient is young, because a repaired meniscus functions better long-term.
• Partial meniscectomy: Removing only the torn, unstable fragment while preserving as much healthy meniscus as possible. Done when the tear is in the avascular zone where repair is unlikely to heal.

The camera shows exactly where the tear is, how large it is, whether it is stable or unstable, and whether repair is feasible.

2. ACL Reconstruction

All ACL surgeries are done arthroscopically. The camera allows the surgeon to confirm the tear, harvest the graft through a separate incision, drill tunnels at precise anatomic positions, and thread and fix the graft — entirely through portals. The result is indistinguishable from open ACL surgery in outcome, with significantly less approach trauma.

3. Cartilage Procedures

Damaged cartilage (chondral lesions) can be addressed arthroscopically:

• Microfracture: Tiny perforations made in the bone beneath the damaged cartilage to stimulate a repair response
• Debridement: Removing loose, flapped, or unstable cartilage that is causing pain or locking
• OATS (Osteochondral Autograft Transfer): Transplanting small cartilage plugs from a non-load-bearing area to the damaged area

4. Loose Body Removal

Fragments of bone or cartilage that have broken off and are floating freely in the joint cause pain and mechanical locking. Arthroscopic retrieval of these loose bodies provides immediate relief.

5. Synovectomy

Removal of inflamed synovial tissue in conditions like rheumatoid arthritis or pigmented villonodular synovitis (PVNS) — done arthroscopically with a shaver device.

Shoulder Arthroscopy

The shoulder is the second most frequently arthroscoped joint. Applications include:

Rotator cuff repair: When the tendons of the rotator cuff tear (usually supraspinatus, sometimes infraspinatus), arthroscopic repair re-attaches the tendon to the bone using suture anchors — tiny devices implanted into the bone that hold the sutures that reattach the tendon.

Bankart repair (shoulder stabilisation): After repeated shoulder dislocations, the labrum (cartilage ring around the shoulder socket) tears from the socket edge. Arthroscopic repair re-anchors the labrum.

Acromioplasty: Removal of a bony spur on the underside of the acromion (shoulder roof) that impinges on the rotator cuff tendons.

Biceps tenodesis: Dealing with a torn or inflamed biceps tendon where it enters the shoulder.

Frozen shoulder release: In severe frozen shoulder unresponsive to physiotherapy and injections, arthroscopic capsular release can restore movement dramatically.

Hip Arthroscopy

Less common than knee or shoulder, but available at specialist centres. Used for:

• FAI (Femoroacetabular Impingement): reshaping the hip ball or socket rim to reduce abnormal contact
• Labral tears: repairing or reconstructing the hip labrum
• Loose body removal

Hip arthroscopy requires specialised traction equipment to distract the hip joint enough to introduce instruments safely.

The Procedure: What to Expect

1. Anesthesia

Most arthroscopic procedures are performed under spinal or general anesthesia. For short diagnostic procedures or ankle arthroscopy, local anesthesia with sedation may be used.

2. Positioning

For knee arthroscopy, you lie on your back. A leg holder positions the knee at a comfortable angle. For shoulder arthroscopy, positioning depends on approach (beach chair or lateral decubitus).

3. Portal Placement

Two or three small stab incisions (portals) are made at specific positions around the joint. Their location is planned to access the areas of concern while avoiding nerves and blood vessels.

4. Distension

Sterile saline is pumped into the joint to distend it and provide a clear fluid medium for the camera. The joint becomes temporarily full and taut — this is what creates the workspace for instruments.

5. The Procedure

The arthroscope enters through the primary portal. The surgeon systematically inspects all compartments of the joint, comparing what is found with the pre-operative MRI. Working portals are added as needed. All therapeutic work is done through the portals.

Most knee arthroscopic procedures take 30–90 minutes depending on complexity.

6. Wound Closure

Portals are closed with 1–2 sutures or steri-strips. A compression bandage is applied. Most patients walk out the same day.

Recovery

Arthroscopy is not a trivial procedure despite its small incisions — the joint has been instrumented, and it reacts. Swelling, stiffness, and some pain are normal in the first 1–2 weeks.

Diagnostic arthroscopy alone: Return to normal activity within 1–2 weeks.

Meniscal repair: Protected weight-bearing for 4–6 weeks; return to sport 4–6 months.

Partial meniscectomy: Walking within 1–3 days; return to sport 4–6 weeks.

Rotator cuff repair: Sling for 4–6 weeks; physiotherapy for 4–6 months; full return to work 3–6 months depending on job demands.

ACL reconstruction: Return to cutting sport at 8–12 months.

Arthroscopy at Prakash Hospital, Noida

Dr. Mayank Chauhan performs arthroscopic procedures at Prakash Hospital, Sector 33, Noida, for both the knee and shoulder. He evaluates each patient's MRI and clinical findings to determine whether arthroscopy is indicated and, if so, what the procedure involves.

Patients from Noida, Greater Noida, Ghaziabad, and the broader Delhi NCR attend for arthroscopic evaluation and surgery.\

To book a consultation, call the number listed on the website.