Arthroscopy
From Wikipedia,
the free encyclopedia
Arthroscopy (also called arthroscopic
surgery) is a minimally invasive surgical procedure
in which an examination and sometimes treatment of damage of the interior of a joint is performed
using an arthroscope, a type of endoscope
that is inserted into the joint through a small incision. Arthroscopic
procedures can be performed either to evaluate or to treat many orthopaedic conditions including torn floating cartilage,
torn surface cartilage, ACL reconstruction, and trimming damaged cartilage.
The advantage of arthroscopy over
traditional open surgery is that the joint does not have to be
opened up fully. Instead, only two small incisions are made - one for the arthroscope and one for the surgical instruments. This
reduces recovery
time and may increase the rate of surgical success due to less
trauma to the connective tissue. It is especially useful for professional athletes, who frequently injure
knee joints and require fast healing time. There is also less scarring, because
of the smaller incisions. Irrigation fluid is used to distend the joint and
make a surgical space. Sometimes this fluid leaks into the surrounding soft
tissue causing extravasation and edema [1]
The surgical instruments used are
smaller than traditional instruments. Surgeons view the joint area on a video
monitor, and can diagnose and repair torn joint tissue, such as ligaments and menisci or cartilage
Arthroscopy is used for joints of
the knee, shoulder, elbow, wrist, ankle, and hip.
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Lateral meniscus located
between thigh bone (femur,
above) and shin bone (tibia,
below). The tibial cartilage
displays a fissure (tip of teaser instrument).
Knee arthroscopy has in many
cases replaced the classic arthrotomy that was performed in the
past. Today knee arthroscopy is commonly performed for treating meniscus
injury, reconstruction of the anterior cruciate
ligament and for cartilage microfracturing. Arthroscopy
can also be performed just for diagnosing and checking of the knee; however,
the latter use has been mainly replaced by magnetic resonance imaging.
During an average knee
arthroscopy, a small fiberoptic camera (the endoscope) is
inserted into the joint through a small incision, about 4 mm (1/8 inch) long. A
special fluid is used to visualize the joint parts. More incisions might be
performed in order to check other parts of the knee. Then other miniature
instruments are used and the surgery is performed.
Recovery after a knee arthroscopy
is significantly faster as compared to arthrotomy.
Most patients can return home and walk using crutches the same or the next day
after the surgery. Recovery time depends on the reason that surgery was needed
and the patient's physical condition. Usually a patient can fully load his leg
within a couple of days and after a few weeks the joint function can fully
recover. It is not uncommon for athletes who have an above average physical
condition to return to normal athletic activities within a few weeks.
Arthroscopic surgeries of the
knee are done for many reasons, but the usefulness of surgery for treating osteoarthritis
is doubtful. A double-blind placebo-controlled study on arthroscopic surgery for
osteoarthritis of the knee was published in the New England Journal of Medicine
in 2002.[2]
In this three-group study, 180 military veterans with osteoarthritis of the
knee were randomly assigned to receive arthroscopic débridement
with lavage, just arthroscopic lavage,
or a sham surgery, which made superficial incisions to the skin while
pretending to do the surgery. For two years after the surgeries, patients
reported their pain levels and were evaluated for joint motion. Neither the
patients nor the independent evaluators knew which patients had received which
surgery. The study reported, "At no point did either of the intervention
groups report less pain or better function than the placebo group."[3] Because there is no confirmed usefulness for these
surgeries, many agencies are reconsidering paying for a surgery which seems to
create risks with no benefit.[4] A 2008 study confirmed that there was no long-term
benefit for chronic pain, above medication and physical therapy.[5] Since one of the main reasons for arthroscopy is to
repair or trim a painful and torn or damaged meniscus, a recent study in the
New England Journal of Medicine which shows that about 60% of these tears cause
no pain and are found in asymptomatic subjects, may further call the rationale
for this procedure into question.[6]
Many invasive spine procedures
involve the removal of bone, muscle, and ligaments to access and treat
problematic areas. In some cases, thoracic (mid-spine) conditions requires a surgeon to access the
problem area through the rib cage, dramatically lengthening recovery time.
Arthroscopic (also endoscopic) spinal procedures allow a surgeon to access
and treat a variety of spinal conditions with minimal damage to surrounding
tissues. Recovery times are greatly reduced due to the relatively small size of
incision(s) required, and many patients are treated on an outpatient basis.[7]
Recovery rates and times vary according to condition severity and the patient's
overall health.
Arthroscopic procedures treat
·
Spinal disc herniation
and degenerative
discs
·
tumors
·
general spine trauma
Arthroscopic view showing two of the wrist bones.
Arthroscopy of the wrist is used to
investigate and treat symptoms of repetitive strain injury, fractures of the
wrist and torn or damaged ligaments. It can also be used to ascertain joint
damage caused by arthritis.
Pioneering work in the field of
arthroscopy began as early as the 1920s with the work of Eugen Bircher.[8] Bircher published several papers in the 1920s about his
use of arthroscopy of the knee for diagnostic purposes.[8] After diagnosing torn tissue through arthroscopy,
Bircher used open surgery to remove or repair the damaged tissue.
Initially, he used an electric Jacobaeus thoracolaparoscope for his diagnostic procedures, which
produced a dim view of the joint. Later, he developed a double-contrast
approach to improve visibility.[9] Bircher gave up endoscopy in
1930, and his work was largely neglected for several decades.
While Bircher is often considered
the inventor of arthroscopy of the knee,[10] the Japanese surgeon
The first operating arthroscope was jointly designed by these men, and they
worked together to produce the first high-quality color intraarticular
photography[14] The field benefitted
significantly from technological advances, particularly advances in flexible
fiber optics during the 1970s and 1980s.
1. ^ *[1]Wikipedia
ariticle on extravasation
2. ^ http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12110735
"A controlled trial of arthroscopic surgery for osteoarthritis of the
knee" N Engl J Med 2002 Jul 11;347(2):81-8,
Moseley JB; O'Malley K; Petersen NJ; Menke TJ; Brody
BA; Kuykendall DH; Hollingsworth JC; Ashton CM; Wray NP
3. ^ "NEJM -- A Controlled
Trial of Arthroscopic Surgery for Osteoarthritis of the Knee".
Retrieved on 2008-01-14.
4. ^ "Research diversity
in DeBakey awards - From the Laboratories Online
Newsletter at Baylor College of Medicine (January 2003)". Retrieved on
2008-01-14.
5. ^ Kirkley A, Birmingham TB,
Litchfield RB, et al (September 2008). "A
randomized trial of arthroscopic surgery for osteoarthritis of the knee".
N. Engl. J. Med. 359 (11): 1097–107. doi:10.1056/NEJMoa0708333. PMID 18784099. http://content.nejm.org/cgi/pmidlookup?view=short&pmid=18784099&promo=ONFLNS19.
6. ^ Martin Englund, M.D., Ph.D.,
Ali Guermazi, M.D., Daniel Gale, M.D., David J.
Hunter, M.B.,B.S., Ph.D., Piran Aliabadi,
M.D., Margaret Clancy, M.P.H., and David T. Felson,
M.D., M.P.H., et al (September 2008). "Incidental
Meniscal Findings on Knee MRI in Middle-Aged and Elderly Persons". N.
Engl. J. Med. 359 (11): 1108–1115. doi:10.1056/NEJMoa0708333. PMID 18784100. http://content.nejm.org/cgi/content/abstract/359/11/1108.
7. ^ "Minimally
Invasive Endoscopic Spinal Surgery". June20,
2005. Cleveland Clinic contribution to SpineUniverse.com
8. ^ a b CH Bennett & C Chebli,
'Knee Arthroscopy'
9. ^ Kieser CW, Jackson RW (2003).
"Eugen
Bircher (1882-1956) the first knee surgeon to use diagnostic arthroscopy".
Arthroscopy 19 (7): 771–6. PMID 12966386. http://linkinghub.elsevier.com/retrieve/pii/S0749806303006935.
10.
^ Böni T (1996).
"[Knee problems from a medical history viewpoint]" (in German). Ther Umsch 53 (10): 716–23. PMID 8966679.
11.
^ Watanabe M: History arthroscopic surgery. In Shahriaree H (first edition): O'Connor's Textbook of
Arthroscopic surgery. Philadelphia, J.B. Lippincott
Co., 1983.
12.
^ Jackson RW (1987). "Memories of the early days of
arthroscopy: 1965-1975. The formative years". Arthroscopy 3
(1): 1–3. PMID 3551979.
13.
^ Metcalf RW (1985). "A decade of arthroscopic
surgery: AANA. Presidential address". Arthroscopy 1
(4): 221–5. PMID 3913437.
14.
^ Allen FR, Shahriaree H: Richard L. O'Connor-A Tribute. J Bone Joint
64A:315, 1982.
