Arthroscopy 

Arthroscopy is a minimally invasive surgical procedure to diagnose or treat problems in a joint. During the procedure, an arthroscope (a narrow endoscopic camera) is inserted into the joint via a small incision, allowing the doctor to visualise inside of the joint. An additional small incision is made for the surgical instruments to access the joint.    Arthroscopy can be carried out on any joint, but is mostly used for the knee, shoulder, elbow, wrist, ankle, foot, and hip. Common arthroscopic procedures include reconstruction of the anterior cruciate ligament, repair of meniscus tears and rotator cuff tears, and debridement (i.e. clearing debris) of the joint.

To provide a better view of the joint during arthroscopy, the joint is filled with a sterile saline irrigation solution. This solution displaces the synovial fluid — and its major component, hyaluronic acid — that normally fills the joint. A crucial component of the synovial fluid and cartilage, hyaluronic acid lubricates the joint and acts as a shock absorber. Without the synovial fluid filling the joint, the protective hyaluronan coating on the cartilage and synovial membrane is diluted. Additionally, there is a loss of the masking effect that hyaluronic acid usually has on pain receptors.¹    Following the operation, patients commonly experience pain, swelling and impaired joint mobility due to the lack of synovial fluid.² Injecting hyaluronic acid into the joint can improve post-operative recovery, reducing the likelihood and severity of these post-operative complications.  Injection of hyaluronic acid following arthroscopy has been proven to:

• Reduce post-operative pain and swelling^3–8
• Improve joint function and mobility4,9  Reduce post-operative painkiller consumption^4,7,8
• Reduce time to discharge from hospital^7,8
• Accelerate the return to work or sport after surgery^3,10

Due to the small incisions required for arthroscopy, the recovery time is significantly shorter than for open surgery. Depending on the joint, whether any joint repair was performed, and the patient’s state of health, recovery can vary from 1 week to several months. Patients undergoing knee arthroscopy can usually expect to return to normal activities after 4–6 weeks, and for rotator cuff arthroscopy this may take 6–8 weeks. Return to sporting activities may take 3–6 months. 

Pain in the joint following an arthroscopy is normal, and patients are prescribed painkillers to manage this. Patients are also advised to apply ice to reduce the swelling and pain in the first day following surgery.    Oral nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen are often prescribed for post-arthroscopy pain management. Most patients have no problems with taking oral NSAIDs over a short period, but some people may suffer from side-effects if they already have cardiovascular or gut conditions. Due to the risk of side-effects, oral NSAIDs are not recommended for long-term use.¹¹    Opioids (sometimes called narcotics) may be prescribed for managing more severe pain, but for most patients this level of pain relief is not necessary.¹² Side effects of opioids include sleepiness, constipation, and nausea, and they come with a risk of addiction, so they are not recommended as first option.¹³    Corticosteroid and anaesthetic injections into the joint have previously been used for pain management following arthroscopy but are no longer recommended due to the damaging effect they can have on the cartilage.^14–17    Injection of hyaluronic acid into the joint cavity at the end of the arthroscopy procedure is an effective approach to reduce post-operative pain and painkiller use following arthroscopy.^4,7,8  

Hyaluronic acid is a molecule that is naturally produced by the human body, and is present in the skin, the joints and the tendons. The injection of hyaluronic acid following arthroscopy is well tolerated and safe, and no adverse events have been reported. Hyaluronic acid can safely be used in patients with comorbidities.