What is Arthroscopic Surgery?
Arthroscopy is a surgical procedure by which the internal structure of a joint is examined for diagnosis and/or treatment using a tube-like viewing instrument called an Arthroscopy. Arthroscopy was popularized in the 1960s and is now common practice throughout the world. Typically, it is performed by orthopedic surgeons in an outpatient setting. When performed in the outpatient setting, patients can usually return home after the procedure.
If procedures are performed in addition to examining the joint with the Arthroscopy, this is called arthroscopic surgery. There are a number of procedures that are done in this fashion. If a procedure can be done arthroscopically instead of by traditional surgical techniques, it usually causes less tissue trauma, results in less pain, and may promote a quicker recovery.
Why is Arthroscopic Surgery Necessary?
Diagnosing joint injuries and disease begins with a thorough medical history, physical examination, and usually X-rays. Additional tests such as magnetic resonance imaging (MRI) or computed tomography (CT) also scan may be needed.
Through the Arthroscopy, a final diagnosis is made, which may be more accurate than through “open” surgery or from X-ray studies.
Disease and injuries can damage bones, cartilage, ligaments, muscles, and tendons. Some of the most frequent conditions found during arthroscopic examinations of joints are:
For example, synovitis is an inflammation of the lining in the knee, shoulder, elbow, wrist, or ankle.
Acute or Chronic Injury
- Shoulder: Rotator cuff tendon tears, impingement syndrome, and recurrent dislocations
- Knee: Meniscal (cartilage) tears, chondromalacia (wearing or injury of cartilage cushion), and anterior cruciate ligament tears with instability
- Wrist: Carpal tunnel syndrome
- Loose bodies of bone and/or cartilage: for example, knee, shoulder, elbow, ankle, or wrist
Some problems associated with arthritis also can be treated. Several procedures may combine arthroscopic and standard surgery.
- Rotator cuff surgery
- Repair or resection of torn cartilage (meniscus) from knee or shoulder
- Reconstruction of anterior cruciate ligament in knee
- Removal of inflamed lining (synovium) in knee, shoulder, elbow, wrist, ankle
- Release of carpal tunnel
- Repair of torn ligaments
- Removal of loose bone or cartilage in knee, shoulder, elbow, ankle, wrist.
Although the inside of nearly all joints can be viewed with an Arthroscopy, six joints are most frequently examined with this instrument. These include the knee, shoulder, elbow, ankle, hip, and wrist. As advances are made in fiberoptic technology and new techniques are developed by orthopaedic surgeons, other joints may 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 anesthetics and the special equipment in a hospital operating room or outpatient surgical suite. You will be given a general, spinal, or a local anesthetic, depending on the joint or suspected problem.
A small incision (about the size of a buttonhole) will be made to insert the Arthroscopy. Several other incisions may be made to see other parts of the joint or insert other instruments.
When indicated, corrective surgery is performed with specially designed instruments that are inserted into the joint through accessory incisions. Initially, arthroscopy was simply a diagnostic tool for planning standard open surgery. With development of better instrumentation and surgical techniques, many conditions can be treated arthroscopically.
For instance, most meniscal tears in the knee can be treated successfully with arthroscopic surgery.
After arthroscopic surgery, the small incisions will be covered with a dressing. You will be moved from the operating room to a recovery room. Many patients need little or no pain medications.
Before being discharged, you will be given instructions about care for your incisions, what activities you should avoid, and which exercises you should do to aid your recovery. During the follow-up visit, the surgeon will inspect your incisions; remove sutures, if present; and discuss your rehabilitation program.
The amount of surgery required and recovery time will depend on the complexity of your problem. Occasionally, during arthroscopy, the surgeon may discover that the injury or disease cannot be treated adequately with arthroscopy alone. The extensive “open” surgery may be performed while you are still anesthetized, or at a later date after you have discussed the findings with your surgeon.
What are the Advantages of Arthroscopic Surgery?
Although arthroscopic surgery has received a lot of public attention because it is 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. Most patients have their arthroscopic surgery as outpatients and are home several hours after the surgery.