Arthroscopy

Overview

Arthroscopy, a minimally invasive alternative to typical open surgical methods and today the most routinely done orthopedic surgical procedure, was one of the twentieth century's most significant developments in orthopedic surgery.

 

What is an Arthroscopy?

Arthroscopy is a surgical treatment that allows a doctor to examine the insides of your joints. The doctor uses a narrow viewing device known as an arthroscope, or scope. It enables the doctor to examine the joint surfaces as well as the tough tissue that covers and cushions the ends of the bones (cartilage). The doctor can also observe the soft tissues that surround the bones, such as the tissue that links them (ligaments).

Minimally invasive operations cause less postoperative edema than open procedures and decrease discomfort, complications, and recovery times. Arthroscopy has grown from a diagnostic tool to a therapeutic instrument capable of treating a wide range of injuries and diseases. Many injuries, particularly those that would have ended an athlete's career in the past, can now be treated with arthroscopy, allowing for a faster recovery to full function.

While arthroscopy has reduced morbidity overall when compared to open methods, it is still an intrusive operation with inherent dangers. Almost all arthroscopic operations may be done as an outpatient treatment. Ochsner conducted 211 arthroscopic operations in 1999.

 

Understanding joints

A joint is the point at which two bones come together. Joints allow various components of the body to move and be flexible. Muscles pull on tendons that are linked to the bones to provide bone movement.

The end of bones is protected by cartilage. A little quantity of thick fluid called synovial fluid exists between the cartilage of two bones that form a joint. This fluid lubricates the joint, allowing for smooth movement of the bones.

The tissue around a joint produces synovial fluid (the synovium). The capsule refers to the synovium's outer layer. This is robust, provides joint stability, and prevents the bones from sliding 'out of joint.' Surrounding ligaments and muscles also contribute to joint support and stability.

The cartilage covering the lower region of the knee joint thickens in the inner and outer parts of the joint. These two cartilage regions are known as menisci. The menisci in the knee operate as shock absorbers and are occasionally damaged after a knee injury. In addition, there are two strong cross-shaped (cruciate) ligaments in the center of the knee joints that connect to the ends of the calf bone (tibia) and the thigh bone (femur). These can also be torn as a result of a knee injury.

 

When is Arthroscopy used?

Disease and injury may all harm your bones, cartilage, ligaments, muscles, and tendons. Your doctor will conduct a full medical history, a physical examination, and request imaging procedures, generally x-rays, to diagnose your problem. A further imaging investigation, such as a magnetic resonance imaging (MRI) scan or a computed tomography (CT) scan, may be required for some disorders. Your doctor will select the best treatment option for your disease after establishing a diagnosis.

 

Conditions

Conditions that are commonly treated with arthroscopic procedures include:

• Inflammation. Synovitis, for example, is a disorder in which the tissues around the knee, shoulder, elbow, wrist, and ankle joint become inflamed.

• Acute or chronic injuries, including:

• Rotator cuff tendon tears
• Shoulder impingement
• Recurrent dislocation in the shoulder
• Meniscal (cartilage) tears in the knee
• Chondromalacia (wearing or injury of the cartilage cushion in the knee)
• Anterior cruciate ligament (ACL) tears with instability in the knee
• Carpal tunnel syndrome in the wrist
• Loose bodies of bone and/or cartilage, particularly in the knee, shoulder, elbow, ankle, or wrist

Some arthritis-related issues can also be addressed arthroscopically.

 

Benefits of Arthroscopy

Joint surgery needed long incisions and arthrotomies prior to the widespread clinical use of arthroscopy and its specialized instruments for exposure and treatment of joint disease. Arthroscopy has various advantages versus long open arthrotomies. When compared to less invasive arthroscopic treatments, longer joint exposure prolongs healing, increases discomfort, and raises the risk of complications such as infection and arthrofibrosis. In general, minimally invasive operations cause less discomfort and edema than open procedures. As a consequence, arthroscopically treated patients recover faster, begin rehabilitation sooner, and return to normal activity and employment sooner.

As treatment techniques and justifications have evolved, injuries, particularly those in sports, that would have been career-ending in the past can now be handled with arthroscopy, allowing patients to recover to full function. Anterior cruciate knee ligament injuries in runners and intra-articular shoulder pathology in throwers are two examples. While prolonged open treatments can address these issues, the comorbidity associated with open surgeries frequently precludes such patients from recovering to their pre-injury functional condition. For professional athletes, these sorts of injuries frequently resulted in the termination of their lucrative careers.

Another economical advantage of arthroscopy is that nearly all arthroscopic treatments may be performed as outpatient procedures. Some arthroscopists even have the ability to do operations in an office environment, which reduces expenses even more. Arthroscopy can be conducted under a variety of anesthetic conditions ranging from local to general. The type of anesthetic used depends on the nature of the surgery as well as the patient's and physician's preferences.

 

How to Prepare?

Arthroscopic surgery is frequently performed as an outpatient procedure, eliminating the requirement for an overnight hospital stay. Before your procedure, you may be subjected to further examinations, such as blood or urine tests. Make arrangements for someone to drive you home. You will be unable to drive or go home on your own due to anesthesia and pain medication.

If you get ankle, knee, or hip arthroscopy, your doctor will discuss utilizing crutches following the treatment. If you undergo arthroscopy on an arm joint, you will most likely need to wear a sling or splint afterwards.

 

How it is Done?

You will be asked to take off any jewelry and put on a hospital gown. To assist you relax before the treatment, you may be given a sedative. Shaving the skin surrounding your joint is an option.

 

During the procedure

Local or general anesthesia can be used during arthroscopy and arthroscopic surgery. The type of anesthetic used is determined by the joint being evaluated as well as several other factors. The skin around the joint will be cleansed. You will be asked to take the optimal position for the process. For example, for knee surgeries, you may need to lie on your back with your knee bent, or on your side for shoulder procedures, and so on. To limit blood flow during knee arthroscopy, a pressure band (tourniquet) may be wrapped around the upper part of the leg.

The surgeon creates a tiny incision (cut) near to the joint that is only a few millimetres long. The narrow telescope with a light source (the arthroscope) is inserted into the joint through the incision. A pencil-sized arthroscope is used to examine the knee joint. Smaller joints, such as the wrist and ankle, require a thinner one. The surgeon makes one or more distinct incisions to insert:

• A thin examining probe into the joint; or
• Fine instruments which are used for surgery; or
• Fluid to make viewing easier and to flush out the joint.

The arthroscope sends images to a viewing screen through a camera attachment. The surgeon can view within the joint, including the ends of the probe or surgical equipment, by gazing at the screen. As a result, the surgeon spends a significant amount of time watching the viewing screen to aid him or her in moving the tools within the joint.

The arthroscope and other tools are removed once the surgery is completed. The incisions may require a stitch or two, but because the wounds are so tiny, stitches are rarely required. The incisions are covered with a sterile covering. To reduce swelling, apply an ice pack for a few minutes. A knee joint may then be wrapped with a big bandage or other knee support depending on what was done and the condition you have.

Many folks can leave the hospital right away. The types of difficulties vary. As a result, a doctor or nurse will give you advice for follow-up and what you should and should not do. For example, if you should have physiotherapy, rest, or exercise, and so on.

 

How long the test takes?

The length of the operation is determined by what is done. It may just take 15 minutes. However, it might take an hour or more.

 

How it Feels?

If you get a local anesthetic before to the treatment, you will experience a brief burning or stinging sensation in your skin. You will feel a thumping sensation as the arthroscope is inserted into the joint. As your doctor moves joint structures around, you may feel a minor tugging in the joint region.

You will be sleeping if you have a general anesthesia. You will feel nothing. Your arm or leg will be numb for several hours if you get a regional anesthetic.

 

Knee arthroscopy

Knee arthroscopy, also known as knee scoping, is a minimally invasive medical treatment used to diagnose and treat knee problems or injuries. It is done with the use of an arthroscope, which is a small surgical device with a light and camera on the end that is introduced into the knee.

If a patient's discomfort is not responding to nonsurgical treatments such as medication, cortisone injections, or physical therapy, a doctor may prescribe knee scoping. Knee arthroscopy, in particular, is frequently effective in reducing or eliminating pain caused by cartilage or soft tissue injury.

Knee scoping is preferred by many doctors and patients over alternative treatments. This is due to the fact that the orthopedic knee surgeon just needs to create a little incision to employ the arthroscope. In most cases, there is less knee pain, less joint stiffness, and a faster recovery than with other surgeries.

 

When Knee Arthroscopy is Performed?

Knee arthroscopy can be used when making or confirming a diagnosis and performing surgery:

• Making a Diagnosis: A doctor may prescribe an X-ray or other imaging tests if a patient complains of knee discomfort. However, the clinician may want further information before proceeding with a therapy such as surgery. In this case, the doctor can do knee scoping to provide a diagnosis or confirm therapy. A doctor makes a single small incision in the knee, inserts the tiny arthroscope, and the pictures are shown on a television screen. A surgeon could use this to examine a meniscus tear to determine the degree of the injury.
• Performing Surgery: In addition to the hole for the arthroscope, tiny incisions are created at several places around the knee joint when arthroscopy is utilized for surgery. These extra incisions allow the clinician to inject microscopic surgical instruments as needed into the region. The surgeon can repair torn ligaments, remove a torn or damaged meniscus, remove loose bone fragments, and conduct additional procedures using the pictures from the arthroscope as a guide.

 

Recovery

Arthroscopy recovery is usually faster than open surgery recovery. The majority of individuals leave the hospital on the day of the procedure with detailed instructions on how to recuperate.

General recovery tips can include:

• Applying ice packs to the dressing and surrounding area to reduce swelling and pain
• Keeping the leg elevated for several days after surgery
• Resting well and often
• Changing the dressing regularly
• Using crutches and following the doctor’s recommendations about applying weight to the knee

Before a patient leaves the hospital, doctors will usually give them certain instructions. They may also prescribe pain relievers or recommend over-the-counter medications for pain treatment. In some circumstances, doctors may advise patients to take aspirin to lower their risk of blood clots.

Recovery periods might differ. Returning to mild exercise in 1-3 weeks and most other physical activities in 6-8 weeks is possible.

 

Exercises

Exercises might be beneficial both before and after knee arthroscopy surgery. Working with a physical therapist to strengthen the muscles around the knee may aid in the full recovery of the knee. Doctors may also instruct patients on how to perform minor stretches and exercises at home. Exercises are an essential component of therapy. They are required to regain complete knee strength and range of motion.

The activities chosen will be determined by the severity of the ailment and the individual's general health. Before attempting workouts at home, consult with a doctor or physical therapist.

 

Results

Most of the time, your doctor will be able to discuss the results with you immediately following the test.

 

Normal

The ligaments of a typical, healthy joint resemble white wires. The cartilage is white and smooth. There are no loose fragments of tissue in the joint, and the joint fluid is clear. If no damage or illness is visible in the joint, your doctor may determine that it is normal and not the source of your problems.

 

Abnormal

Ligaments and cartilage in a damaged or diseased joint are aberrant in color and form. Your doctor may be able to recognize the problem if there is joint injury or illness. During the arthroscopy, your doctor may even do surgery to correct the joint condition. Examples of joint injury or illness include:

• Torn, displaced, or loose fragments of soft tissues (such as ligaments or cartilage)
• Abnormal growths, cysts, or ganglions.
• Signs of joint or cartilage damage caused by injury or diseases such as arthritis.

 

Risks

Arthroscopy complications are uncommon. Joint stiffness or long-term joint discomfort might occur. Bleeding inside the joint is possible. If surgery is performed during the operation, this is more likely.

There is a slight risk of infection, a blood clot in the afflicted limb, or nerve or joint injury. There is also a little risk of structural damage within the joint.

A dangerous disease known as compartment syndrome might arise in rare circumstances. This occurs when pressure builds up inside a muscle compartment (most commonly in the front of the calf or forearm). When this happens, immediate medical attention is required to relieve the pressure. Problems with general anesthesia might result in death in very rare circumstances.

 

Conclusion 

Arthroscopy is a surgical procedure used by orthopedic surgeons to diagnose and treat joint disorders. An orthopedic surgeon performs arthroscopic surgery by making a tiny incision in the patient's skin and inserting pencil-sized equipment with a small lens and lighting system to magnify and illuminate the structures inside the joint. Light is sent to the end of the arthroscope that is put into the joint through fiber optics.