Arthroscopy - Information on the Arthroscopy Procedure & Clinics

The first attempts at arthroscopy were made as early as the beginning of the 20th century. Initially, equipment used for cystoscopy was employed for this purpose. However, due to technical limitations, the results were not significant.

It was not until the 1960s that the first arthroscopic (joint-viewing) surgeries on the knee joint were performed. They were used primarily for meniscus surgeries.

The method of knee arthroscopy did not become established as a routine procedure until the 1980s. During this period, physicians also began to use arthroscopy on other joints, such as the

• the shoulder,
• ankle, and
• elbow joints.

Today, arthroscopic surgeries are among the most common procedures of all. The procedure is so common and straightforward to perform that it is increasingly carried out on an outpatient basis. Thanks to the now very small instruments, even the wrist, as well as the metacarpophalangeal and metatarsophalangeal joints, can be treated arthroscopically.

The major joints of the human body © freshidea / Fotolia

Arthroscopy is used for a wide range of joint conditions—both for diagnosis and treatment.

Diagnostically, arthroscopy is used to investigate unexplained joint symptoms when imaging techniques such as X-rays or MRI do not provide clear results. With the help of arthroscopy, doctors can directly examine the structures within the joint and thus reliably diagnose conditions such as cartilage damage, ligament injuries, or inflammation.

Therapeutically, arthroscopy is primarily established for the following procedures:

• meniscus surgeries,
• cruciate ligament surgeries,
• Knee cartilage surgeries,
• Treatments for impingement in the shoulder joint, as well as
• tendon repairs and stabilization for ligament injuries.

Thanks to improved techniques, it is increasingly possible to perform arthroscopic procedures on small joints and complex surgeries on large joints. In the future, this will also allow for

• cartilage transplants,
• artificial meniscus replacement, and
• many other joint surgeries

will routinely be possible using minimally invasive techniques.

Elbow osteoarthritis (cubital osteoarthritis) is less common than osteoarthritis of the knee or hip, but it can cause severe pain and limited mobility. Typical symptoms include pain on weight-bearing, a crunching sensation in the joint, swelling, and increasing stiffness, especially during rotational and extension movements.

Causes usually include age-related cartilage wear, previous injuries (e.g., bone fractures or ligament injuries), overuse from sports or work, and inflammatory joint diseases.

Treatment depends on the stage of osteoarthritis: conservative treatment with physical therapy, pain relievers, and injections to alleviate symptoms—or surgical intervention, such as arthroscopic surgery, in which loose bodies are removed and mobility is improved. In advanced cases, joint replacement may also be necessary.

Depending on the joint, arthroscopy can be performed under

• local anesthesia,
• so-called regional anesthesia (e.g., “spinal anesthesia”), or
• general anesthesia

. Special positioning of the leg or arm in support systems, such as a leg holder, is often required for the procedure.

In addition, during surgical procedures on the knee, ankle, elbow, and wrist, a tourniquet is applied. It resembles the cuff used to measure blood pressure and serves to prevent bleeding during the operation. This improves visibility inside the joint during the procedure.

The arthroscope itself consists of several parts:

• a hollow tube (sheath or trocar sleeve) with an internal rod (trocar),
• various ports for irrigation fluid, and
• the optical system.

The optical system includes a lens system, a connection for the cold light cable, and the camera connection. This allows images from inside the joint to be transmitted directly to a monitor. Modern camera systems offer options for digital video and image documentation, as well as editing and printing. 

Here is how arthroscopy proceeds step by step:

• Many surgeons inject a local anesthetic at the site of the planned skin incision. This allows for better examination of the joint space using the syringe needle and helps alleviate pain after the surgery.
• Then, through a 5- to 7-mm skin incision, the hollow tube (introducer with trocar) and the camera system are inserted into the joint.
• The surgeon can view the joint surface in many areas at high magnification on a large monitor.
• To improve visibility, flush out debris, and widen the narrow joint space, the joint capsule is continuously irrigated with fluid via the arthroscope.
• After an initial examination of the joint space and identification of the possible condition, a second incision is made in the skin to provide a working access point. A small probe hook is inserted through this incision. This allows the surgeon to palpate joint structures and assess their surface condition and stability.
• Once pathological changes have been identified, a variety of surgical instruments can be inserted under direct visualization. The surgeon uses these to operate on structures such as the medial or lateral meniscus, the cartilage, and many other structures.
• After the surgery is complete, the camera is removed, a drain is inserted if necessary, and the small skin incisions are sutured. A sterile dressing is applied with light compression.

Arthroscopy setup—joint, instruments for diagnosis and treatment, monitor for visualization © bilderzwerg / Fotolia

After arthroscopy, medication is typically used only for thrombosis prevention (e.g., heparin injections). No specific routine medication therapy is required.

If the patient experiences pain, they will, of course, be given pain medication.

Arthroscopic surgery is generally low-risk. Depending on the study, serious complications occur in 1 out of 10,000 to 1 out of 25,000 cases.

In addition to the patient’s pre-existing conditions, the size and complexity of the surgery are the most important factors.

In simple meniscus surgery, the most common complications include

• swelling,
• pain,
• joint effusions,
• ligament strains, and
• , more rarely, thrombosis

may occur. Major surgeries (cruciate ligament injuries, tendon tears, 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.

Less commonly, during more complex, longer procedures,

• more extensive nerve damage due to pressure or injury,
• pulmonary embolisms (blood clots traveling to the pulmonary arteries), and
• circulatory disorders caused by swelling or injury to larger blood vessels.

Intolerance to implants and suture material has been occurring more frequently recently due to an increase in allergies.

In isolated cases,

• skin burns caused by electrosurgical knives,
• breakage of surgical instruments,
• positioning injuries caused by excessive pressure, or
• damage caused by drilling devices

may occur. The patient will be informed in detail about the individual risks prior to surgery.

There is no single, universally applicable postoperative care plan for arthroscopy. Postoperative care depends on the individual case.

In simple meniscus or cartilage surgeries, the joint cartilage can move freely just a few days after surgery, and pain is minimal. Weight-bearing can also resume quickly. This is also referred to as early functional treatment.

Occasionally, manual lymphatic drainage or physical therapy is required in cases of swelling or movement restrictions.

For nearly all surgeries 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 surgery,

• cooling,
• rest, and
• elevation

are recommended. These measures help prevent excessive swelling.

For

• cruciate ligament surgery,
• cartilage transplants,
• tendon sutures, and
• other more complex surgeries,

, partial weight-bearing is often required for more than 4 weeks. There are no uniform guidelines in this regard.

Arthroscopy is now one of the most common surgical procedures performed on humans. It can often be performed on an outpatient basis. Thanks to improved techniques and extensive experience, increasingly complex surgeries can be performed using arthroscopy.

Mini-instruments now even allow for the examination and surgery of small joint surfaces, such as toe joints. Arthroscopic procedures

• allow for faster rehabilitation,
• generally carry lower risks than open surgeries using conventional techniques, and
• thereby enable a quick return to daily life.

The small incisions in the joint cartilage

• minimize tissue damage,
• reduce the risk of infection and wound healing complications, and
• are also more cosmetically favorable.

Overall, this technique offers many advantages for patients. However, it places ever-greater demands on surgeons, leading to increased specialization in this field as well.