Loose bodies, also commonly termed joint mice, are pieces of cartilage and bones that are found floating in the synovial fluid of one’s joint. The fragments cause knee pains, swelling, inflammation, the sensation of your joints buckling up, and a discomforting feeling of foreign movement in the knee that leads to mental irritation. Discomfort is even present when one is immobilised, significantly impacting their quality of life.

Loose bodies in one’s knee joint is often caused by complications from:

• Prior orthopaedic procedure
• Degenerative diseases that release fragments of cartilage and bones into the synovial membrane
• Recurrent dislocation of the patella

Loose body removal refers to the arthroscopic treatment approach to remove debris from the knee joint. There is also a secondary surgical option namely an arthrotomy, however, it is only required when there are large loose body pieces and tends to be disfavoured as it involves larger incisions and tends to be more invasive. The surgical approach taken differs according to the exact location and size of loose bodies which are identified during screening and imaging tests. Factors affecting suitability for loose body removal are age and health condition.

There are 3 types of loose bodies which are removed during an arthroscopic loose body removal:

• Fibrinous loose bodies
• Cartilaginous loose bodies
• Osteocartilaginous loose bodies

During the surgery, two or three small incisions are made at the knee and an arthroscope is inserted, allowing your surgeon to visually assess the condition of your knee through the camera. This phase of the procedure is also known as arthroscopic diagnosis.

The surgeon then attempts to identify the location of the loose bodies, subsequently extracting them from the knee joint using a suction cup. The surgical site is then irrigated to prevent infections before it is closed either by suture or staples.

• Minimally invasive
• Quicker discharge
• Minimal scarring
• Short recovery period

Cartilage repair can be used to treat the following conditions:

• Arthritis: arthritis such as tuberculosis arthritis and rheumatoid arthritis can be treated with loose body removal.  
• Fractures: fractures can cause bits of bones or cartilage to break away. Hence, loose body removal will help to remove them.
• Osteochondritis dissecans: also known as OCD, is a condition that most commonly develops in the joints of children and adolescents. It occurs when a piece of bone separates due to loss of blood supply.
• Joint inflammation: injuries and inflammatory arthritis are common causes of joint inflammation. It is characterised by pain and swelling.
• Synovial chondromatosis: a rare condition that occurs when the synovial has benign or non-cancerous growths or nodules made of cartilage.
• Osteochondromas: most common bone growth that occurs when the cartilage or bone near the growth plate overgrows.

Loose body removal surgeries are often conducted as secondary surgery (surgery performed after the initial surgical procedure). Upon loose body removal treatment, one can observe dramatic improvement in the quality of life accompanied by psychological and pain relief. Additionally, loose body removal will also recover joint mobility and function.

A loose body removal surgery prevents or at minimum, reduces the risk of the onset of osteoarthritis and other degenerative conditions. Additionally, you would also reduce risks of damage to the articular cartilage.

Recovery could take anywhere between 4-6 weeks and up to 6 months. If other injuries are involved in the joint, the duration of recovery could last longer. The recovery period also depends on the volume of loose body presence and the damage incurred.

Discipline and dedication towards physiotherapy would help in speeding up recovery. Diets and post-surgical habits could also impact your healing rate. With positive post-surgical care and collaborative work with your orthopaedist, a positive outcome can be anticipated.

Your orthopaedist will be able to provide you with a bespoke treatment plan, tailored to your needs and requirements.

Ideally, your surgeon would attempt to identify and remove loose bodies within one session. However, there are cases where repeated surgeries are required. Some factors may be continued degeneration of knee joints, and an increase in loose body presence. Multiple surgeries might be necessary to remove newly formed loose bodies or loose bodies which were evasive in former surgeries.

Loose body removal is a complicated surgery by comparison. It can be difficult to identify the position of loose body pieces. Occasionally loose bodies identified in imaging may simply disappear when arthroscopy is conducted. This is especially true if faultiness in surgical methods from previous knee injuries is evident.