Arthroscopy


What is arthroscopy?
Arthroscopy is a surgical procedure by which a joint is examined for diagnosis and/or treatment using an endoscope called as arthroscope. Typically, it is performed by specialized orthopedic surgeons in an outpatient basis, so that patients can usually return home after the procedure.

The arthroscope is a small tube that contains optical fibers and lenses, inserted through tiny incisions in the skin into the joint. The scope is connected to a video camera and the interior of the joint is seen on monitor TV.

If procedures are performed in addition to examining the joint with the arthroscope, this is called arthroscopic surgery. There are a lot of procedures that are done in this fashion. If a procedure can be done arthroscopically instead of traditional surgical techniques, it usually causes less iatrogenic tissue trauma, is painless and may promotes quicker rehabilitation.

 



Endoscope Camera

 

 

Arthroscopic tower Knee arthroscopy portals


Which diseases are suitable for arthroscopy?
Arthroscopy is helpful in diagnosis and treatment of many types of arthritis as well as various injuries within the joint.

Noninflammatory degenerative arthritis, as osteoarthritis can be seen, using the arthroscope, as erroded cartilage. Furthermore, for isolated cartilage wear in younger patients, repair of deep lesions in the cartilage, using a "paste" of a patient's own cartilage cells harvested and grown in the laboratory, has been performed using an arthroscope.

In inflammatory arthritis, such as rheumatoid arthritis, some patients can sometimes benefit by excising the pannus (synovectomy). The tissue lining the joint (synovium) can be biopsied and examined to determine the cause of the inflammation and discover infections. Arthroscopy can provide more information in situations which cannot be diagnosed by simply aspirating (withdrawing fluid with a needle) and analyzing the joint fluid

Arthroscopy is considered most valuable in cartilage tears, meniscus lesions, ligament sprains and tears, cartilage deterioration, shoulder instability and cuff arthropathy. Arthroscopy is commonly used in the evaluation of knees and shoulders but can also be used to examine and treat conditions of the wrist, ankles, and elbows.

Non inflammatory diseases Chondroplasty

 

Meniscus tear ACL tear

 

PCL tear Chondral transplantation

 

Shoulder dislocation Calcific tendonitis

 

Rotator cuff tear Ligament reconstruction


What is done in preparation for arthroscopy?
Arthroscopy is essentially a bloodless procedure and generally has few complications. The underlying health of the patient is considered when determining who is a candidate for arthroscopy. Most importantly, the patient should be able tolerate the anesthetic that is used during the procedure. Medical problems such as diabetes and high blood pressure should be considered prior to surgery.

Preoperative evaluation of a patient's health will generally include a physical examination, and blood tests. Patients who have a history of heart or lung problems and generally anyone over the age of 50 will usually be asked to obtain an electrocardiogram (EKG) and a chest X-Ray. Any signs of ongoing infection in the body usually postpones arthroscopy, unless it is being done for possible infection of the joint in question.

How is arthroscopy performed?
Arthroscopy is most often performed as an outpatient procedure. The type of anesthesia used varies depending on the joint being examined and the medical health of the patient. Arthroscopy can be performed under a general anesthetic, a spinal or epidural anesthetic, a regional block (where only the extremity being examined is numbed), or even a local anesthetic. After adequate anesthesia is achieved, the procedure can begin. An incision is made on the side of the joint to be examined and the arthroscope is inserted into the incision. Other instruments are sometimes placed in another incision to help maneuver certain structures into the view of the arthroscope. In arthroscopic surgery, additional instruments for surgical repairs are inserted into the joint through the arthroscope. These instruments can be used to cut, remove, and sew damaged tissues. Once the procedure is completed, the arthroscope in removed and the incisions are sutured. Sterile dressing is placed over the incision and ice therapy begins immediately.

Cannula No sutures but strips


What are the advantages with arthroscopy?
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 orthopaedic patients and is generally easier on the patient than "open" surgery. The technique is the gold standard in examination of the joint, navigating the scope in the furthest anatomical structures. There is no blood loss, no severe pain, no severe danger in anesthesia and the surgeon has the possibility performing several repairs at the same time when needed. Most patients have their arthroscopic surgery as outpatients and are home several hours after the surgery.

What about the recovery after arthroscopy?
Immediately after arthroscopic surgery, patients may be sleepy, especially if a general anesthetic has been used. Medications are administered to control pain if needed. If a local anesthetic has been used, there may be no pain at all immediately after the procedure. For several days after arthroscopy, patients will generally be asked to rest and elevate the joint while applying ice packs to minimize pain and swelling. After surgery, a physical therapy program is gradually started that strengthens the muscles surrounding the joint and prevents scarring (contracture) of surrounding soft tissues. The goal is to recover stability and strength of the joint rapidly and safely, while preventing the build-up of scar tissue. Rehabilitation is absolutely individualized to each patient.


Regional block

What are the possible complications?
Although uncommon, complications do occur occasionally during or following arthroscopy. Infection, phlebitis (blood clots of a vein), excessive swelling and instrument breakage are the most common complications, but occur in far less than 1 percent of all arthroscopic procedures. Nevertheless, such complications are easily overtaken


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