Understanding Arthroscopic Surgery
Arthroscopic surgery is a medical procedure in which the internal structure of a joint is examined for diagnostic or therapeutic purposes using a specialized instrument called an Arthroscope. Arthroscopy was popularized in the 1960s and has since become a common practice worldwide. Typically, orthopedic surgeons perform this procedure in an outpatient setting, allowing patients to return home after the surgery.
When arthroscopic procedures are performed to address joint issues observed during the examination with an Arthroscope, it is referred to as arthroscopic surgery. This approach is preferred for its ability to minimize tissue trauma, reduce pain, and facilitate a quicker recovery compared to traditional surgical techniques
An arthroscope is a small, thin tube that is inserted into the body. A camera and light source are attached to the arthroscope.
Why Arthroscopic Surgery is Necessary
The process of diagnosing joint injuries and diseases starts with a thorough medical history review, a physical examination, and often X-rays. Additional tests, such as magnetic resonance imaging (MRI) or computed tomography (CT) scans, may be required.
Arthroscopy is used to provide a definitive diagnosis, which is often more accurate than open surgery or X-ray studies. Joint issues commonly identified during arthroscopic examinations include:
- Inflammation: Such as synovitis, which is the inflammation of joint lining in the knee, shoulder, elbow, wrist, or ankle.
- Acute or Chronic Injuries: Like rotator cuff tendon tears, impingement syndrome, recurrent dislocations in the shoulder, meniscal (cartilage) tears, chondromalacia (cartilage cushion wear or injury), and anterior cruciate ligament tears with instability in the knee, or carpal tunnel syndrome in the wrist.
- Removal of Loose Bodies: This can involve bone or cartilage in various joints like the knee, shoulder, elbow, ankle, or wrist.
- Arthritis-Related Problems: Examples include rotator cuff tendon tears, impingement syndrome, recurrent dislocations in the shoulder, meniscal (cartilage) tears and anterior cruciate ligament tears with instability in the knee, and carpal tunnel syndrome in the wrist.
Removal of Loose Bodies: Bone or cartilage fragments in joints like the knee, shoulder, elbow, ankle, or wrist.
Arthritis-related problems can also be treated using arthroscopic and standard surgical techniques combined.
The parts of the shoulder joint as seen through an arthroscope: the rotator cuff (RC), the head of the humerus (HH), and the biceps tendon (B).
How Arthroscopic Surgery is Performed
Arthroscopic surgery, while less invasive and having a quicker recovery than open surgery, still requires the use of anesthesia and specialized equipment in a hospital operating room or an outpatient surgical suite. The type of anesthesia used depends on the joint or suspected problem and may include general, spinal, or local anesthesia
A small incision, roughly the size of a buttonhole, is made to insert the Arthroscope. Additional incisions may be made to access other parts of the joint or insert other instruments. When corrective surgery is needed, specially designed instruments are used through these incisions. Initially, arthroscopy was primarily a diagnostic tool for planning traditional open surgery. However, advances in instrumentation and surgical techniques have allowed for the treatment of many conditions through arthroscopy.
For instance, most meniscal tears in the knee can be effectively treated with arthroscopic surgery. After the procedure, small incisions are covered with dressings, and patients are transferred to a recovery room. Many require minimal to no pain medication.
Upon discharge, patients receive instructions on incision care, activity restrictions, and recommended exercises to aid in their recovery. During follow-up visits, the surgeon inspects incisions, removes sutures if necessary, and discusses the rehabilitation program
The complexity of the problem determines the extent of surgery and recovery time. Occasionally, during arthroscopy, the surgeon may find that the injury or disease cannot be adequately treated arthroscopically. In such cases, extensive open surgery may be required, either while the patient is still under anesthesia or at a later date after discussing the findings with the surgeon.
The surgeon inserts miniature scissors to trim a torn meniscus.
Advantages of Arthroscopic Surgery
While arthroscopic surgery has gained attention due to its use in treating well-known athletes, it is an invaluable tool for all orthopedic patients and is generally less burdensome for the patient compared to open surgery. Most patients undergo arthroscopic surgery as outpatients and return home within a few hours after the procedure.