When Is Arthroscopic Knee Surgery Necessary?

Knee pain is one of the most common complaints orthopedic surgeons face.
It’s often manageable with conservative care—but sometimes, surgery is required.

Here’s the challenge:
Surgical intervention should be precise, necessary, and justified by clear diagnostic findings. That’s where arthroscopic knee surgery comes in—and where you, as the surgeon, must decide if it’s the right tool for the job.

First, What Is Arthroscopic Knee Surgery?

Arthroscopy is a minimally invasive surgical technique that allows you to look inside a joint using a small camera (arthroscope). Through tiny incisions, you can visualize, diagnose, and treat a range of intra-articular pathologies.

The main advantage?
Less tissue trauma, faster recovery, and fewer complications compared to open procedures.

But just because a technique is “minimally invasive,” it doesn’t always mean it’s the best—or necessary—option.

Understanding the Context: Why Patients—and Surgeons—Must Be Selective

You’ve probably seen it yourself:
Patients come in expecting surgery, hoping it will “clean up” their knee pain. But the truth is, arthroscopy is not effective for degenerative joint disease alone, especially when no mechanical symptoms are present.

So, how do you know when it’s appropriate?

Let’s break it down clinically.

Based on current clinical guidelines and peer-reviewed evidence, arthroscopy is most appropriate when the following apply:

Mechanical Symptoms Are Present

If a patient reports:

• Locking
  
  
• Catching
  
  
• Giving way
  
  
• Clicking with movement
  
  

It often indicates a structural abnormality like a:

• Meniscus tear
  
  
• Loose body
  
  
• Cartilage flap
  
  
• Synovial plica impingement
  
  

In these cases, the procedure not only diagnoses but also corrects the issue in one session.

The most common indications are meniscectomy, anterior cruciate ligament reconstruction with meniscal sutures, and removal of loose bodies.

Non-Surgical Management Has Failed

You’ve tried:

• Physical therapy
  
  
• Anti-inflammatory medication
  
  
• Activity modification
  
  
• Corticosteroid or hyaluronic acid injections
  
  

But the patient still reports persistent pain and loss of function. If conservative treatment has failed over several months, and imaging supports it, arthroscopy becomes a viable next step.

You Need Direct Visualization for Diagnosis

Sometimes, imaging isn’t enough.
MRI can miss certain cartilage lesions or under-represent synovial pathology. Arthroscopy provides real-time, direct insight into the joint.

This diagnostic role is especially important when symptoms don’t align with imaging findings.

Planning Comes First: How PeekMed Improves Arthroscopic Surgery

• When meniscus injuries are degenerative, for example, and we need to understand the mechanical axis of the limb and determine whether the patient is a candidate for osteotomy, PeekMed has an automatic planning solution.

• When there are repeated ACL tears (two or more), they may be associated with an increased slope. PeekMed has an automatic planning solution.
• When there are multiple tunnels in ACL revision surgeries, PeekMed can help determine the best positioning of the new tunnels to avoid conflict and decide if it is better to perform the surgery in two stages.
  
  

Is Arthroscopic Knee Surgery Necessary?

Here’s your checklist:

When paired with robotic precision and digital planning, arthroscopic surgery becomes more than just less invasive—it becomes smart, strategic, and highly effective.

References

American Academy of Orthopaedic Surgeons. (n.d.). Knee arthroscopy. OrthoInfo. Retrieved May 13, 2025, from https://orthoinfo.aaos.org/en/treatment/knee-arthroscopy/

Mount Sinai Health System. (n.d.). Knee arthroscopy. Mount Sinai Health Library. Retrieved May 13, 2025, from https://www.mountsinai.org/health-library/surgery/knee-arthroscopy

Bupa UK. (2021, December). Knee arthroscopy. Bupa Health Information. Retrieved May 13, 2025, from https://www.bupa.co.uk/health-information/knee-pain/knee-arthroscopy

Harvard Health Publishing. (2020, April 20). Knee arthroscopy: Should this common knee surgery be performed less often? Harvard Medical School. Retrieved May 13, 2025, from https://www.health.harvard.edu/blog/knee-arthroscopy-should-this-common-knee-surgery-be-perf