Arthroscopy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Arthroscopy (also called arthroscopic surgery) 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 orthopaedic 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, only two small incisions are made - one for the arthroscope and one for the surgical instruments. 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.

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 ligaments and menisci.

Arthroscopy is used for joints of the knee, shoulder, elbow, wrist, ankle and hip.

Historical Perspective

2000 marks the end of the third decade of arthroscopic surgery, although pioneering work in the field began as early as the 1920s with the work of Eugen Bircher.[2] Arthroscopic surgery was begun by a Japanese surgeon (Masaki Watanabe, MD)[1]; however, inspired by the work and teaching of a Japanese surgeon, Dr. Richard O'Connor and later Dr. Heshmat Shahriaree began experimenting with ways to excise fragments of menisci[2] in the early 1970s. Largely through his effort in the ensuing years, arthroscopic surgery was developed and advanced[3]. Dr. O'Connor paved the way for arthroscopic surgery[4] and did more to pioneer and develop the techniques of arthroscopic meniscectomy than any other person in North America[5]. No wonder Dr. Masaki Watanabe wrote: "From his efforts, I was convinced that O'Connor would be the man to perfect the methodology of arthroscopic meniscectomy, bringing most types of meniscectomy within the scope of arthroscopic control."[1] Together both doctors fashioned the first operating arthroscope and helped to generate and produce the first high-quality color intraarticular photography[6]. Dr. O'Connor wrote the first book under the title, Arthroscopy. Dr. Shahriaree has written three books on arthroscopic surgery: Arthroscopic Surgery, First Edition (1984); Arthroscopic Surgery, Second Edition (1992) both of which were published by J.B. Lippincott Company. His third book was a rendition of his Second Edition, which was translated in Chinese.

Knee Arthroscopy

Knee arthroscopy has in many cases replaced the classic arthrotomy that was performed in the past. Today knee arthroscopy is commonly performed for treating with damaged meniscus cartilage, 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 endoscope, is inserted in the joint through a small incision that has an approximate size of 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

Recovery after a knee arthroscopy is a lot faster compared to arthrotomy. Most patients can return home and walk using crutches the same or the next day after the surgery. Usually after a month a patient can fully load his leg and after a few weeks the joint function can fully recover. It is not uncommon for athletes who have a beyond average physical condition to return to normal athletic activities within a few weeks.

However the recovery time also depends on the diagnosis that the arthroscopy was performed for, thus each case is unique and the patient must consult his personal doctor and physician regarding his physiotherapy.

A double-blind placebo-controlled study on arthroscopic surgery for osteoarthritis of the knee was published in the New England Journal of Medicine in July 2002 and concluded that the group that received actual arthroscopy did not report better function or pain than the placebo group."[7]

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.[8]

Arthroscopic procedures treat:

Similar to knee arthroscopy, recovery rates and times vary according to condition severity and patient's overall health. Any patient considering surgery should consult his or her physician/specialist for further education, evaluation, & treatment options.

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References

  1. 1.0 1.1 Watanabe M: History arthroscopic surgery. In Shahriaree H (first edition): O'Connor's Textbook of Arthroscopic surgery. Philadelphia, J.B. Lippincott Co., 1983.
  2. Metcalf RW: A decade of arthroscopic surgery: A.A.N.A. Presidential Address. Arthroscopy 1:221, 1985.
  3. Casscells SW: The early days of arthroscopy in the United States. Arthroscopy 3:71, 1987.
  4. Schonoholtz GE: In Memory of Richard L. O'Connor-Memorial Service. Covina, California, December 4, 1980.
  5. Jackson RW: Memories of the early days of Arthroscopy: 1965-1975. The formative years. Arthroscopy 3:1, 1987.
  6. Allen FR, Shahriaree H: Richard L. O'Connor-A Tribute. J Bone Joint 64A:315, 1982.
  7. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12110735 "A controlled trial of arthroscopic surgery for osteoarthritis of the knee" N Engl J Med 2002 Jul 11;347(2):81-8, Moseley JB; O'Malley K; Petersen NJ; Menke TJ; Brody BA; Kuykendall DH; Hollingsworth JC; Ashton CM; Wray NP
  8. http://www.spineuniverse.com/displayarticle.php/article2016.html "Minimally Invasive Endoscopic Spinal Surgery" 20 June 2005, Cleveland Clinic contribution to SpineUniverse.com

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