Arthroscopy (also called arthroscopic surgery) is a minimally invasive surgical procedure in which an examination and sometimes treatment of damage of the interior of a joint is performed using an arthroscope, a type of endoscope that is inserted into the joint through a small incision. Arthroscopic procedures can be performed either to evaluate or to treat many orthopaedic conditions including torn floating cartilage, torn surface cartilage, ACL reconstruction, and trimming damaged cartilage. A minimally invasive medical procedure is defined as one that is carried out by entering the body through the skin or through a body cavity or anatomical opening, but with the smallest damage possible to these structures. ... “Surgeon” redirects here. ... For other uses, see Joint (disambiguation). ... Endoscopic images of a duodenal ulcer A flexible endoscope. ...

The advantage of arthroscopy over traditional open surgery is that the joint does not have to be opened up fully. Instead, only two small incisions are made - one for the arthroscope and one for the surgical instruments. This reduces recovery time and may increase the rate of surgical success due to less trauma to the connective tissue. It is especially useful for professional athletes, who frequently injure knee joints and require fast healing time. There is also less scarring, because of the smaller incisions. Irrigation fluid is used to distend the joint and make a surgical space. Sometimes this fluid leaks into the surrounding soft tissue causing extravasation and edema ^[1] open surgery ... Connective tissue is one of the four types of tissue in traditional classifications (the others being epithelial, muscle, and nervous tissue. ... Professional sports are sports in which the participants receive payment for playing, as opposed to amateur sports where they are not. ... Extravasation refers to the leakage of a fluid out of its container. ...

The surgical instruments used are smaller than traditional instruments. Surgeons view the joint area on a video monitor, and can diagnose and repair torn joint tissue, such as ligaments and menisci. In anatomy, the term ligament is used to denote three different types of structures:[1] Fibrous tissue that connects bones to other bones. ... In anatomy, a meniscus is a moon-shaped figure. ...

Arthroscopy is used for joints of the knee, shoulder, elbow, wrist, ankle, and hip.

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 with damaged meniscus cartilage, 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. Cartilage is a type of dense connective tissue. ... The anterior cruciate ligament (or ACL) is one of the four major ligaments of the knee. ... MRI redirects here. ...

During an average knee arthroscopy, a small fiberoptic camera (the endoscope) is inserted into the joint through a small incision, about 4 mm (1/8 inch) long. A special fluid is used to visualize the joint parts. More incisions might be performed in order to check other parts of the knee. Then other miniature instruments are used and the surgery is performed.

Recovery after a knee arthroscopy is a lot faster compared to arthrotomy. Most patients can return home and walk using crutches the same or the next day after the surgery. Recovery time depends on the reason that surgery was needed and the patient's physical condition. Usually after a month a patient can fully load his leg and after a few weeks the joint function can fully recover. It is not uncommon for athletes who have a beyond average physical condition to return to normal athletic activities within a few weeks.

Arthroscopic surgeries of the knee are done for many reasons, but the usefulness of surgery for treating osteoarthritis is doubtful. A double-blind placebo-controlled study on arthroscopic surgery for osteoarthritis of the knee was published in the New England Journal of Medicine in July 2002.^[2] In this three-group study, 180 military veterans with osteoarthritis of the knee were randomly assigned to receive arthroscopic débridement with lavage, just arthroscopic lavage, or a sham surgery, which made superficial incisions to the skin while pretending to do the surgery. For two years after the surgeries, patients reported their pain levels and were evaluated for joint motion. Neither the patients nor the independent evaluators knew which patients had received which surgery. The study reported that "At no point did either of the intervention groups report less pain or better function than the placebo group."^[3] Because there is no confirmed usefulness for these surgeries, many agencies are reconsidering paying for a surgery which seems to create risks with no benefit.^[4] Osteoarthritis (OA, also known as degenerative arthritis, degenerative joint disease), is a condition in which low-grade inflammation results in pain in the joints, caused by abnormal wearing of the cartilage that covers and acts as a cushion inside joints and destruction or decrease of synovial fluid that lubricates those... The New England Journal of Medicine (New Engl J Med or NEJM) is a peer-reviewed medical journal published by the Massachusetts Medical Society. ...

Spinal 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. Diagram of a tsetse fly, showing the head, thorax and abdomen The thorax is a division of an animals body, that lies between the head and the abdomen. ...

Arthroscopic (also endoscopic) spinal procedures allow a surgeon to access and treat a variety of spinal conditions with minimal damage to surrounding tissues. Recovery times are greatly reduced due to the relatively small size of incision(s) required, and many patients are treated on an outpatient basis.^[5] Endoscopy means looking inside and refers to looking inside the human body for medical reasons. ...

Arthroscopic procedures treat:

• bulging discs / herniated discs
  
• degenerative discs
  
• spinal deformity
  
• tumors
  
• general spine trauma
  

Recovery rates and times vary according to condition severity and patient's overall health. Tumor (American English) or tumour (British English) originally means swelling, and is sometimes still used with that meaning. ...

History

Pioneering work in the field of arthroscopy began as early as the 1920s with the work of Eugen Bircher.^[6] Bircher published several papers in the 1920s about his use of arthroscopy of the knee for diagnostic purposes.^[6] After diagnosing torn tissue through arthroscopy, Bircher used open surgery to remove or repair the damaged tissue. Initially, he used an electric Jacobaeus thoracolaparoscope for his diagnostic procedures, which produced a dim view of the joint. Later, he developed a double-contrast approach to improve visibility.^[7] Bircher gave up endoscopy in 1930, and his work was largely neglected for several decades. Eugen Bircher (February 17, 1882 in Aarau-October 20, 1956) was a Swiss military leader who became associated with a pro-Nazi position in the inter-war years. ... open surgery ...

While Bircher is often considered the inventor of arthroscopy of the knee,^[8] the Japanese surgeon Masaki Watanabe, MD receives primary credit for using arthroscopy for interventional surgery.^[9][10] Watanabe was inspired by the work and teaching of Dr Richard O'Connor. Later, Dr. Heshmat Shahriaree began experimenting with ways to excise fragments of menisci.^[11]

The first operating arthroscope was jointly designed by these men, and they worked together to produce the first high-quality color intraarticular photography^[12] The field benefitted significantly from technological advances, particularly advances in flexible fiber optics during the 1970s and 1980s.

References

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External links

• The KNEEguru - educational site packed with knee content including tutorials on diagnostic knee arthroscopy by Dr Angus Strover
• Shoulder Arthroscopy
• Ankle Arthroscopy
• Shoulder SLAP tear images
• Knee 3D Presentation
• SpineUniverse Minimally Invasive Spine Surgery Information Center - Articles from different institutes, organizations, and spine professionals