Arthroscopy is a surgical procedure that allows an orthopedic surgeon to view, diagnose, and treat problems inside joints such as the knee, shoulder, wrist, elbow, ankle, and hip.
The procedure has been a boon to athletes because it can repair a joint problem without significantly compromising training or the loss of an athlete's level of fitness. In a famous example, marathon runner Joan Benoit Samuelson won the 1984 United States Olympic Trials marathon only 17 days after receiving arthroscopic knee surgery. A few months later, she captured the gold medal in the 1984 Summer Olympic Games in Los Angeles.
The term arthroscopy is derived from two Greek words: arthro (joint) and skopein (to look), and literally translates as "to look within the joint." This inspection is done via an incision that is about the size of a buttonhole, large enough to accommodate the insertion through the skin of a series of instruments that are the size and shape of a pencil. Each instrument houses a fiber optic light source and a surgical tool (such as a cutter, vacuum, or ultrasonic probe) at the end that is inserted into the incision. The other end of the instrument is connected to a television camera, which allows the surgeon to view the inside of the joint.
Arthroscopy can be done using a single incision, where the inserted probe contains both the fiber optics and the surgical tool. Alternately, two incisions can be made: one accommodates the optic probe and the other the surgical probe. The ability to see the joint without having to surgically expose the region is the reason why arthroscopy is relatively noninvasive and comfortable, compared to traditional surgery.
Arthroscopy typically complements other noninvasive diagnostic procedures such as x-ray imaging, magnetic resonance imaging, or computed tomography. These imaging techniques can provide a lot of information about the nature of the joint problem. Arthroscopy is important in providing the final diagnosis and in actually remedying the problem.
When used as a remedy, general surgery is often the final option for many injuries and illnesses. This is also true for arthroscopy. Options such as the icing of the affected joint following activity, stopping the athletic activity for a period of time, and the use of medications such as cortisone will be tried first. If these fail to alleviate the problem, arthroscopy may offer relief.
The joint problems that can be successfully remedied using arthroscopy occur commonly with recreational and elite athletes. One example is damage to the rotator cuff, which is a group of four muscles and associated tendons that surround the shoulder joint. Inflammation of a tendon or the adjacent sac of lubricating fluid (the bursa), a tear in one of the tendons or muscles of the rotator cuff, or the pinching of a tendon against the socket joint of the shoulder disrupts the normal functioning of the shoulder. In organized sports, rotator cuff injuries are most commonly associated with baseball pitchers.
Similarly, inflammation or muscle/tendon damage can occur in the joints of the wrist, elbow, hip, and knee. The injuries can result from overuse of the joint, which is a hazard of all sports, or from a traumatic impact in a sport such as football, rugby, hockey, skiing, or soccer.
As with other forms of surgery, an anesthetic is required prior to arthroscopy. While sometimes general anesthesia is used, more frequently a local anesthetic suffices. Indeed, depending on the severity of the injury and the physical condition of the patient, arthroscopy may be performed during a regularly scheduled office visit to an orthopedic surgeon. More typically, however, arthroscopy is done in the hospital setting.
Following the insertion of the arthroscope into the joint, fluid is introduced to expand the joint to make it easier for the surgeon to view the damage. Repairs can then be made. These include removal or remediation of a torn cartilage (meniscus) in a knee, realignment or repair of the patella (the bone of the kneecap), reconstruction of the anterior cruciate ligament (ACL) of the knee, relief of wrist and arm carpal tunnel-induced numbness and pain, ligament repair or reattachment in other joints, removal of the inflamed lining (synovium) of a joint, and removal of loose bone or cartilage from a joint.
As one example, shoulder instability resulting from a torn tendon can be repaired using an arthroscopic procedure called Bankart repair. In this technique, the arthroscope functions essentially as a staple gun. The torn ends of a tendon are reattached by means of inserted tacks. The method has a claimed success rate of upwards of 90% in preventing re-dislocation.
After surgery, which typically lasts for an hour or less, the incision is sutured shut and is covered by a protective dressing to prevent infection. Discomfort is usually minimal, with only non-prescription pain medication given, if at all.
Recovery from an arthroscopic procedure is typically swift and uneventful. The wound dressing is