What is arthroscopy?

Arthroscopy (Greek words: arthros = joint, skopion = to look) simply means to look into the joint. This is a surgical procedure. The surgeon makes a small about 5-millimeter size incision to put an arthroscope into the joint. The arthroscope is a small, pencil – sized, metallic instrument. It contains a system of lenses and is attached to fibreoptic cables. A small, match - box sized powerful camera and a light source is attached to the end of the arthroscope, which is outside the joint.

The joint is illuminated to a desired amount through the fibreoptic cables. The camera takes the picture of the joint. The picture is displayed on a monitor of the size of a domestic television. With this advanced tool almost all the nooks and corners, different parts and components of a joint can be clearly and easily seen. Any disease affecting the inside of a joint can be seen and diagnosed. Various surgical procedures can be performed under this arthroscopic vision.

Why is arthroscopy necessary?

Joints are very essential to us. Injuries and disease can affect a joint. It is important to know what has gone wrong in a joint when a patient complains of a joint problem. A doctor evaluates the affected joint by asking relevant questions to the patient. Certain blood tests, X-rays and CT or MRI of the joint are taken.

Arthroscopy helps to see the insides of the joint. The surgeon can at the same time rectify the problem. Patients get the benefit of accurate diagnosis, arthroscopic operation and this avoids an ‘open’ operation.

What are the conditions that can be diagnosed with arthroscopy?

A wide variety of injuries and diseases affecting the different components of a joint can be diagnosed by arthroscopy. The most frequent conditions found during arthroscopic examinations of joints are:

* Inflammation of joint lining (synovium) – synovitis.
*Injuries both fresh (acute) and old (chronic) – affecting joint cushions (meniscus’ tear), structure providing mechanical stability to joints ( ligaments’ rupture), shiny layer of joint (cartilage’s injury), and bones (cysts, fractures, loose bodies).
* Mechanical factors like maltracking of knee cap (patella), mechanical locking of knee (bucket handle tear of meniscus), incongruity of joint surfaces and instability of joints.
* Abnormal factors from birth (congenital) like abnormal fold of joint lining (plica), abnormal joint cushion (discoid meniscus) and bony malformations.

Which are the joints subjected to arthroscopy?

The knee, shoulder and ankle joints are nowadays commonly subjected to arthroscopic examination and operations. The other joints are the elbow and the wrist. As advances in engineering and production of finer instruments take place, there is a possibility of extending these procedures to other smaller joints like finger joints and deep joints like the hip in near future.

How is arthroscopy performed?

Arthroscopy is an operation that requires anaesthesia. Whole body anaesthesia (general anaesthesia), below the waist anaesthesia (spinal or epidural anaesthesia), one limb only (regional anaesthesia) or local anaesthesia may be used.

A small stab incision, about the size of a buttonhole, is made over the joint. This is just sufficient for the entry of an arthroscope into the joint. In a systematic procedure, a joint is visualized by rotating the arthroscope to get a view of the different positions of the joint. Through similar holes other operating instruments are put into the joint. Some examples of such operations are:

*In knee joint: synovial biopsy, removal of loose bodies, removal of torn meniscus (partial menisectomy), removal of diseased synovium (partial synovectomy) and repair or reconstruction of ligaments and meniscus.
*In shoulder joint: loose bodies removal, repair of torn cushion (labrum), repair of shoulder movers (rotator cuff) and stabilisation of loose joint and a shoulder which dislocates repeatedly and easily with certain movements often known as recurrent dislocation of shoulder.

What happens after arthroscopy?

After arthroscopic operation is over, the stab incisions and other incisions are stitched. A clean dressing is put over the joint. Pain killers and antibiotics are prescribed. After the minor procedure (e.g. partial menisectomy) one can go home on the day of operation. For major operations (e.g. ligament reconstruction), one has to stay in the hospital for a couple of days.

The patient is made to walk with support on the day of operation or next day depending on the nature of operation and the pain tolerance. Physiotherapy is essential after the operation for the best result. Special training is required for athletes to resume their sport.

What are the possible complications?

Complications are infrequent and occur in less than 1 percent of all arthroscopic procedures. They include infection, excessive swelling or bleeding, and damage to the blood vessels or nerves.

Although the puncture wounds are small and pain in the joint that underwent arthroscopy is minimal, it may take a few weeks for the joint to recover fully if a major surgical repair has been done.

 

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