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Procedure
Arthroscopy is done to both diagnose and treat conditions of several joints of the body. Almost always performed in an outpatient setting, these procedures have become one of the most common types of orthopedic surgery.
This procedure takes about an hour and can be done on either an inpatient or outpatient basis. There is no special preparation, but the patient may be asked to fast for 8 to 12 hours beforehand.
The joint, particularly the knee, may be wrapped in an elastic bandage, or a tourniquet may be used to keep as much blood as possible away from the joint. A local anesthetic is injected and a small incision made through which an endoscope - in this instance an arthroscope - is inserted. The joint may be rotated to several positions of extension and flexion during the procedure.
Various attachments to the endoscope may be used to irrigate the joint or take a biopsy specimen. There may be some pressure or discomfort from the tourniquet or the procedure.
The incision will be sutured and bandaged, and although the patient may walk or use the joint afterward, excessive use should be avoided for several weeks.
Although used primarily on the knee, arthroscopy is an appropriate procedure for many other joints, such as the shoulder, ankle, and elbow. Arthroscopy is a key diagnostic procedure and is more accurate than x-rays because it reveals soft tissue in addition to bones.
An orthopedic surgeon may recommend arthroscopy to confirm a diagnosis or to make a diagnosis that was not possible through other means. Often, the problem can be surgically corrected during the diagnostic arthroscopy.
Arthroscopic surgery may also be indicated when pain, instability, and inability to use the joint persist despite nonsurgical treatment. Through tiny incisions, an endoscope (a miniature fiber-optic telescope) is inserted into the joint. On a video monitor, the surgeon can see the joint in color and in motion while performing major surgery. Patients can often go home on the same day.
Arthroscopic surgery disturbs and displaces a joint to a far lesser degree than conventional surgery and minimizes the amount of invasion, discomfort, scarring, and recovery time.
In conventional surgery, a large incision is needed and has associated risks, which include infection, poor healing, and a long, disfiguring scar. The injuries inflicted by conventional surgery often take longer to heal than surgical repair within the joint.
Knee. Problems with several aspects of the knee may be diagnosed and repaired through arthroscopy. This includes meniscus tears and injuries to the cruciate ligaments. An arthroscope allows a thorough analysis of knee problems, can be used to diagnose ligament tears, see toughened surfaces, and plan open-knee surgery. After arthroscopy, the knee may feel slightly uncomfortable and a gurgling noise may be heard for a time when walking. After about four weeks or less of mild exercise, regular sports can often be resumed.
Shoulder. Irritation of the rotator cuff tendon - an injury prevalent among tennis players and others who use the shoulder area in sports or work-related activities - is frequently diagnosed arthroscopically. Treatment includes shaving down the torn tendon edges and trimming the underside of the acromion (shoulder blade), a source of irritation. Arthroscopy is also used in the diagnosis and treatment of dislocations and arthritis in the shoulder.
Ankle. Many ankles are arthroscoped because of degenerative arthritis, which is often due to an injury. Treatment consists of smoothing the rough areas of cartilage. In advanced cases of arthritis, fusing the bones is an option. Joint lining problems, bone spurs, loose bodies, and torn ligaments are also diagnosed and treated arthroscopically.
Elbow. Elbow problems usually involve loose or fragmented tissue or bone and worn cartilage due to arthritis, repeated overuse, or injury. Arthroscopy is used to smooth roughened cartilage. It can also help other elbow conditions including bone spurs and joint lining problems.
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