Arthroscopic surgery is a procedure to visualize, diagnose, and treat joint problems. The name is derived from the Greek words arthron, which means joint, and skopein, which means to look at.
Arthroscopic surgery is used to identify, monitor, and diagnose joint injuries and disease; or to remove bone or cartilage or repair tendons or ligaments. Diagnostic arthroscopic surgery is performed when medical history, physical exam, x rays, and other tests such as MRIs or CTs don't provide a definitive diagnosis.
Diagnostic arthroscopic surgery should not be performed unless conservative treatment does not fix the problem.
In arthroscopic surgery, an orthopedic surgeon uses an arthroscope, a fiber-optic instrument, to see the inside of a joint. After making an incision about the size of a buttonhole in the patient's skin, a sterile sodium chloride solution is injected to distend the joint. The arthroscope, an instrument the size of a pencil, is then inserted into the joint. The arthroscope has a lens and a lighting system through which the structures inside the joint are transmitted to a miniature television camera attached to the end of the arthroscope. The surgeon uses irrigation and suction to remove blood and debris from the joint before examining it. Other incisions may be made in order to see other parts of the joint or to insert additional instruments. Looking at the interior of the joint on the television screen, the surgeon can then determine the amount or type of injury and, if necessary, take a biopsy specimen or repair or correct the problem. Arthroscopic surgery can be used to remove floating bits of cartilage and treat minor tears and other disorders. When the procedure is finished, the arthroscope is removed and the joint is irrigated. The site of the incision is bandaged.
Arthroscopic surgery is used to diagnose and treat joint problems, most commonly in the knee, but also in the shoulder, elbow, ankle, wrist, and hip. Some of the most common joint problems seen with an arthroscope are:
- inflammation in the knee, shoulder, elbow, wrist, or ankle
- injuries to the shoulder (rotator cuff tendon tears, impingement syndrome, and recurrent dislocations), knee (cartilage tears, wearing down of or injury to the cartilage cushion, and anterior cruciate ligament tears with instability), and wrist (carpal tunnel syndrome)
- loose bodies of bone and/or cartilage in the knee, shoulder, elbow, ankle, or wrist
Corrective arthroscopic surgery is performed with instruments that are inserted through additional incisions. Arthritis can sometimes be treated with arthroscopic surgery. Some problems are treated with a combination of arthroscopic and standard surgery.
Also called arthroscopy, the procedure is performed in a hospital or outpatient surgical facility. The type of anesthesia (local, spinal, or general) and the length of the procedure depends on the joint operated on and the complexity of the suspected problem. Arthroscopic surgery rarely takes more than an hour. Most patients who have arthroscopic surgery are released that same day; some patients stay in the hospital overnight.
Considered the most important orthopedic development in the 20th century, arthroscopic surgery is widely used. The use of arthroscopic surgery on famous athletes has been well publicized. It is estimated that 80% of orthopedic surgeons practice arthroscopic surgery. Arthroscopic surgery was initially a diagnostic tool used prior to open surgery, but as better instruments and techniques were developed, it began to be used to actually treat a variety of joint problems. New techniques currently under development are likely to lead to other joints being treated with arthroscopic surgery in the future. Recently, lasers were introduced in arthroscopic surgery and other new energy sources are being explored. Lasers and electromagnetic radiation can repair rather than resect injuries and may be more cost effective than instruments.
Before the procedure, blood and urine studies and x rays of the joint will be conducted.
Immediately after the procedure, the patient will spend several hours in the recovery room. An ice pack will be put on the joint that was operated on for up to 48 hours after the procedure. Pain medicine, prescription or non-prescription, will be given. The morning after the surgery, the dressing can be removed and replaced by adhesive strips. The patient should call his/her doctor upon experiencing an increase in pain, swelling, redness, drainage or bleeding at the site of the surgery, signs of infection (headache, muscle aches, dizziness, fever), or nausea or vomiting.
It takes several days for the puncture wounds to heal, and several weeks for the joint to fully recover. Many patients can resume their daily activities, including going back to work, within a few days of the procedure. A rehabilitation program, including physical therapy, may be suggested to speed recovery and improve the future functioning of the joint.
Complications are rare in arthroscopic surgery, occurring in less than 1% of patients. These include infection and inflammation, blood vessel clots, damage to blood vessels or nerves, and instrument breakage.
Andrews, James R, and Laura A. Timmerman. Diagnostic and Operative Arthroscopy. Philadelphia: W. B. Saunders Co.,1997.
Brillhart, Allen T., ed. Arthroscoic Laser Surgery: Clinical Applications. New York: Springer-Verlag, 1995.
Oxford Medical Publications. Oxford Textbook of Sports Medicine. New York: Oxford Medical Publications, 1994.
"Arthroscopic Knee Surgery." Harvard Women's Health Watch 4 (Dec. 1996): 4.
Pierce, Michael W. "Arthroscopic Surgery." Scientific American 276 (Feb. 1997): 108.
"Should You Be Scoped?" Prevention (Aug. 1997): 82.
Wilkinson, Todd. "Pop, Crackle, Snap." Women's Sports & Fitness (Apr. 1998): 68.
"Arthroscopy." American Academy of Orthopaedic Surgeons. 15 Apr. 1998. <http://www.aos.org/wordhtml/pat_educ/arthrosc.htm>.
"Arthroscopy." ThriveOnline. 15 Apr. 1998. <http://thriveonline.oxygen.com>.
"Knee Arthroscopy." The Center for Orthopaedics and Sports Medicine. 15 Apr. 1998. <http://www.arthroscopy.com/spo4002.htm>.
Lori De Milto
Joint—The point where bones meet. Arthroscopic surgery is used on joint problems.
Laser—A device that concentrates electromagnetic radiation into a narrow beam and treats tissue quickly without heating surrounding areas.
Orthopedics—The medical specialty that deals with preserving, restoring, and developing form and function in the extremities, spine, and other structures using medical, surgical, and physical methods. Arthroscopic surgery is performed by orthopedic surgeons.