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Arthroscopy is a surgical procedure orthopaedic surgeons use to
visualize, diagnose and treat problems inside a joint.
The word arthroscopy comes from two Greek words,
"arthro" (joint) and "skopein" (to look). The term literally means "to look
within the joint." In an arthroscopic examination, an orthopaedic surgeon makes
a small incision in the patient's skin and then inserts pencil-sized instruments
that contain a small lens and lighting system to magnify and illuminate the
structures inside the joint. Light is transmitted through fiber optics to the
end of the arthroscope that is inserted into the joint. By attaching the
arthroscope to a miniature television camera, the surgeon is able to see the
interior of the joint through this very small incision rather than a large
incision needed for surgery.
The television camera attached to the arthroscope
displays the image of the joint on a television screen, allowing the surgeon to
look, for example, throughout the knee-at cartilage and ligaments, and under the
kneecap. The surgeon can determine the amount or type of injury, and then repair
or correct the problem, if it is necessary.
Diagnosing joint injuries and disease begins with a thorough medical history, physical
examination, and usually X-rays. Additional tests such as an MRI, or CT also scan may
be needed. Through the arthroscope, a final diagnosis is made which may be more accurate
than through "open" surgery or from X-ray studies.
Disease and injuries can damage bones, cartilage, ligaments, muscles, and tendons.
Some of the most frequent conditions found during arthroscopic examinations of
joints are:
Inflammation - Synovitis-inflamed lining (synovium) in knee, shoulder, elbow, wrist, or ankle.
Injury - acute and chronic
Shoulder - rotator cuff tendon tears, impingement syndrome, and recurrent dislocations
Knee - meniscal (cartilage) tears, chondromalacia (wearing or injury of cartilage cushion), and anterior cruciate ligament tears with instability.
Wrist - carpal tunnel syndrome
Loose bodies of bone and/or cartilage - knee, shoulder, elbow, ankle, or wrist
Although the inside of nearly all joints can be viewed with an arthroscope, six joints are most frequently examined with this instrument. These include the knee, shoulder, elbow, ankle, hip, and wrist. As advances are made by engineers in electronic technology and new techniques are developed by orthopaedic surgeons, other joints may be treated more frequently in the future.
Arthroscopic surgery, although much easier in terms of recovery than
"open" surgery, still requires the use of anesthetics and
the special equipment in a hospital operating room or outpatient surgical
suite. You will be given a general, spinal or a local anesthetic, depending
on the joint or suspected problem.
A small incision (about the size of a buttonhole) will be made to
insert the arthroscope. Several other incisions may be made to see other
parts of the joint or insert other instruments.
When indicated, corrective surgery is performed with specially-designed
instruments that are inserted into the joint through accessory incisions.
Initially, arthroscopy was simply a diagnostic tool for planning standard
open surgery. With development of better instrumentation and surgical
techniques, many conditions can be treated arthroscopically.
For instance, most meniscal tears in the knee can be treated
successfully with arthroscopic surgery.
Some problems associated with arthritis also can be treated.
Several disorders are treated with a combination of
arthroscopic and standard surgery.
- Rotator cuff procedure
- Repair or resection of torn cartilage (meniscus) from knee or shoulder
- Reconstruction of anterior cruciate ligament in knee
- Removal of inflamed lining (synovium) in knee, shoulder, elbow, wrist, ankle
- Release of carpal tunnel
- Repair of torn ligaments
- Removal of loose bone or cartilage in knee, shoulder, elbow, ankle, wrist.
After arthroscopic surgery, the small incisions will be covered with a
dressing. You will be moved from the operating room to a recovery room.
Many patients need little or no pain medications.
Before being discharged, you will be given instructions about
care for your incisions, what activities you should avoid, and which
exercises you should do to aid your recovery. During the follow-up visit,
the surgeon will inspect your incisions; remove sutures, if present; and
discuss your rehabilitation program.
The amount of surgery required and recovery time will depend on
the complexity of your problem. Occasionally, during
arthroscopy, the surgeon may discover that the
injury or disease cannot be treated adequately with
arthroscopy alone. The extensive "open"
surgery may be performed while you are still
anesthetized, or at a later date after you have
discussed the findings with your surgeon.
Although Uncommon, complications do occur
occasionally during or following arthroscopy.
Infection, phlebitis (blood clots of a vein),
excessive swelling or bleeding, damage to blood
vessels or nerves, and instrument breakage are
the most common complications, but occur in far
less than 1 percent of all arthroscopic
procedures.
Although arthroscopic surgery has recieved a lot
of public attention because it is used to treat
well-known athletes, it is an extremely valuable
tool for all orthopedic patients and is
generally easier on the patient than
"open" surgery. Most patients
have their arthroscopic surgery as outpatients
and are home several hours after the surgery.
The small puncture wounds take several days to
heal. The operative dressing can usually be
removed the morning after surgery and adhesive
strips can be applied to cover the small healing incisions.
Although the puncture wounds are small and pain
in the joint that underwent arthroscopy is
minimal, it takes several weeks for the joint to
maximally recover. A specific activity or
rehabilitation program may be suggested to speed
your recovery and protect future joint function.
it is not unusual for patients to go back to
work or school or resume daily activities within
a few days. Athletes and others who are in good
physical condition may in some cases return to athletic
activities within a few weeks. Remember though,
that people who have arthroscopy can have
different diagnoses and preexisting conditions,
so each patient's arthroscopic surgery is unique
to that person. Recovery time will reflect that
individual person.
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