Arthroscopy (arthroscopic surgery) is a minimally invasive surgical procedure on a joint. The examination and damage treatment is performed using an arthroscope. This means an endoscope is inserted into the joint through a small incision and arthroscopic procedures are performed in cases such as torn cartilage (meniscus), torn surface (articular) cartilage, ACL reconstruction, trimming damaged cartilage, etc.
Minimally-invasive arthroscopic procedures are also performed for treatment of:
• spinal disc herniation and degenerative discs
• spinal deformity
• tumors
• general spine trauma
The advantage over traditional open surgery is that the joint does not have to be opened up fully. For knee arthroscopy only two small incisions are made, one for the arthroscope and one for the surgical instruments to be used in the knee cavity. This technique reduces recovery time and may increase the success rate due to less trauma to connective tissue. Arthroscopy is especially useful for professional athletes, where frequently injured knee joints require special technique and faster healing time. MI also means smaller incisions, thus less scarring.
The arthroscopy instruments are smaller than traditional surgical instruments. Doctors view the joint area on a video monitor, and can diagnose and repair torn joint tissue, such as ligaments and menisci or cartilage.
It is technically possible to do an arthroscopic examination of almost every joint, but is most commonly used for the knee, shoulder, elbow, wrist, ankle, foot, and hip.
Minimally invasive approach
The double incision surgery and minimally invasive surgery seeks to reduce soft tissue damage through reducing the size of the incision. However, component positioning accuracy and visualization of the bone structures is significantly impaired. This can result in unintended fractures and soft tissue injury. Surgeons using these approaches are advised to use intraoperative x-ray fluoroscopy or computer guidance systems.
Computer-assisted arthroscopic surgery techniques and approach
Computer-assisted surgery techniques are also available to guide the surgeon to provide enhanced accuracy. Several commercial CAS systems are available for use worldwide. HipNav was the first system developed specifically for total hip replacement, and included navigation and preoperative planning based on a preoperative CT scan of the patient. Improved patient outcomes and reduced complications have not been demonstrated when these systems are used when compared to standard techniques.
Knee arthroscopy
Knee arthroscopy has in many cases replaced the classic arthrotomy that was performed in the past. Today knee arthroscopy is commonly performed for treating meniscus injury, reconstruction of the anterior cruciate ligament and for cartilage microfracturing. Arthroscopy can also be performed just for diagnosing and checking of the knee; however, the latter use has been mainly replaced by magnetic resonance imaging.
Osteoarthritis
Arthroscopic surgeries of the knee are done for many reasons, but it is not clear whether it is more effective for osteoarthritis than more conservative therapies.
Because there is no confirmed benefit for these surgeries in cases of osteoarthritis of the knee, many payors are reluctant to reimburse surgeons and hospitals for what can be considered a procedure which seems to create the risks of surgery with questionable or no demonstrable benefit. However this is still a widely adopted treatment for a range of conditions including Labral tears, Femoroacetabular impingement, Osteochondritis dissecans.
Meniscal tears
A torn meniscus is in a majority of cases non-symptomatic. One of the primary reasons for performing arthroscopies is to repair or trim a painful and torn or damaged meniscus. The surgery is known as an arthroscopic partial meniscectomy (APM). Arthroscopic surgery, however, does not appear to result in benefits in adults with mild osteoarthritis who have a meniscal tear.
Knee arthroscopy recovery
After knee arthroscopy there will be swelling around the knee, which can take anywhere from 7–15 days to completely settle. It is important to wait until there is no swelling before doing any serious exercise or extensive walking, because the knee will not be fully stable; extensive exercise may cause pain and in some cases cause the knee to swell more. The spread of the swell might cause serious problems.
Hip arthroscopy
Hip arthroscopy was initially used for the diagnosis of unexplained hip pain, but is now widely used in the treatment of conditions both in and outside the hip joint. The most common indication currently is for the treatment of femoroacetabular impingement (FAI) and its associated pathologies. Hip conditions that may be treated arthroscopically also includes labral tears, loose / foreign body removal, hip washout (for infection) or biopsy, chondral (cartilage) lesions, osteochondritis dissecans, ligamentum teres injuries (and reconstruction), Iliopsoas tendinopathy (or ‘snapping psoas’), trochanteric pain syndrome, snapping iliotibial band, osteoarthritis (controversial), sciatic nerve compression (piriformis syndrome), ischiofemoral impingement and direct assessment of hip replacement.
Shoulder arthroscopy
Arthroscopy is commonly used for treatment of diseases of the shoulder including subacromial impingement, acromioclavicular osteoarthritis, rotator cuff tears, frozen shoulder (adhesive capsulitis), chronic tendonitis, removal of loose bodies and partial tears of the long biceps tendon, SLAP lesions and shoulder instability. The most common indications include subacromial decompression, bankarts lesion repair and rotator cuff repair. All these procedures were done by opening the joint through big incisions before the advent of arthroscopy. Arthroscopic shoulder surgeries have gained momentum in the past decade. 'Keyhole surgery' of the shoulder as it is popularly known has reduced inpatient time and rehabilitation requirements and is often a daycare procedure.
Wrist arthroscopy
Arthroscopy of the wrist is used to investigate and treat symptoms of repetitive strain injury, fractures of the wrist and torn or damaged ligaments. It can also be used to ascertain joint damage caused by wrist osteoarthritis.
Spine arthroscopy
Many invasive spine procedures involve the removal of bone, muscle, and ligaments to access and treat problematic areas. In some cases, thoracic (mid-spine) conditions requires a surgeon to access the problem area through the rib cage, dramatically lengthening recovery time.
Arthroscopic (also endoscopic spinal procedures) allow access to and treatment of spinal conditions with minimal damage to surrounding tissues. Recovery times are greatly reduced due to the relatively small size of incision(s), and many patients are treated as outpatients. Recovery rates and times vary according to condition severity and the patient's overall health.
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