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Arthroscopy (also called arthroscopic or keyhole surgery) is a minimally invasive surgery on a joint in which an examination and sometimes treatment of damage is performed using an arthroscope, an endoscope that is inserted into the joint through a small incision. Arthroscopic procedures can be performed during ACL reconstruction.
The advantage over traditional open surgery is that the joint does not have to be opened up fully. For knee arthroscopy only two small incisions are made, one for the arthroscope and one for the surgical instruments to be used in the knee cavity. This reduces Healing time and may increase the rate of success due to less trauma to the connective tissue. It has gained popularity due to evidence of faster recovery times with less scarring, because of the smaller incisions. Irrigation fluid (most commonly 'normal' Normal saline) is used to distend the joint and make a surgical space.
The surgical instruments are smaller than traditional instruments. Surgeons view the joint area on a video monitor, and can diagnose and repair torn joint tissue, such as . It is technically possible to do an arthroscopic examination of almost every joint, but is most commonly used for the knee, shoulder, elbow, wrist, ankle, foot, and hip.
It has, in many cases, replaced the classic open surgery (arthrotomy) that was performed in the past. Arthroscopic knee surgery is one of the most common orthopaedic procedures, performed approximately 2 million times worldwide each year. The procedures are more commonly performed to treat meniscus injury and to perform anterior cruciate ligament reconstruction.
While knee arthroscopy is commonly used for partial meniscectomy (trimming a torn meniscus) on middle aged to older adults with knee pain, the claimed positive results seem to lack scientific evidence. Many studies have shown the outcomes from knee arthroscopic surgery for osteoarthritis and degenerative meniscal tears are no better than the outcomes from placebo (fake) surgery or other treatments (such as exercise therapy).
During an average knee arthroscopy, a small fiberoptic camera (the arthroscope) is inserted into the joint through a small incision, about 4 mm (1/8 inch) width. More incisions might be performed in order to visually check other parts of the knee and to insert the miniature instruments that are used to perform surgical procedures.
Two major trials of arthroscopic surgery for osteoarthritis of the knee found no benefit for these surgeries. Even though randomized control trials have demonstrated this to be a procedure which involves the risks of surgery with questionable or no demonstrable long-term benefit, insurance companies (government and private) world-wide have generally felt obliged to continue funding it. An exception is Germany, where funding has been removed for the indication of knee osteoarthritis. It is claimed that German surgeons have continued to perform knee arthroscopy and instead claim rebates on the basis of a sub-diagnosis, such as meniscal tear.
A 2017 meta-analysis confirmed that there is only a very small and usually unimportant reduction in pain and improvement in function at 3 months (e.g. an average pain reduction of approximately 5 on a scale from 0 to 100). A separate review found that most people would consider a reduction in pain of approximately 12 on the same 0 to 100 scale important—suggesting that for most people, the pain reduction at 3 months is not important. Arthroscopy did not reduce pain or improve function or quality of life at one year. There are important adverse effects.
Hip arthroscopy is a widely adopted treatment for a range of conditions, including labral tears, femoroacetabular impingement, osteochondritis dissecans.
Arthroscopic procedures (also endoscopic spinal procedures) allow access to and treatment of spinal conditions with minimal damage to surrounding tissues. Recovery times are greatly reduced due to the relatively small size of incisions, and many patients are treated as outpatients." Minimally Invasive Endoscopic Spinal Surgery". June 20, 2005. Cleveland Clinic contribution to SpineUniverse.com Recovery rates and times vary according to condition severity and the patient's overall health.
Arthroscopic procedures treat
Pioneering work began as early as the 1920s with the work of Eugen Bircher. He published several papers in the 1920s about his use of arthroscopy of the knee for diagnostic purposes. After diagnosing torn tissue, he 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. He gave up endoscopy in 1930, and his work was largely neglected for several decades.
While he is often considered the inventor of arthroscopy of the knee, the Japanese surgeon Masaki Watanabe, MD, receives primary credit for using arthroscopy for interventional surgery. Watanabe was inspired by the work and teaching of Dr Richard O'Connor. Later, Dr. Heshmat Shahriaree began experimenting with ways to excise fragments of menisci.
The first operating arthroscope was designed by them, and they worked together to produce the first high-quality color intraarticular photography. The field benefited significantly from technological advances, particularly advances in flexible fiber optics during the 1970s and 1980s.
Canadian doctor Robert Jackson is credited with bringing the procedure to the Western world. In 1964, Jackson was in Tokyo completing a one-year fellowship and serving as a physician for the Canadian Olympic team. While there, he spent time at the clinic of Watanabe learning the thirty year old procedure that had only been used to investigate arthritis in the elderly. Jackson returned to Toronto where he continued to practice the technique, eventually becoming "the world's foremost expert on arthroscopy".
According to Sports Illustrated, "Jackson's particular genius was to recognize a wider application for the procedure than Watanabe ever did." Jackson realized the technique could be used for young, athletic patients that had suffered injuries. Torn knee cartilage or ligaments previously would require an arthrotomy procedure and might mean a year or more of rehab or the end of a career. Jackson believed the less invasive procedure with its smaller incisions would be able to save the career of injured athletes. While many were skeptical at first, Jackson's efforts to develop, teach and popularize the procedure helped to prolong the careers of athletes such as Bobby Orr, Willis Reed, Joan Benoit and Mary Lou Retton. For this, Jackson was named one of Sports Illustrated
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