Orthopaedic surgeons use to arthroscopy, a surgical procedure, to visualize, diagnose and treat problems inside a joint. It literally means "to look within the joint." During arthroscopy, an orthopaedic surgeon makes a small incision in the patient's skin and inserts pencil-sized instruments that contain a small lens and lighting system to magnify and illuminate the structures inside 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.

Why is arthroscopy 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.

How is arthroscopy performed?

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. Then, 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.

Are complications possible?

Complications occur in a fraction of one percent of all arthroscopic procedures. The most common complications include infection, phlebitis (blood clots of a vein), excessive swelling or bleeding, damage to blood vessels or nerves, and instrument breakage.

What are the advantages?

Arthroscopic surgery receives a lot of public attention because it is used to treat well-known athletes, but it is an extremely valuable tool for all orthopaedic patients. It is generally easier for a patient than "traditional" surgery. Most patients have their arthroscopic surgery as outpatients and are home several hours after the surgery.

Recovery after arthroscopy

The tiny entry wounds take several days to heal. Patients can usually remove the operative dressing the morning after surgery and then apply adhesive strips 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 rehabilitation program may speed your recover and protect future joint function.

Many patients can resume daily activities, including work and school, 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 many different diagnoses and preexisting conditions, so each patient's arthroscopic surgery is unique to that person. Recovery time will reflect that individuality.

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