Keyhole (Arthroscopic) Surgery in Singapore

What is Keyhole (Arthroscopic) Surgery and When is it Recommended?

Keyhole, or arthroscopic surgery, allows orthopaedic surgeons to see inside a joint using a tiny camera (arthroscope) connected to a high-definition monitor. Through 2-3 small incisions, your surgeon can diagnose and treat soft-tissue or cartilage injuries without large open cuts.

It usually recommended when symptoms / pain persists that may prompt surgical consideration or when conservative options fail. In regard to body joints, a Keyhole surgery is routinely performed on:

• Knees (meniscus, ACL, cartilage repair)

• Shoulders (labral tears, instability, rotator cuff repair)

• Elbows (loose bodies, stiffness, cartilage lesions)

Keyhole surgery is preferred over open surgery for various beneficial reasons.

✅ It is minimally invasive - Small cuts (~5–10 mm) are made to insert the arthroscope thus preserving muscle and tissue.

✅ Less pain and swelling - The surrounding area has reduced inflammation as compared to open surgery.

✅ Faster recovery - It is often done as a day surgery thus reducing length of stay at the hospital and resumption of quicker rehabilitation.

✅ Precise diagnosis - High-resolution arthroscopic camera visualises cartilage, ligaments, and tendons.

✅ Lower infection risk - As the incision is very small, there is only a small wound with minimal scarring thus reducing risk of infection.

Common Conditions Treated with Arthroscopic (Keyhole) Surgery

Knee Conditions

• Meniscus tear (C-shaped cartilage acting as shock absorber): The meniscus cushions your knee joint and distributes weight evenly. Tears from twisting or sports injuries can cause pain, swelling or locking. Arthroscopy trims or repairs the torn segment through tiny incisions to restore smooth movement and prevent early arthritis. It may take 3-6 weeks to return to normal walking.

• Anterior/Posterior Cruciate Ligament (ACL/PCL) tears: These central knee ligaments stabilise forward and backward motion. A torn ACL or PCL causes instability, giving-way episodes, and reduced sports performance. Arthroscopic ligament reconstruction using grafts rebuilds stability and protects the joint from further damage. It may take 6-9 months to return to sports.

• Chondral injury or cartilage flap: Cartilage damage on the femur or tibia surface leads to painful “catching” or grinding. Arthroscopy smoothens or reattaches cartilage and sometimes uses microfracture techniques to stimulate healing.

• Early knee osteoarthritis: In mild arthritis with localised cartilage damage, arthroscopy removes loose tissue (debridement) or creates small holes (microfracture) to stimulate new cartilage growth, easing symptoms and improving motion. May take about 2-4 weeks to reduce pain.

• Loose bodies or synovitis: Small bone or cartilage fragments can float inside the joint, causing sudden locking or swelling. Arthroscopy allows precise removal and treatment of inflamed joint lining (synovectomy). Typical recovery may take 2-4 weeks.

• Baker’s cyst: A Baker’s cyst forms when fluid builds up behind the knee due to underlying joint irritation. Arthroscopy addresses the root cause (e.g., meniscus tear or inflammation) to reduce recurrence. Recovery period may be 4-6 weeks depending on the cause of the cyst.

Arthroscopic view of Dr Bryan’s meniscus root repair

• Labral tears (SLAP, Bankart, reverse Bankart): The labrum deepens the shoulder socket. Tears from trauma or repetitive overhead use cause pain, clicking, and instability. Arthroscopic repair reattaches the torn rim and stabilises the joint. It may take about 4-6 months to return to premorbid level.

• Shoulder instability / dislocations: Recurrent shoulder dislocations stretch or tear stabilising structures like the capsule and labrum. Arthroscopic stabilisation using keyhole surgery (e.g., Bankart repair, remplissage) restores the capsule-labrum complex for long-term stability. It may take about 4-6 months to return to premorbid level.

• Rotator cuff tear or impingement: The rotator cuff tendons control shoulder strength and motion. These tendons can tear or fray due to overuse or ageing and thus cause night pain and weakness. Arthroscopy removes inflamed tissue or reattaches torn tendons to restore strength and pain-free movement. The recovery period may be 3-6 months.

• Frozen shoulder (Adhesive Capsulitis): Scarred capsule tissue limits shoulder movement and causes frozen shoulder. Keyhole arthroscopic surgery gently cuts tight bands, improving range of motion and relieving stiffness. Recovery period is about 4-8 weeks

• Calcific tendonitis: Calcium deposits form within the rotator cuff, causing sharp pain with arm elevation. Arthroscopic removal of the deposits provides rapid relief and restores mobility. Recovery period may be about 3-6 weeks.

• Loose bodies or bone spurs: After an injury or arthritis, small bone or cartilage fragments can lodge inside the elbow joint, restricting motion. Keyhole surgery removes them through small portals to restore smooth motion. Recovery timeline is about 3-6 weeks.

• Tennis/ golfer’s elbow: Chronic tendon degeneration from repetitive strain may need surgical cleaning (debridement) via keyhole approach when non-surgical care fails. Recovery may take 4-8 weeks.

• Post-traumatic stiffness or locking: After elbow fractures or dislocations, scar tissue and bone overgrowth limit elbow extension. Arthroscopic release improves range and function with minimal trauma to surrounding tissues. It may take 6-12 weeks to restore normal function.

*Timelines of the above injuries may vary by injury severity and rehabilitation progress.

Who is Suitable for Keyhole surgery?

Keyhole surgery is suitable for individuals whose joint pain or mobility issues do not improve with conservative treatment such as physiotherapy, medication, or activity modification.

You may be a good candidate for arthroscopy if:

• You have persistent pain or swelling in the knee, shoulder, or elbow.

• Imaging (e.g. MRI or X-ray) shows cartilage, ligament, or soft-tissue damage.

• You experience mechanical symptoms — locking, catching, or instability at the knee, shoulder or elbow joint.

• You wish to return to sports or active lifestyle as soon as you can.

• Your joint condition is not severe enough to require open or joint-replacement surgery.

You may NOT be a good candidate for arthroscopy if:

• You have advanced arthritis (where open or replacement surgery may offer better outcomes).

• You have certain medical conditions that limit wound healing.

Your orthopaedic surgeon will evaluate your condition, imaging results, and activity goals to determine if keyhole surgery is right for you.

What to Expect if You Are Scheduled for Keyhole Surgery?

At Beacon Orthopaedics, we ensure a smooth and supportive surgical experience from your first consultation to full recovery.

Step 1: Consultation & Diagnosis

Our orthopaedic surgeon will do a comprehensive assessment.

Review of your symptoms, medical history and a thorough physical examination is performed.

There will be on-site X-ray and MRI scanning for accurate diagnosis.

Step 2: Pre-Surgery Preparation

Your surgeon explains the procedure, recovery plan and expected outcomes.

Pre-operative health checks ensure safety for anaesthesia.

You’ll receive instructions on fasting, medication, and transport.

Step 3: Day of Surgery

Surgery may be performed under general or regional anaesthesia.

Surgery usually takes 30–90 minutes, depending on complexity.

You may expect to go home on the same day if no complications arise.

Step 4: Post-Surgery Care

You’ll rest in recovery for a few hours and receive wound-care guidance.

Mild discomfort or swelling is expected for a few days over the wound area.

Pain relief and antibiotics may be prescribed.

Step 5: Physiotherapy & Follow-Up

Our partner physiotherapists will craft out a structured and individualised rehabilitation plan for you.

Follow-up appointments will be scheduled to track healing and progress.

Post-surgery care with cold wrap over the operated shoulder

What Happens During Arthroscopic (Keyhole) Surgery Procedure?

Arthroscopy uses advanced imaging and precision tools to treat joint problems with minimal trauma. You may expect the following procedure:

1. You will be asleep, or your limb is numbed during the procedure.

2. Small incisions (2–3 tiny portals) are made around the affected joint.

3. A camera (arthroscope) is inserted to view the affected internal structures on a monitor.

4. Mini instruments are then used to repair or remove damaged tissue. Some of the common procedures are trimming of the meniscus, ligament reconstruction and labral repair.

5. The small incisions are then closed with a few stitches.

6. Dressing of the wound may be done with sterile bandages to facilitate healing.

7. If no other issues persist, patients may go home on the same day.

Typical Duration for a Keyhole Surgery

Knee arthroscopy: 45–60 minutes

Shoulder arthroscopy: 60–90 minutes

Elbow arthroscopy: 30–60 minutes

Advantages of Keyhole Surgery Vs. Open Surgery

Keyhole Surgery

• Incision - 5-10cm

• Tissue Disruption - More muscle/tendon splitting

• Pain & Swelling - Higher

• Recovery Time - Months

• Infection Risk - Higher

• Cosmetic Outcome - Larger Scars
  

✅ Thus, keyhole surgery is the treatment of choice when indicated.

What are the Risks & Complications of a Keyhole Surgery?

Arthroscopy is generally safe and has a low complication rate, especially when performed by experienced orthopaedic surgeons. However, as with any surgery, there are potential risks.

Common and Mild Risks

• Temporary pain, stiffness, or swelling

• Bruising around incision sites

• Minor bleeding or fluid leakage

Less Common but Possible Risks

• Infection at incision site (rare)

• Blood clots (deep vein thrombosis, very rare)

• Nerve or blood vessel injury near the joint

• Joint stiffness or formation of scar tissue

• Anaesthesia-related side effects such as nausea or dizziness

Recovery & Rehabilitation Pathway Post Keyhole Surgery

Once keyhole surgery is the treatment of choice, you may expect the following recovery and rehabilitation pathway:

• Day-surgery procedures under general or regional anaesthesia.

• Discharge with detailed physiotherapy protocol and sling/crutches if required.

• Early passive motion to prevent stiffness.

• Progressive exercises/ strengthening under guidance of Beacon’s partner sports physiotherapists

• Return to Desk work: 1–2 weeks; Driving: 2–3 weeks (depending on the site of the surgery); Recreational sports: usually 3–6 months

Rehabilitation duration may vary according to the joint involved in the surgery.