The first attempts at arthroscopy were made at the beginning of the 20th century. Initially, devices were used for cystoscopy. However, for technical reasons, the successes were not significant.
It was not until the 1960s that the first arthroscopic operations were performed on the knee joint. They were mainly used for meniscus operations.
The method of knee joint arthroscopy only became established as a routine operation in the 1980s. During this time, doctors also began to use arthroscopy on other joints, such as the
Today, arthroscopic surgery is one of the most common procedures of all. The procedure is so common and easy to perform that it is increasingly being performed on an outpatient basis. Thanks to the now very small instruments, even wrists and metacarpophalangeal joints of the toes and fingers can be arthroscopized.
The large joints of the human body © freshidea / Fotolia
Arthroscopy is used for a variety of joint diseases. The most common and best known are
Tightness in the shoulder joint and tendon sutures are also often operated on arthroscopically today.
Thanks to improved technology, small joints and complex operations on large joints can increasingly be performed arthroscopically. In the future
be routinely performed arthroscopically.
Depending on the joint, arthroscopy can be performed under
- partial anesthesia,
- so-called regional anesthesia (e.g. "back anesthesia") or
- general anesthesia
can be performed. Special positioning of the leg or arm in support systems, such as a so-called leg holder, is often required for the operation.
In addition, a tourniquet cuff is applied for operations on the knee, ankle, elbow and wrist. This is similar to a cuff used to measure blood pressure and is used to prevent bleeding during the operation. This improves visibility in the joint during the operation.
The arthroscope itself consists of several parts:
- a hollow tube (sheath or trocar sleeve) with an internal rod (trocar),
- various connections for irrigation fluid and
- the optical system.
The optical system contains a lens system, a connection for the cold light cable and the camera connection. This allows the images from the joint to be transferred directly to a monitor. Modern camera systems offer the option of digital video and image documentation, processing and printing.
This is how arthroscopy works step by step:
- Many surgeons inject a local anesthetic at the site of the planned incision. This makes it easier to check the joint space with the help of the syringe needle and to achieve pain relief after the operation.
- The hollow tube (sheath with trocar) and the camera system are then inserted into the joint via a 5 to 7 mm skin incision.
- The surgeon can view the joint in many areas with high magnification via a large monitor .
- To improve visibility, flush out material and widen the narrow joint space, the joint is constantly flushed with fluid via the arthroscope.
- After an initial inspection of the joint space and visualization of the possible disease, a second skin incision is made as a working access. A small tactile hook is inserted through this. This allows the surgeon to palpate parts of the joint and check the surface and stability.
- Once pathological changes have been identified, a variety of instruments can be inserted under visualization. The surgeon uses these to operate on the inner or outer meniscus, the cartilage and many other structures.
- At the end of the operation, the camera is removed, a drain is inserted if necessary and the small incisions are sutured. A sterile bandage is applied with light compression.
Set-up of an arthroscopy - joint, instruments for diagnosis and therapy, monitor for control © bilderzwerg / Fotolia
After an arthroscopy, medication is usually only used for thrombosis prophylaxis (e.g. heparin injections). Special routine drug therapy is not necessary.
If pain occurs, the patient will of course be given painkillers.
Arthroscopic operations are generally low-risk. Serious complications occur in 1:10,000 to 1:25,000 cases, depending on the study.
In addition to the patient's pre-existing conditions, the size and severity of the operation are decisive factors.
With simple meniscus surgery, the main complications can be
- Swelling,
- pain,
- joint effusions,
- ligament stretching and
- more rarely thrombosis
occur. Major operations (cruciate ligament injuries, tendon ruptures, etc.) are associated with higher complication rates.
In general, the main risks are
- Injury to cartilage, cutaneous nerves or small blood vessels,
- thrombosis and
- infection.
More rarely, in the context of more complex longer procedures, there is also
Incompatibility of implants and suture material has recently become more common in the context of increasing allergies.
In individual cases
- Burns to the skin from electric knives,
- breakage of surgical equipment,
- damage to positioning due to excessive pressure or
- damage caused by drilling equipment
may occur. The patient will be informed in detail about the individual risks before the operation.
There is no general, generally applicable aftercare concept for arthroscopy. The follow-up treatment depends on the individual case.
In the case of simple meniscus or cartilage operations, the joint can be moved freely just a few days after the operation. Weight bearing can also be resumed quickly. This is also referred to as early functional treatment.
Occasionally, manual lymph drainage or physiotherapy is required in the event of swelling or movement disorders.
In almost all operations on the lower extremities, thrombosis prophylaxis with low-molecular-weight heparin is recommended until the patient is able to bear weight. For the first few days after the operation
- Cooling,
- rest and
- elevation
are recommended. These measures prevent excessive swelling.
For
often require more than 4 weeks of partial weight bearing. There are no standardized regulations here.
Arthroscopy is one of the most common procedures performed on people today. It is often possible on an outpatient basis. Thanks to improved technology and extensive experience, increasingly complex operations can be performed using arthroscopy.
Mini instruments now even make it possible to assess and operate on small joints such as toe joints. Operations using the arthroscopic technique
- allow faster rehabilitation,
- usually have lower risks than open operations using conventional techniques and
- and therefore enable a quick return to everyday life.
The small access points into the joint
- protect the tissue,
- reduce infections and wound healing disorders and
- are also cosmetically more favorable.
Overall, this technique offers many advantages for patients. However, it places ever higher demands on the surgeon, so that more specialization is also developing here.
