Arthroscopy
Encyclopedia
Arthroscopy is a minimally invasive surgical procedure
in which an examination and sometimes treatment of damage of the interior of a joint
is performed using an arthroscope, a type of endoscope
that is inserted into the joint through a small incision. Arthroscopic procedures can be performed either to evaluate or to treat many orthopedic conditions including torn floating cartilage, torn surface cartilage, ACL reconstruction, and trimming damaged cartilage.
The advantage of arthroscopy over traditional open surgery is that the joint does not have to be opened up fully. Instead, for knee arthroscopy for example, only two small incisions are made — one for the arthroscope and one for the surgical instruments to be used in the knee cavity. This reduces recovery
time and may increase the rate of surgical success due to less trauma to the connective tissue
. It is especially useful for professional athletes, who frequently injure knee joints and require fast healing time. There is also less scarring, because of the smaller incisions. Irrigation fluid is used to distend the joint and make a surgical space. Sometimes this fluid leaks into the surrounding soft tissue causing extravasation
and edema
.
The surgical instruments used are smaller than traditional instruments. Surgeons view the joint area on a video monitor, and can diagnose and repair torn joint tissue, such as ligament
s and menisci
or cartilage
.
It is technically possible to do an arthroscopic examination of almost every joint in the human body. The joints that are most commonly examined and treated by arthroscopy are the knee, shoulder, elbow, wrist, ankle, foot, and hip.
solution as his optic media and entered the joint by a portal on the outer border of the patella. However, it is not clear if these examinations were anatomic studies of deceased or of living patients.
Pioneering work in the field of arthroscopy began as early as the 1920s with the work of Eugen Bircher
. Bircher published several papers in the 1920s about his use of arthroscopy of the knee for diagnostic purposes. After diagnosing torn tissue through arthroscopy, Bircher used open surgery to remove or repair the damaged tissue. Initially, he used an electric Jacobaeus thoracolaparoscope for his diagnostic procedures, which produced a dim view of the joint. Later, he developed a double-contrast approach to improve visibility. Bircher gave up endoscopy in 1930, and his work was largely neglected for several decades.
While Bircher is often considered the inventor of arthroscopy of the knee, the Japanese surgeon Masaki Watanabe, MD receives primary credit for using arthroscopy for interventional surgery. Watanabe was inspired by the work and teaching of Dr Richard O'Connor. Later, Dr. Heshmat Shahriaree began experimenting with ways to excise fragments of menisci.
The first operating arthroscope was jointly designed by these men, and they worked together to produce the first high-quality color intraarticular photography. The field benefited significantly from technological advances, particularly advances in flexible fiber optics during the 1970s and 1980s.
that was performed in the past. Today knee arthroscopy is commonly performed for treating meniscus injury
, reconstruction of the anterior cruciate ligament
and for cartilage microfracturing. Arthroscopy can also be performed just for diagnosing and checking of the knee; however, the latter use has been mainly replaced by magnetic resonance imaging
.
During an average knee arthroscopy, a small fiberoptic camera (the arthroscope) is inserted into the joint through a small incision, about 4 mm (1/8 inch) long. A special fluid is used to visualize the joint parts. More incisions might be performed in order to check other parts of the knee. Then other miniature instruments are used and the surgery is performed.
is questionable. A double-blind
placebo-controlled study on arthroscopic surgery for osteoarthritis of the knee was published in the New England Journal of Medicine
in 2002. In this three-group study, 180 military veterans with osteoarthritis of the knee were randomly assigned to receive arthroscopic débridement with lavage, or arthroscopic lavage alone without debridement (a procedure only imitating the surgical debridement, where superficial incisions to the skin were made to give the appearance that the debridement procedure had been performed). For two years after the surgeries, patients reported their pain levels and were evaluated for joint motion. Neither the patients nor the independent evaluators knew which patients had received which surgery (thus the "double blind" notation). The study reported, "At no point did either of the intervention groups report less pain or better function than the placebo group." Because there is no confirmed benefit for these surgeries in cases of osteoarthritis of the knee, many payors are reluctant to reimburse surgeons and hospitals for what can be considered a procedure which seems to create the risks of surgery with questionable or no demonstrable benefit.
A 2008 study confirmed that there was no long-term benefit for chronic pain, above medication and physical therapy. Since one of the main reasons for arthroscopy is to repair or trim a painful and torn or damaged meniscus, a recent study in the New England Journal of Medicine which shows that about 60% of these tears cause no pain and are found in asymptomatic subjects, further calls the rationale for this procedure into question.
was initially used for the diagnosis of unexplained hip pain, but is now widely used in the treatment of conditions both in and outside the hip joint itself. The most common indication currently is for the treatment of femoroacetabular impingement (FAI) and its associated pathologies, however, this is by no means where it ends. Hip conditions that may be treated arthroscopically also includes labral tears, loose / foreign body removal, hip washout (for infection) or biopsy, chondral (cartilage) lesions, osteochondritis dissecans, ligamentum teres injuries (and reconstruction), Iliopsoas tendinopathy (or ‘snapping psoas’), trochanteric pain syndrome, snapping iliotibial band, osteoarthritis (controversial), sciatic nerve compression (piriformis syndrome), ischiofemoral impingement and direct assessment of hip replacement.
s, frozen shoulder
(adhesive capsulitis), chronic tendonitis and partial tears of the long biceps tendon, SLAP lesions
and shoulder instability.
is used to investigate and treat symptoms of repetitive strain injury
, fractures of the wrist and torn or damaged ligaments. It can also be used to ascertain joint damage caused by arthritis
.
Arthroscopic (also endoscopic) spinal procedures allow a surgeon to access and treat a variety of spinal conditions with minimal damage to surrounding tissues. Recovery times are greatly reduced due to the relatively small size of incision(s) required, and many patients are treated on an outpatient basis. Recovery rates and times vary according to condition severity and the patient's overall health.
Arthroscopic procedures treat
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...
in which an examination and sometimes treatment of damage of the interior of a joint
Joint
A joint is the location at which two or more bones make contact. They are constructed to allow movement and provide mechanical support, and are classified structurally and functionally.-Classification:...
is performed using an arthroscope, a type of endoscope
Endoscopy
Endoscopy means looking inside and typically refers to looking inside the body for medical reasons using an endoscope , an instrument used to examine the interior of a hollow organ or cavity of the body. Unlike most other medical imaging devices, endoscopes are inserted directly into the organ...
that is inserted into the joint through a small incision. Arthroscopic procedures can be performed either to evaluate or to treat many orthopedic conditions including torn floating cartilage, torn surface cartilage, ACL reconstruction, and trimming damaged cartilage.
The advantage of arthroscopy over traditional open surgery is that the joint does not have to be opened up fully. Instead, for knee arthroscopy for example, only two small incisions are made — one for the arthroscope and one for the surgical instruments to be used in the knee cavity. This reduces recovery
Healing
Physiological healing is the restoration of damaged living tissue, organs and biological system to normal function. It is the process by which the cells in the body regenerate and repair to reduce the size of a damaged or necrotic area....
time and may increase the rate of surgical success due to less trauma to the connective tissue
Connective tissue
"Connective tissue" is a fibrous tissue. It is one of the four traditional classes of tissues . Connective Tissue is found throughout the body.In fact the whole framework of the skeleton and the different specialized connective tissues from the crown of the head to the toes determine the form of...
. It is especially useful for professional athletes, who frequently injure knee joints and require fast healing time. There is also less scarring, because of the smaller incisions. Irrigation fluid is used to distend the joint and make a surgical space. Sometimes this fluid leaks into the surrounding soft tissue causing extravasation
Extravasation
Extravasation is the accidental administration of intravenously infused medicinal drugs into the surrounding tissue, either by leakage , or direct exposure...
and edema
Edema
Edema or oedema ; both words from the Greek , oídēma "swelling"), formerly known as dropsy or hydropsy, is an abnormal accumulation of fluid beneath the skin or in one or more cavities of the body that produces swelling...
.
The surgical instruments used are smaller than traditional instruments. Surgeons view the joint area on a video monitor, and can diagnose and repair torn joint tissue, such as ligament
Ligament
In anatomy, the term ligament is used to denote any of three types of structures. Most commonly, it refers to fibrous tissue that connects bones to other bones and is also known as articular ligament, articular larua, fibrous ligament, or true ligament.Ligament can also refer to:* Peritoneal...
s and menisci
Meniscus (anatomy)
In anatomy, a meniscus is a crescent-shaped fibrocartilaginous structure that, in contrast to articular disks, only partly divides a joint cavity. In humans it is present in the knee, acromioclavicular, sternoclavicular, and temporomandibular joints; in other organisms they may be present in other...
or cartilage
Articular cartilage repair
The aim of an articular cartilage repair treatment is to restore the surface of an articular joint's hyaline cartilage. Over the last decades, surgeons and researchers have been working hard to elaborate surgical cartilage repair interventions...
.
It is technically possible to do an arthroscopic examination of almost every joint in the human body. The joints that are most commonly examined and treated by arthroscopy are the knee, shoulder, elbow, wrist, ankle, foot, and hip.
History
Professor Kenji Takagi in Tokyo has traditionally been credited for performing the first arthroscopic examination of the knee joint of a patient in 1919. He used a 7.3 mm cystoscope for his first arthroscopies. Recently it has been discovered that the Danish physician Severin Nordentoft reported on arthroscopies of the knee joint as early as 1912 at the Proceedings of the 4lst Congress of the German Society of Surgeons at Berlin. He baptized the procedure (in Latin) arthroscopia genu. Nordentoft used sterile saline or boric acidBoric acid
Boric acid, also called hydrogen borate or boracic acid or orthoboric acid or acidum boricum, is a weak acid of boron often used as an antiseptic, insecticide, flame retardant, as a neutron absorber, and as a precursor of other chemical compounds. It exists in the form of colorless crystals or a...
solution as his optic media and entered the joint by a portal on the outer border of the patella. However, it is not clear if these examinations were anatomic studies of deceased or of living patients.
Pioneering work in the field of arthroscopy began as early as the 1920s with the work of Eugen Bircher
Eugen Bircher
Eugen Bircher was a Swiss politician and military leader who became associated with a pro-German position in the inter-war years.- Military and political career :...
. Bircher published several papers in the 1920s about his use of arthroscopy of the knee for diagnostic purposes. After diagnosing torn tissue through arthroscopy, Bircher used open surgery to remove or repair the damaged tissue. Initially, he used an electric Jacobaeus thoracolaparoscope for his diagnostic procedures, which produced a dim view of the joint. Later, he developed a double-contrast approach to improve visibility. Bircher gave up endoscopy in 1930, and his work was largely neglected for several decades.
While Bircher is often considered the inventor of arthroscopy of the knee, the Japanese surgeon Masaki Watanabe, MD receives primary credit for using arthroscopy for interventional surgery. Watanabe was inspired by the work and teaching of Dr Richard O'Connor. Later, Dr. Heshmat Shahriaree began experimenting with ways to excise fragments of menisci.
The first operating arthroscope was jointly designed by these men, and they worked together to produce the first high-quality color intraarticular photography. The field benefited significantly from technological advances, particularly advances in flexible fiber optics during the 1970s and 1980s.
Knee arthroscopy
Knee arthroscopy has in many cases replaced the classic arthrotomyArthrotomy
An Arthrotomy is a process involving creating an opening in a joint.It may be involved in drainage.-References:...
that was performed in the past. Today knee arthroscopy is commonly performed for treating meniscus injury
Tear of meniscus
In sports and orthopedics, a tear of a meniscus is a rupturing of one or more of the fibrocartilage strips in the knee called menisci. When doctors and patients refer to "torn cartilage" in the knee, they actually may be referring to an injury to a meniscus at the top of one of the tibiae. Menisci...
, reconstruction of the anterior cruciate ligament
Anterior cruciate ligament
The anterior cruciate ligament is a cruciate ligament which is one of the four major ligaments of the human knee. In the quadruped stifle , based on its anatomical position, it is referred to as the cranial cruciate ligament.The ACL originates from deep within the notch of the distal femur...
and for cartilage microfracturing. Arthroscopy can also be performed just for diagnosing and checking of the knee; however, the latter use has been mainly replaced by magnetic resonance imaging
Magnetic resonance imaging
Magnetic resonance imaging , nuclear magnetic resonance imaging , or magnetic resonance tomography is a medical imaging technique used in radiology to visualize detailed internal structures...
.
During an average knee arthroscopy, a small fiberoptic camera (the arthroscope) is inserted into the joint through a small incision, about 4 mm (1/8 inch) long. A special fluid is used to visualize the joint parts. More incisions might be performed in order to check other parts of the knee. Then other miniature instruments are used and the surgery is performed.
For osteoarthritis
Arthroscopic surgeries of the knee are done for many reasons, but the usefulness of surgery for treating osteoarthritisOsteoarthritis
Osteoarthritis also known as degenerative arthritis or degenerative joint disease, is a group of mechanical abnormalities involving degradation of joints, including articular cartilage and subchondral bone. Symptoms may include joint pain, tenderness, stiffness, locking, and sometimes an effusion...
is questionable. A double-blind
Double-blind
A blind or blinded experiment is a scientific experiment where some of the people involved are prevented from knowing certain information that might lead to conscious or subconscious bias on their part, invalidating the results....
placebo-controlled study on arthroscopic surgery for osteoarthritis of the knee was published in the New England Journal of Medicine
New England Journal of Medicine
The New England Journal of Medicine is an English-language peer-reviewed medical journal published by the Massachusetts Medical Society. It describes itself as the oldest continuously published medical journal in the world.-History:...
in 2002. In this three-group study, 180 military veterans with osteoarthritis of the knee were randomly assigned to receive arthroscopic débridement with lavage, or arthroscopic lavage alone without debridement (a procedure only imitating the surgical debridement, where superficial incisions to the skin were made to give the appearance that the debridement procedure had been performed). For two years after the surgeries, patients reported their pain levels and were evaluated for joint motion. Neither the patients nor the independent evaluators knew which patients had received which surgery (thus the "double blind" notation). The study reported, "At no point did either of the intervention groups report less pain or better function than the placebo group." Because there is no confirmed benefit for these surgeries in cases of osteoarthritis of the knee, many payors are reluctant to reimburse surgeons and hospitals for what can be considered a procedure which seems to create the risks of surgery with questionable or no demonstrable benefit.
A 2008 study confirmed that there was no long-term benefit for chronic pain, above medication and physical therapy. Since one of the main reasons for arthroscopy is to repair or trim a painful and torn or damaged meniscus, a recent study in the New England Journal of Medicine which shows that about 60% of these tears cause no pain and are found in asymptomatic subjects, further calls the rationale for this procedure into question.
After surgery
After having a knee arthroscopy, there will be swelling around the knee. Swelling can take anywhere from 7–15 days to completely settle. It is important to wait until there is no swelling left around the knee before doing any serious exercise or extensive walking, because the knee will not be fully stable; extensive exercise may cause pain and in some cases cause the knee to swell more.Hip arthroscopy
Hip arthroscopyHip arthroscopy
The term arthroscopy refers to the viewing of the interior of a joint through a small operating telescope. In recent years, this technique has been used to help in the treatment of many joint pathologies and has gained popularity because of the small incisions used and improved recovery times when...
was initially used for the diagnosis of unexplained hip pain, but is now widely used in the treatment of conditions both in and outside the hip joint itself. The most common indication currently is for the treatment of femoroacetabular impingement (FAI) and its associated pathologies, however, this is by no means where it ends. Hip conditions that may be treated arthroscopically also includes labral tears, loose / foreign body removal, hip washout (for infection) or biopsy, chondral (cartilage) lesions, osteochondritis dissecans, ligamentum teres injuries (and reconstruction), Iliopsoas tendinopathy (or ‘snapping psoas’), trochanteric pain syndrome, snapping iliotibial band, osteoarthritis (controversial), sciatic nerve compression (piriformis syndrome), ischiofemoral impingement and direct assessment of hip replacement.
Shoulder arthroscopy
Arthroscopy is commonly used for treatment of various diseases of the shoulder including subacromial impingement, acromioclavicular osteoarthritis, rotator cuff tearRotator cuff tear
Rotator cuff tears are tears of one or more of the four tendons of the rotator cuff muscles. A rotator cuff injury can include any type of irritation or damage to the rotator cuff muscles or tendons....
s, frozen shoulder
Frozen shoulder
Frozen shoulder, medically referred to as adhesive capsulitis, is a disorder in which the shoulder capsule, the connective tissue surrounding the glenohumeral joint of the shoulder, becomes inflamed and stiff, greatly restricting motion and causing chronic pain.Adhesive capsulitis is a painful and...
(adhesive capsulitis), chronic tendonitis and partial tears of the long biceps tendon, SLAP lesions
SLAP tear
A SLAP tear or SLAP lesion is an injury to the Glenoid labrum . SLAP is an acronym that stands for "superior labral tear from anterior to posterior".-Overview:...
and shoulder instability.
Wrist arthroscopy
Arthroscopy of the wristWrist
In human anatomy, the wrist is variously defined as 1) the carpus or carpal bones, the complex of eight bones forming the proximal skeletal segment of the hand;...
is used to investigate and treat symptoms of repetitive strain injury
Repetitive strain injury
Repetitive strain injury is an injury of the musculoskeletal and nervous systems that may be caused by...
, fractures of the wrist and torn or damaged ligaments. It can also be used to ascertain joint damage caused by arthritis
Arthritis
Arthritis is a form of joint disorder that involves inflammation of one or more joints....
.
Spinal arthroscopy
Many invasive spine procedures involve the removal of bone, muscle, and ligaments to access and treat problematic areas. In some cases, thoracic (mid-spine) conditions requires a surgeon to access the problem area through the rib cage, dramatically lengthening recovery time.Arthroscopic (also endoscopic) spinal procedures allow a surgeon to access and treat a variety of spinal conditions with minimal damage to surrounding tissues. Recovery times are greatly reduced due to the relatively small size of incision(s) required, and many patients are treated on an outpatient basis. Recovery rates and times vary according to condition severity and the patient's overall health.
Arthroscopic procedures treat
- Spinal disc herniationSpinal disc herniationA spinal disc herniation , informally and misleadingly called a "slipped disc", is a medical condition affecting the spine due to trauma, lifting injuries, or idiopathic, in which a tear in the outer, fibrous ring of an intervertebral disc allows the soft, central portion A spinal disc herniation...
and degenerative discs - spinal deformity
- tumors
- general spine traumaPhysical traumaTrauma refers to "a body wound or shock produced by sudden physical injury, as from violence or accident." It can also be described as "a physical wound or injury, such as a fracture or blow." Major trauma can result in secondary complications such as circulatory shock, respiratory failure and death...
External links
- Arthroscopy Association of North America
- Arthroscopy: The Journal of Arthroscopic and Related Surgery
- Knee 3D Presentation
- SpineUniverse Minimally Invasive Spine Surgery Information Center — Articles from different institutes, organizations, and spine professionals