What is arthroscopy? In what cases is it performed?
Arthroscopy is derived from the Greek words “arthro” (joint) and “skopein” (to look), and literally means “to look inside a joint.”
One of the greatest revolutions in orthopedic surgical care, arthroscopy is now one of the most commonly performed orthopedic procedures performed on every joint in the human body. It was first developed in the 19th century with the use of the cystoscope on cadaver knees, and later became an indispensable component of modern orthopedic care with more specialized arthroscopic equipment.
What is arthroscopy?
Arthroscopy is a surgical procedure that orthopedic surgeons use to treat problems inside a joint. Initially, arthroscopy was a simple diagnostic tool used to plan standard open surgery. However, with the development of better instrumentation and surgical techniques, many conditions can now be treated with arthroscopic techniques.
In what cases is arthroscopy performed?
Your bones, cartilage, ligaments, muscles, and tendons can all be damaged by disease and injury. To diagnose your condition, your doctor will take a comprehensive medical history, perform a physical exam, and order imaging studies (usually X-rays). In some cases, additional imaging studies, such as a magnetic resonance imaging (MRI) scan or a computed tomography (CT) scan, may be necessary. Once a diagnosis is made, your doctor will determine the most appropriate treatment option for your condition.
Conditions that are commonly treated with arthroscopic procedures include:
Inflammation: For example, synovitis is a condition that causes inflammation of the tissues surrounding the knee, shoulder, elbow, wrist, and ankle joints.
Acute or chronic injuries:
- Rotator cuff tendon tears
- Shoulder impingement
- Recurrent dislocations of the shoulder
- Meniscus (cartilage) tears in the knee
- Chondromalacia (wear and tear of the cartilage pad in the knee)
- Anterior cruciate ligament (ACL) tears with instability in the knee
- Carpal tunnel syndrome in the wrist
- Loose bone and/or cartilage bodies, especially in the knee, shoulder, elbow, ankle or wrist
- Some arthritis-related problems can also be treated arthroscopically.
How is arthroscopy performed?
The following procedures are performed with arthroscopy alone or in combination with open surgery:
- Rotator cuff repair
- Repair or resection of torn cartilage (meniscus) from the knee or shoulder
- Reconstruction of the anterior cruciate ligament (ACL) in the knee
- Removal of synovium from the knee, shoulder, elbow, wrist, or ankle
- Release of the carpal tunnel in the wrist
- Repair of torn ligaments
- Removal of loose bone or cartilage from the knee, shoulder, elbow, wrist, or ankle
Although the inside of almost any joint can be visualized with an arthroscope, the knee, shoulder, elbow, ankle, hip, and wrist are most commonly examined.
In arthroscopic surgery, the surgeon makes a small incision in the patient’s skin, then inserts a pen-sized instrument containing a tiny lens and lighting system to magnify and illuminate the structures inside the joint. The light is transmitted through fiber optics to the tip of the arthroscope, which is inserted into the joint.
By connecting the arthroscope to a miniature camera, the surgeon can see inside the joint through this very small incision, rather than through the larger incision required for open surgery.
The camera attached to the arthroscope displays an image of the joint on a video monitor, allowing the surgeon to look through it. This allows the surgeon to see the cartilage, ligaments, and under the kneecap. This allows your surgeon to determine the extent or type of injury and then repair or correct the problem if necessary. After arthroscopic surgery, the small incisions will be covered with a dressing.
Before you are discharged, your doctor will give you instructions on how to care for your incisions, what activities you should avoid, and what exercises you should do to help you heal. At your next appointment, your surgeon will examine your incisions; He or she will remove any stitches and provide information about your rehabilitation program.
The number of surgeries required and the length of recovery time will depend on the complexity of your problem. Sometimes, during arthroscopy, the surgeon may decide that the injury or disease cannot be adequately treated with arthroscopy alone. More extensive open surgery may be performed at a later date while you are still under anesthesia or after discussing the findings with your surgeon.
What is hip arthroscopy?
Your doctor may recommend hip arthroscopy if you have a painful condition that has not responded to nonsurgical treatments.
Hip arthroscopy can relieve the painful symptoms of many conditions that damage the labrum, articular cartilage, or other soft tissues surrounding the joint. This damage can be caused by injuries and the following conditions:
- Femoroacetabular impingement (FAI): A disorder in which extra bone develops along the acetabulum (pincer impingement) or on the femoral head (cam impingement). This excessive bone growth can damage the soft tissues of the hip, especially the articular cartilage, during movement. Sometimes, bone growths develop both in the acetabulum and the femoral head, and osteoarthritis can develop.
- Hip labrum tears
- Dysplasia: A condition in which the hip socket is abnormally shallow. This places more stress on the labrum to hold the femoral head in the socket, making the labrum more susceptible to tearing. The surgeon takes great care during arthroscopy of a dysplastic joint because joint instability can develop after surgery.
- Hip fissure: Causes a tendon to rub against the outside of the joint. This type of fissure is usually harmless and does not require treatment. However, surgery may be helpful if the tendon has been damaged by repeated friction.
- Synovitis: Inflammation of the tissues surrounding the joint.
- Bin or cartilage that has loosened and moved within the joint
- Hip joint infection
- Tendon ruptures or disorders involving the hamstring (upper back muscle group), gluteus medius, minimus muscles
- Ischiofemoral impingement
- Sciatic nerve compression by the hip/hamstring
You may need crutches after your procedure. In some cases, you will only use them until the limping stops. In most cases, physical therapy is necessary to achieve the best recovery. Certain exercises are important to regain your strength and range of motion.
What is knee arthroscopy?
Knee arthroscopy can relieve the painful symptoms of many conditions that damage the cartilage surfaces and other soft tissues surrounding the joint. Common arthroscopic procedures for the knee include:
- Partial meniscus removal, torn meniscus repair, or meniscus transplant
- Reconstruction of a torn anterior cruciate ligament or posterior cruciate ligament
- Removal of inflamed synovial tissue
- Cutting or reconstructing damaged joint cartilage
- Removal of loose bone or cartilage fragments caused by conditions such as synovial chondromatosis
- Treatment of patella (kneecap) problems
- Treatment of knee sepsis (infection)
You can usually go home the same day after surgery. It is recommended that you have someone with you to drive you home and check you the first evening.
Your recovery will depend on the type of damage to your knee. If you haven’t had ligament reconstruction, meniscus repair, or cartilage restoration, you can return to most physical activities after 6 to 8 weeks, or sometimes much sooner. However, you may need to avoid high-impact activities for a longer period of time.
If you work in a strenuous job, it may take longer for you to return to work. You should discuss with your doctor when it is safe to return to work.
What is shoulder arthroscopy?
Injury, overuse, and age-related wear and tear are responsible for most shoulder problems. Shoulder arthroscopy can relieve the painful symptoms of many problems that damage the rotator cuff tendons, labrum, articular cartilage, and other soft tissues surrounding the joint.
Common arthroscopic procedures include:
- Rotator cuff repair
- Removal or repair of the labrum
- Repair of ligaments
- Removal of inflamed tissue or loose cartilage
- Repair of recurrent shoulder dislocation (chronic shoulder instability)
- Nerve release
- Fracture repair
- Cyst excision
Although recovery from arthroscopy is usually quicker than recovery from open surgery, it may take weeks or months for your shoulder joint to fully heal.
You can expect some pain and discomfort for a few weeks after surgery. However, if you have had more extensive surgery, it may take longer for your pain to subside. Ice will help relieve pain and swelling. Your doctor may prescribe a pain reliever if needed.
Although it does not affect the healing of your shoulder, lying flat can pull on your shoulder and cause discomfort. Some patients find it more comfortable to sleep propped up in a recliner or bed in the first few days after surgery.
You will likely need a sling or special immobilizer to protect your shoulder. Your surgeon will specify how long the sling will be needed.
What is elbow arthroscopy?
Elbow arthroscopy may be recommended to:
- Treat tennis elbow (lateral epicondylitis)
- Remove loose cartilage and bone fragments
- Treat scar tissue and bone growth to improve range of motion
- Treat osteoarthritis (wear-and-tear arthritis)
- Treat rheumatoid arthritis (inflammatory arthritis)
- Treat osteochondritis dissecans (activity-related damage to the capitellum of the humerus, seen in throwers or gymnasts)
- Treat certain fractures
There are currently several elbow treatments that are more effective than open surgery. These include surgeries such as:
- Treat golfer’s elbow (medial epicondylitis)
- Repair collateral ligaments
- Repair some types of fractures
- Replace an elbow joint (arthroplasty)
- Release the cubital tunnel to decompress the ulnar nerve (funny bone nerve)
In some cases, surgeons combine arthroscopic and open procedures. For example, in a severe case of osteochondritis dissecans, a loose piece of bone may be removed arthroscopically and the damaged area of the humerus may be treated with a bone graft using an open surgical technique.
What are the advantages of arthroscopy?
Although arthroscopic surgery has received much public attention because it is often used to treat well-known athletes, it is an extremely valuable tool for all orthopedic patients and is generally easier on the patient than open surgery.
What is recovery like after arthroscopy?
After surgery, the small incisions take a few days to heal. The surgical dressing can usually be removed the morning after surgery, and adhesive tape can be applied to close the incisions.
Although the incisions are small and the pain in the arthroscopic joint is minimal, it takes several weeks for the joint to heal to its fullest extent. A specific activity and rehabilitation program may be recommended to speed your recovery and preserve future joint function.
It is not uncommon for patients to return to work or school or to resume their daily activities within a few days. Athletes and others who are in good physical condition can sometimes return to athletic activities within a few weeks. However, it is important to remember that people who undergo arthroscopy may have many different diagnoses and preexisting conditions. Therefore, each patient’s recovery time is unique to that individual.
Many people return to their previous, unrestricted activities after arthroscopy. Your recovery will depend on the type of damage to your hip. Sometimes, the damage may be too severe to completely reverse, and the procedure may not be successful.
For some people, lifestyle changes are necessary to protect the joint. For example, you may need to switch from high-impact exercises (such as running) to low-impact activities (such as swimming or cycling).
What are the possible complications of the operation?
Although rare, complications do sometimes occur during or after arthroscopy. The most common complications include infection, blood clots in a vein (deep vein thrombosis), excessive swelling or bleeding, damage to blood vessels or nerves, and instrument fracture. However, these occur in less than 1% of all arthroscopic procedures.
Sources:
- American Academy of Orthopedic Surgeons (AAOS)
- Bone & Joint
- Journal of Arthroscopic Surgery and Sports Medicine (JASSM)