Arthroscopy

Getting a Close Look into the Joints

Gone are the days when orthopaedic surgeons needed to perform open surgery on damaged shoulders and knees, leaving patients to recovery initially in the hospital and followed by rehabilitation for several weeks, if not months.

Today, these conditions affecting joints can be surgically diagnosed and treated in less time, without opening the joint and splitting muscles. In most cases, patients can go home the same day and return to normal activities within weeks or even less.

How is this possible? Through the use of arthroscopy which, in recent decades, has revolutionized orthopaedic surgery.

Arthoscopic surgery is the least traumatic surgery with the best potential for correcting the problem. It also allows for immediate rehabilitation so that a patient is back to normal activities as soon as possible.

Arthroscopy is a direct viewing technique, using fiberoptic lighting directed through a thin tube called an arthroscope that is inserted into the joint without making the large incision required with a standard operation. This permits diagnosis of problems that cannot be revealed by physical examination or by other diagnostic tests.

Through this procedure, an arthroscope is inserted into the joint through a puncture-size incision in the skin that extends downward through the joint capsule or lining. A balanced salt solution is pumped into the joint through the arthroscope to expand the joint capsule for a clearer view of the internal anatomic structures of the joint.

A small camera attached to the arthroscope allows the surgeon to directly view the joint on a television monitor. The arthroscope has angles of 30 degrees and negative 10 degrees to see around corners.

Using the arthroscope, orthopaedic surgeons can diagnose what is wrong inside the joint and repair damage from disease or injury. “The advantage over open surgery is that recovery is usually quicker after arthroscopic surgery since smaller incisions damage little of the overlying anatomic structures.”

The joint may be bent, extended and manipulated so that different areas can be viewed. Then if surgery is necessary, it is usually done at this time by inserting special instruments into the joint through additional small incisions to cut, shave, and remove torn meniscal cartilage, tissue fragments or bone chips, drain blood and repair or reconstruct torn ligaments, or scrape away rough or soft cartilage.” One of the areas where arthroscopic surgery has had the greatest impact is in treating shoulder injuries.

The shoulder joint is prone to injury since it is very mobile. “Overhead repetitive movements and sudden trauma can damage the tissues inside the shoulder. This can cause pain, swelling, weakness, instability, and limitation of movement of the shoulder joint. Although symptoms, physical examination, X-rays, arthrograms and MRI scan tell us a great deal about the nature of the problem, we often need to use shoulder arthroscopy to determine more precisely what is wrong.” The types of disorders that can be diagnosed with arthroscopy include tears involving rotator cuff and long-head biceps tendons, swelling, abnormal anatomic formations, anterior ligament complex, detachments, loose fragments (loose bodies), and synovitis (inflammation of shoulder or knee tissue) arthritis.

Most people undergoing an arthroscopic procedure are able to go home immediately after the procedure.

Afterward, there may be some mild soreness and a slight crepitation sensation in the joint; these should subside within several days. Many people are able to resume their normal activities within a reasonable amount of time, depending on the type of problem and their physical condition, and after consulting with their surgeon.