Current and future perspectives in knee arthroscopy: a narrative review

Purpose: This review provides a comprehensive overview of arthroscopic knee surgery, focusing on anterior cruciate ligament (ACL) injuries, meniscal tears, and articular cartilage lesions. It examines the historical development, current surgical approaches, and anticipated future directions in knee arthroscopy.Current Concepts: Since its introduction to Korea in the 1970s, knee arthroscopy has become an essential technique in orthopedic surgery. Common indications include ACL injuries, meniscal tears, and articular cartilage defects. ACL reconstruction techniques have evolved substantially, with anatomic single-bundle reconstruction now considered the standard approach. Graft options include bone–patellar tendon–bone, quadriceps tendon, and hamstring tendon autografts, with the latter currently the most widely used. Reconstruction of the anterolateral ligament has been investigated in select cases to address residual rotational instability. The meniscus plays a crucial role in load transmission, joint stability, shock absorption, and lubrication; preserving it is vital, although repair outcomes depend on tear location, pattern, and patient age. Because articular cartilage has limited healing capacity, treatment strategies include marrow stimulation techniques, osteochondral grafts, and autologous chondrocyte implantation.Discussion and Conclusion: Knee arthroscopy was the first, and remains the most advanced, domain within orthopedic arthroscopy. Emerging technologies such as needle arthroscopy, robotic assistance, and patient-specific planning are expected to improve surgical accuracy and recovery. Individualized treatment protocols based on individual patient characteristics may enable more personalized and effective interventions.