Arthroscopy is a surgical procedure used by orthopedic surgeons to visualize, diagnose and treat joint problems.
The word arthroscopy comes from two Greek words, ìartroî (articulation) and ìscopyî (look), and together they literally mean ìmire within the articulation.î During arthroscopic surgery the orthopedic surgeon makes a small incision in the patient’s skin and then inserts a pencil-sized instrument, which contains a small lens and a light system to magnify and illuminate the structure within the joint. The light is transmitted through optical fibers to the tip of the arthroscope that has been inserted into the joint. Then by connecting this arthroscope with a miniature television camera, the surgeon can see the inside of the joint through a very small incision, instead of one of a larger size needed in the case of surgery.
The television camera connected to the arthroscope shows the image of the joint on a television screen, thus allowing the surgeon to see, for example, inside the knee, the cartilage or ligaments, or below the kneecap. The surgeon can determine the amount or type of damage, and then if it is necessary to repair or correct the problem.
Why is arthroscopy necessary?
Diagnosis of joint damage and their diseases begins with a complete review of medical history, physical examinations, and generally X-rays. Additional recognitions may also be necessary, such as an MRI (magnetic resonance imaging), or a CT scan. (cathodic thermography). A final diagnosis is made through the arthroscope, and this may be more accurate than with the use of «open» surgery or X-ray studies.
Diseases and injuries can cause damage to bones, cartilage, ligaments, muscles and tendons. Some of the conditions that are most frequently encountered during arthroscopic joint recognition may be:
Inflammation: Synovitis or inflammation of the lining (synovium) in the knee, shoulder, elbow, wrist of the hand, or ankle.
Injuries: acute and chronic. Example:
Shoulder: rotator cuff rupture, shock syndrome and recurrent dislocations
Knee: meniscal tear (cartilage), chondromalacia (wear or injury of the cartilage cushion), and tearing of the cruciate ligaments causing instability
Carpal tunnel syndrome
Particles detached from bone and / or cartilage in the knee, shoulder, elbow, ankle, or wrist of the hand.
Although the inside of almost all joints can be observed with an arthroscope, six joints are examined more frequently with this instrument. These include the knee, shoulder, elbow, ankle, hip, and wrist of the hand. As the engineers of electronic technology make advances and new techniques are developed by orthopedic surgeons, other joints may also be treated more frequently in the future.
How is arthroscopic surgery performed?
Arthroscopic surgery, although much easier in terms of recovery than open surgery, still requires the use of anesthesia and special equipment in the operating room of a hospital or surgery room for outpatients. You will receive a general anesthetic, spinal or local anesthesia, depending on the joint or the problem to be solved.
A small incision (like the size of the hole in a shirt button) will be made to insert the arthroscope. Several other incisions can be made to see other parts of that joint or insert other instruments.
When indicated, corrective surgery is performed with specially designed instruments that are inserted into the joint through additional incisions.
At first, arthroscopy was simply a tool for diagnosis and for making plans to perform standard open surgery. With the development of better instruments and techniques for surgery, many pathologies can now be treated arthroscopically.
For example, many tears of the meniscus in the knee can be treated with great success with the use of arthroscopic surgery.
Some problems associated with arthritis can also be treated. Several disorders are treated with a combination of arthroscopic and standard surgery.
Rotating cuff procedure
Repair or resection of a torn cartilage (meniscus) in the knee or shoulder
Reconstruction of tears of the anterior cruciate ligament in the knee
Removal of the inflamed lining (synovium) in the knee, shoulder, elbow, ankle and wrist of the hand
Loosening of the carpal tunnel
Repair of torn ligaments
Removal of loose particles of bone or cartilage in the knee, shoulder, elbow, ankle and wrist of the hand
After arthroscopic surgery, small incisions will be covered with a bandage. Then, you will be moved from the operating room to a recovery room. Most patients do not need or need a small amount of pain medication.
Before you have been discharged, you will be given instructions on how to care for your incisions, what activities to avoid, and what exercises you must do to help your recovery. During follow-up visits, the surgeon will inspect your incisions, remove stitches, if received, and discuss your rehabilitation program.
The duration of surgery and the recovery time will depend on how complicated your problem is. Occasionally, during arthroscopy, the surgeon will discover that the damage or illness can not be adequately treated with only arthroscopy. In cases, more extensive or «open» surgery may be performed while you are still under the effect of anesthesia or at a later date after having discussed the findings with your surgeon.
What can be the possible complications?
Although uncommon, complications occur occasionally during or following arthroscopy; infections, phlebitis (blood clots in the veins), excessive swelling or blood spills, damage to blood vessels or nerves, and broken instruments. These are more common complications, but occur in less than 1 (one) percent of all arthroscopic procedures.
What are the advantages?
Although arthroscopic surgery has received a large amount of public attention focused on its use for the treatment of famous athletes, this surgery is an extremely valuable tool for all orthopedic patients and it is generally easier in the patient than the open surgery .î Most patients receive arthroscopic surgery as outpatients and return home a few hours after receiving it.
Recovery after arthroscopic surgery
Small incisional wounds heal over the course of several days. The bandages of the operation can be removed the next day after surgery and some adhesive bands can be applied to cover the small incisions that are healing.
Although the incisional wounds are small and the pain in the joint that received the arthroscopy is minimal, it usually takes several weeks for the joint to recover to its maximum. A specific program of activities for rehabilitation can be suggested by your doctor to hasten your recovery and to protect the future functioning of the joint.
It is not uncommon for patients to be able to return to work, or school, to continue their daily activities within a few days. Athletes and others who are in good physical condition can in some cases return to their athletic activities within a few weeks. In any case, do not forget that the