What is arthroscopy?

Indications and Procedures

The arthroscope is a rigid tube enclosing a series of lenses around which are wrapped glass fibers for transmitting light. The arthroscope is placed inside a larger metal sheath, which allows fluid to flow between the components. After disinfecting the skin, the surgeon inserts a cannula (tube) into the desired cavity using an obturator, a prosthetic device which is removed and replaced by the arthroscope.

Instruments passed through the cannula include probes, forceps, knives, scissors, and a variety of clamps. Cutting may be done manually or with a motor-driven tool. The surgeon uses a small light and lens on the instrument to see the operative field. The eyepiece of an arthroscope may be replaced by a video camera to allow viewing on a television monitor.

After the skin is prepared and the instruments are inserted, diagnostic or operative procedures are begun. The joint or tissue is thoroughly explored before any further steps are taken. An assistant positions the body part, freeing the surgeon to operate. The most common site for an arthroscopic procedure is the knee; other sites include the elbow, shoulder, and ankle.

After the procedure is completed, the joint is flushed to remove all debris. The instruments are withdrawn, and the skin punctures are closed with a single suture or bandage closure. The patient returns in a week for a postarthroscopic examination and removal of sutures. Rehabilitation is important; it should begin on the day following arthroscopy and can require up to several months, depending on the site and procedure.

Uses and Complications

Arthroscopy is a technique originally developed for diagnosis in joints; it is now used for surgical procedures as well. Typically, arthroscopy is used for knee and shoulder joint injuries, but it can also be used in the ankle, hip, or elbow. The technique has also been applied in innovative ways by podiatric foot and ankle surgeons to relieve different ankle problems, including ligament damage, bone chips, and recurrent pain from end-stage arthritis.

Many simple procedures can be done using local anesthesia, although regional or general anesthesia is preferred. Arthroscopy can be carried out in either a fluid or a gas environment within the joint. A saline solution is often used; it disperses light more evenly but requires a system to pump the fluid in and out. A gas environment is more useful for visualizing surface irregularities of cartilage.

Such techniques have significantly changed orthopedic surgery
. The use of arthroscopy for diagnosis and treatment reduces postoperative infections, the time needed for rehabilitation, and costs. Most arthroscopic procedures are now done on an outpatient basis.

Bibliography

Chow, James C. Y., ed. Advanced Arthroscopy. New York: Springer, 2001.

Clark, Glenn T., Bruce Sanders, and Charles N. Bertolami, eds. Advances in Diagnostic and Surgical Arthroscopy of the Temporomandibular Joint. Philadelphia: W. B. Saunders, 1993.

Geissler, William. Wrist and Elbow Arthroscopy: A Practical Surgical Guide to Techniques. London: Springer, 2013.

Johnson, Donald H. Operative Arthroscopy. Philadelphia: Kluwer, 2013.

Miller, Mark D., Daniel E. Cooper, and Jon J. P. Warner. Review of Sports Medicine and Arthroscopy. 2d ed. Philadelphia: W. B. Saunders, 2002.

Saxena, Amol. Sports Medicine and Arthroscopic Surgery of the Foot and Ankle. New York: Springer, 2013.

Sherman, Orrin Howard, and Jeffrey Minkoff, eds. Arthroscopic Surgery. Baltimore: Williams & Wilkins, 1990.

Tibone, James E., Felix H. Savoie III, and Benjamin S. Shaffer, eds. Shoulder Arthroscopy. New York: Springer, 2003.

Zarins, Bertram, and Richard A. Marder, eds. Revision of Failed Arthroscopic and Ligament Surgery. Malden, Mass.: Blackwell Science, 1998.