The first attempts at arthroscopy were made as early as the beginning of the 20th century, initially using instruments designed for bladder endoscopy. However, due to technical limitations, these early efforts were not particularly successful.
It was not until the 1960s that the first arthroscopic (joint-scoping) procedures on the knee joint were performed, primarily for meniscus surgeries.
As a routine procedure, knee arthroscopy only became established in the 1980s. At that time, physicians also began applying arthroscopy to other joints, such as the
Today, arthroscopic procedures are among the most common surgeries overall. Because the procedure is so routine and straightforward, it is increasingly performed on an outpatient basis. With the use of extremely small instruments, even the wrist as well as toe and finger joints can be examined arthroscopically.
The major joints of the human body © freshidea / Fotolia
Arthroscopy is used for a wide variety of joint conditions – both for diagnosis and for treatment.
Diagnostically, arthroscopy helps clarify unexplained joint problems when imaging methods such as X-rays or MRI do not provide clear results. With joint scoping, physicians can directly visualize joint structures and accurately identify conditions such as cartilage damage, ligament injuries, or inflammation.
Therapeutically, arthroscopy is particularly well established for the following treatments:
- Meniscus surgery,
- ACL reconstruction,
- Cartilage surgery in the knee joint,
- Treatment of impingement in the shoulder joint, and
- Tendon repair and stabilization of ligament injuries.
With improved technology, even small joints and complex surgeries on large joints can now be performed arthroscopically. In the future, procedures such as
will routinely be possible in a minimally invasive manner.
Elbow osteoarthritis (cubital arthrosis) is less common than knee or hip osteoarthritis but can cause significant pain and loss of motion. Typical symptoms include pain during activity, joint grinding, swelling, and increasing stiffness, especially with rotation and extension movements.
Causes are usually age-related cartilage wear, previous injuries (e.g., fractures or ligament tears), overuse from sports or work, as well as inflammatory joint diseases.
Treatment depends on the stage of arthritis: conservative measures such as physical therapy, pain medication, and injections to relieve symptoms – or surgical treatment, such as an arthroscopic joint procedure to remove loose joint bodies and improve mobility. In advanced cases, joint replacement may be necessary.
Depending on the joint, arthroscopy may be performed under
- local anesthesia,
- regional anesthesia (e.g., spinal anesthesia), or
- general anesthesia.
Special positioning of the leg or arm in holding systems, such as a leg holder, is often required for surgery.
In addition, for surgical procedures on the knee, ankle, elbow, or wrist, a tourniquet is applied. Similar to a blood pressure cuff, it helps prevent bleeding during surgery, improving visibility inside the joint.
The arthroscope itself consists of several components:
- a cannula (sheath or trocar sleeve) with an inner trocar,
- various ports for irrigation fluid, and
- the optical system.
The optics include a lens system, a connection for the cold light cable, and a camera adapter. This setup transmits images from inside the joint directly to a monitor. Modern camera systems allow digital video and image documentation with editing and printing capabilities.
This is how arthroscopy is performed step by step:
- Many surgeons inject a local anesthetic at the planned incision site. This helps identify the joint space more accurately and provides pain relief after surgery.
- A 5–7 mm skin incision is made to insert the cannula (sheath with trocar) and camera system into the joint.
- The surgeon views the joint surface on a large monitor, magnified many times.
- To improve visibility, flush debris, and expand the narrow joint space, the joint capsule is continuously irrigated with fluid through the arthroscope.
- After initial inspection and identification of pathology, a second skin incision is made as a working portal. Through this, a small probe hook is inserted to palpate structures and check surface and stability.
- Once abnormalities are confirmed, a variety of instruments can be introduced under direct visualization. These allow the surgeon to operate on the meniscus, cartilage, and many other structures.
- At the end of the procedure, the camera is removed, a drain may be placed, and the small skin incisions are sutured. A sterile compression dressing is then applied.
Setup of an arthroscopy – joint, instruments for diagnosis and treatment, and monitor for visualization © bilderzwerg / Fotolia
After arthroscopy, usually only medication for thrombosis prevention (e.g., heparin injections) is required. No special routine drug therapy is needed.
If pain occurs, patients are, of course, given pain medication.
Arthroscopic surgery is generally considered low risk. Serious complications occur in about 1 in 10,000 to 1 in 25,000 cases, depending on the study.
The main risk factors are the patient’s pre-existing conditions and the extent and complexity of the surgery.
For simple meniscus surgery, potential issues include:
- swelling,
- pain,
- joint effusion,
- ligament strain, and
- less commonly, thrombosis.
Larger procedures (e.g., ACL reconstruction, tendon repair) are associated with higher complication rates.
In general, the main risks are:
- injury to cartilage, skin nerves, or small blood vessels,
- thrombosis, and
- infection.
Less commonly, with more complex and prolonged procedures, complications may include:
Allergic reactions to implants or suture materials have been reported more frequently in recent years, in line with the general rise in allergies.
In rare cases, complications may also include:
- skin burns from electrosurgical instruments,
- breakage of surgical instruments,
- positioning injuries due to excessive pressure, or
- damage from drilling devices.
Patients are informed individually about their specific risks before surgery.
There is no universal aftercare protocol for arthroscopy; postoperative treatment depends on the individual case.
For simple meniscus or cartilage surgeries, the joint can usually be mobilized within a few days, with less pain and rapid return to weight bearing. This is often referred to as early functional therapy.
If swelling or restricted movement occurs, manual lymph drainage or physical therapy may be required.
For nearly all lower extremity procedures, thrombosis prophylaxis with low-molecular-weight heparin is recommended until full weight bearing is achieved. In the first few days after surgery,
- icing,
- rest, and
- elevation
are recommended to prevent excessive swelling.
For more complex procedures such as
partial weight bearing for more than 4 weeks is often required. There are no uniform guidelines.
Arthroscopy is now among the most common surgical procedures. It is often performed on an outpatient basis. With advanced technology and extensive experience, increasingly complex surgeries can be carried out arthroscopically.
Miniaturized instruments even make it possible to assess and treat small joint surfaces, such as toe joints. Arthroscopic procedures
- enable faster rehabilitation,
- generally involve lower risks than traditional open surgery, and
- allow for a quicker return to daily life.
The small incisions into the joint
- preserve tissue,
- reduce infections and wound healing problems, and
- are cosmetically more favorable.
Overall, this technique offers patients many benefits. However, it also places increasing demands on surgeons, leading to greater specialization in the field.
