Arthroscopy is an examination of the interior of a joint by means of an arthroscope inserted into the joint through a small incision in the skin. An arthroscope is a small tubular instrument that contains a light and tiny camera attached to a closed-circuit monitor that displays an enlarged, real-time image. An arthroscope may be about the width of a pencil or smaller, depending on the affected joint.
One of the most common orthopedic measures in the United States, arthroscopy is usually an outpatient procedure. It can be performed on patients of any age but most commonly on those between 20 and 60 years.. Arthroscopy is used selectively, generally only after nonsurgical options (e.g., medications, joint supports, physical therapy) have been exhausted, but in a few conditions, such as acute trauma, it may be used earlier.
Arthroscopy allows for the examination, diagnosis and repair of minor joint problems with only a few small incisions. It is most commonly performed on the knees and shoulders but can also be used on the elbows, wrists, hips, ankles or other joints. It may be useful in diagnosis when other methods such as x-rays or MRI are inconclusive.
It may also be used to collect joint tissue for biopsy and in the treatment and the monitoring of disease and treatment progress. Arthroscopy may be necessary when a patient is experiencing persistent pain, swelling, or giving-way of the joint and other treatments have failed or provided only minimal effectiveness.
A similar procedure known as laparascopy can be performed through an incision in the abdominal region to identify and treat sources of abdominal pain or pelvic pain. Endoscopy involves insertion of a similar scope via the throat or the rectum to diagnose causes of chest pain or abdominal pain.
Arthroscopy may be used to confirm diagnosis of or treat a large number of conditions, including acute trauma to soft tissues. These may be removed, repaired or reconstructed. Examples of such injuries, which often occur during sports, include:
Injury to muscles and tendons that connect the upper arm bone (humerus) to the shoulder blade (scapula).
Arthroscopic surgeons can complete tasks such as repairing tears or performing acromioplasty, which involves shavin bone from a point (acromion) on the scapula.
A complete tear requires extensive rehabilitation to restore function and ease knee pain.
Injury to the cartilage disc (meniscus) between the two surfaces of a joint. These are often allowed to heal naturally. However, arthroscopy may be used to repair these injuries if the tear is complex or the symptoms occur daily. Also, it may be completed if general function is hindered or if leaving the injury unrepaired may cause further damage.
Arthroscopy may be used in treating tears to the Achilles tendon, a common cause of foot pain.
Other conditions in which arthroscopy may used include:
A chronic, inflammatory form of arthritis. Affected portions of the synovium (fluid sac lubricating the joints) may be removed with arthroscopic assistance.
Arthritis caused by infection. Arthroscopy may be used to wash out the joint. This may provide minor, temporary relief.
Degenerative bone arthritis. The use of arthroscopy in the treatment of OA is controversial. Some studies suggest that it provides little or no more benefit than a placebo. However, arthroscopy may be used to smooth off the roughened edges of bone. This is widely done in the knee. It may offer temporary relief of symptoms and may slow down the arthritic process, but it cannot stop the disease.
Softening or degeneration of the cartilage in the joint. This may be identified with arthroscopy. If it is not extensive, it can be treated with arthroscopy, but extensive chondromalacia may require other treatment methods.
Patellofemoral syndrome (runner’s knee)
Arthroscopic shaving of the patella (kneecap) is sometimes recommended to address difficult cases of this overuse injury, a common cause of knee pain.
Loose fragments of bone or cartilage in the joint. These may be identified and removed with arthroscopy.
Compression of the median nerve in the wrist. An arthroscopic technique called endoscopic carpal tunnel release (ECTR) has in recent years become a popular alternative, when appropriate, to traditional open carpal tunnel release surgery.
Types of repetitive stress injury that affect tendons and muscles in the elbow. Arthroscopic surgery can removed damage tissues and release tendons to relieve these causes of elbow and arm pain.
Accumulation of blood in the joint. The blood can be drained during arthroscopy.
This may include the abnormal alignment or instability of the joint. Arthroscopy may be used to correct this.
These may be removed via arthroscopy.
Sometimes arthroscopy is used to determine whether surgery is needed for a broken bone, such as in the glenohumeral region of the shoulder.
Damage to the cartilage rim of the socket-like acetabulum in the hip. In some cases, arthroscopic repair of a torn labrum may prevent degeneration of the hip and avert or delay the need for a hip joint replacement (arthroplasty).
Inflammation of the synovium. Synovectomy (removal of the synovium) may be performed with arthroscopic assistance.
Joint tissue biopsies may be collected and some instances of infection treated during arthroscopy.
Impingement of the radial nerve in the elbow. Symptoms are similar to those of tennis elbow. Arthroscopy may be recommended if conservative treatments such as occupational therapy fail.
Arthroscopy may be used to examine crystal formations in these arthritic conditions.
Arthroscopy might be an option if noninvasive methods fail to stretch the capsule, increase range of motion and ease shoulder pain.
The patient’s baseline data is gathered prior to the procedure. A physician evaluates the patient’s medical history, including symptoms and allergies, and conducts a physical examination to assess motion, stability, strength and alignment of the joint.
Arthrography or other x-rays are taken of the joint, and the physician may order other tests, such as MRI (magnetic resonance imaging), bone scan or blood tests. The benefits and risks involved with arthroscopy are discussed with the patient.
The patient is typically instructed not to eat anything for at least six hours before the procedure. Small amounts of clear liquids (e.g., water, apple juice) may be allowed up to a few hours before the surgery.
Local, regional or general anesthesia may be used during arthroscopy depending upon the wishes and needs of the individual patient and surgeon. A tourniquet is usually applied above the operative joint to decrease blood loss and increase visibility. The procedure itself generally lasts about an hour, occasionally as long as an hour and a half.
The surgeon makes a small incision in the skin around the joint and inserts an arthroscope. The joint is then filled with a sterile saline solution to provide a better view.
Surgical instruments (e.g., scissors, clamps, shavers, lasers) can be inserted either through the arthroscope or through additional small incisions. Damaged tissues are then removed or repaired.
- Removal or repair of torn cartilage
- Reconstruction of a torn ligament or tendon
- Trimming and smoothing of rough areas of bone
- Removal of loose fragments of bone or cartilage
- Removal of inflamed synovium (the fluid sac lubricating the joint)
After surgical repair, the arthroscope and other instruments are removed. The joint is flushed with a sterile saline solution. The incision may be closed by suture, paper tape or stitches, and the joint is covered with a bandage.
After the procedure is complete, the patient is taken to a recovery room for a few hours. Vital signs are monitored until the patient is stable and surgical dressing is inspected for drainage and reinforced. The patient is taught to recognize and report symptoms that may indicate complications, such as severe or persistent pain, excessive drainage, redness, swelling or fever.
The physician may prescribe analgesics for pain and nonsteroidal anti-inflammatory drugs (NSAIDs) for pain and inflammation. Antibiotics may be given to help prevent infection. Devices such as splints, slings, crutches, canes and walkers may also be prescribed.
The patient is typically allowed to go home in one or two hours. It will be necessary for someone to drive the patient home. The joint will need to be wrapped, rested, iced and elevated for several days following the procedure to reduce swelling and pain.
The surgical dressing may typically be removed the day after surgery. The patient may be allowed to shower but will be instructed to avoid directing water at the incisions and will be prohibited from soaking in a tub. The incisions need to be kept clean and dry. Physical therapy or occupational therapy, including gradually progressive exercises of the joint, may be recommended.
Several follow-up appointments may be necessary. Typically, during the first of these, the physician removes the sutures, tape or stitches. The patient can usually resume daily activities within a few days, but the joint may require several weeks to fully recover.
Arthroscopies are now a very common procedure and have very few complications. However, there is always a small risk of complications from the anaesthetic. In addition there is a chance of infection of the cut into the joint or of the joint itself although this is rare. Occasionally a thrombosis (blood clot) may result in the leg following arthroscopy of the knee which may require drug treatment to thin the blood. Again this is an unusual complication.
An arthroscopic meniscectomy is one of the more common types of operation performed on the knee using an arthroscope. Inside the knee there are two discs of cartilage called the menisci by doctors but are commonly referred to as the 'cartilages'. These structures act to pad the shock waves through the knee during activity and help to assist the smooth gliding of the lower leg bone (the tibia) against the upper leg bone (the femur). A common knee injury is where one of these menisci becomes torn. This tends to cause knee pain and sometimes locking or giving-way of the knee.
Before arthroscopes were invented if surgery was needed the whole knee joint had to be surgically opened, with all the possible complications and extended recovery time associated with a major operation. An arthroscopic meniscectomy means that part or all of the affected cartilage can be removed using instruments inserted through the arthroscope itself or through the second incision mentioned above.
After this operation it is important for the patient to follow the instructions of the surgeon. In general the individual will be able to weight bear after only a few days and return to work within a week or so depending on whether the job involves heavy lifting or not.
Another fairly common knee injury is something called a ruptured cruciate ligament. A number of famous footballers have had this injury which involves the rupture (break) of one or both cruciate ligaments which are ligaments inside the knee joint which cross over each other - hence the name 'cruciate'. These ligaments provide stability to the joint. Therefore it is particularly important to repair them in sportsmen/women or those who are very active since otherwise the knee remains unstable and prone to wear and tear.
Again this operation used to require opening the knee joint. However, nowadays it is frequently done using arthroscopic techniques. The operation is quite complicated and therefore the surgeon sometimes uses additional techniques to help him see exactly what is going on inside the joint during surgery including computer graphics and the use of special dyes inside the joint. The ligament is repaired using sutures or grafts introduced into the joint such as a piece of tendon from the kneecap being used to bridge the gap in the ruptured ligament.
A period of rest and physiotherapy is again needed after this operation although a return to most normal activities is possible within about two weeks although the surgeon may restrict more vigorous activities until he is happy with the progress of the patient.
Arthroscopies are used for diagnosis and treatment of other joint conditions and have now become a very common, safe and effective form of management for a number of joint problems.
Arthroscopy offers many diagnostic and therapeutic benefits. It is the most accurate method of diagnosing the cause of internal damage in the joints. It may be used to visualize issues that may not be noticed on x-rays or during an MRI (magnetic resonance imaging). False-positive and false-negative results are typically rare.
Therapeutically, arthroscopy can provide results comparable to open surgeries for certain conditions with fewer complications. The incidence of disease and rate of infection are both reduced. Range of motion is not as likely to be reduced, and less recovery time is needed. Arthroscopy is often, but not always, less costly than open surgeries. But in some cases open surgery is needed.
Risks of arthroscopy are relatively low. Complications are very rare and, when they do occur, are generally minor and treatable.
- Hemarthrosis (blood accumulation within the joint)
- Blood clots
- Synovial cyst (in the fluid sac lubricating the joints)
- Damage to nerves, blood vessels or other soft tissues
Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions about arthroscopy:
- What is the purpose of the arthroscopy recommended for me? Will it be used for diagnosis only or for treatment as well?
- Do I have any noninvasive alternatives? Will I need more-invasive surgery if this procedure does not bring results?
- Do I need to do anything to prepare for my arthroscopy?
- How long will my surgery last?
- What sort of anesthesia will I receive?
- What are the possible risks of my surgery?
- Will I experience much pain?
- What medications might I receive afterward?
- What can I realistically expect from this arthroscopy?
- What will happen if I delay this surgery?
- How many follow–up appointments will I need?
- Will I need physical or occupational therapy?
- About how long will it be before my joint recovers?
- How long may the results of my arthroscopy last?