Arthroscopy

 | September 1, 2006

Arthroscopy

Since the late 1970s, surgeons have been able to work inside a joint and make repairs without fully opening it up. By making small incisions (about a quarter-inch), a surgeon can insert a tiny video camera and miniature surgical instruments to diagnose and repair abnormalities.

This approach, called arthroscopy, made its first appearance in 1918 when Professor Kenji Takagi of Tokyo University, seeking a better view of the knee to diagnose joint stiffness due to tuberculosis, performed the first successful arthroscopy of the human knee on a cadaver. By 1936, Takagi had developed a way to obtain color pictures and video of the interior of the knee joint. The technique was first used on live patients a year later. The limitations of technology at the time hindered widespread use of the technique. By the 1980s, however, technology had improved enough for the technique to be used for surgery, and many new instruments and arthroscopy techniques were developed. With new research and technology, arthroscopic surgery was performed not only on the knee, but also on the shoulder, ankle, wrist, and elbow.

Arthroscopy is less invasive than traditional surgery, and it causes less pain and fewer complications. Today, about 3 million arthroscopic procedures are performed annually in the United States, including about 1.6 million on the knees. The technique has completely transformed the field of sports medicine. The number of hip arthroscopies is relatively small but is steadily increasing.

Too much arthroscopy?

Arthroscopic surgery is now widely used for a variety of injuries and conditions. Many doctors believe it is used too often for arthritis, where its benefits are questionable. As noted in Surgery, a 2002 study found that arthroscopy was no better than placebo surgery. However, the study did not include patients with knee pain caused by torn cartilage or ligaments and those with mechanical knee problems such as locking, catching, or giving out, including cases in which these problems stemmed from osteoarthritis. These patients make up the majority of people undergoing arthroscopy and are more likely to genuinely benefit from it.

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Undergoing arthroscopy

Arthroscopic surgery continues to be a valuable tool for treating many knee and a few hip conditions. If you are scheduled for an arthroscopic procedure, here is what you can expect once anesthesia takes effect.

The orthopedic surgeon makes two incisions (each about a quarter-inch long). Through one, the surgeon inserts an arthroscope — a tool with a tiny light and video camera that transmits images from inside the joint to a monitor in the operating room.

Through the second incision, the doctor introduces tiny instruments (scissors, shavers) to remove fragments of loose bone or cartilage, remove or repair torn menisci, repair torn ligaments, or remove inflamed synovial tissue. Afterward, the doctor removes the instruments and closes the incisions with stitches or tape.

Arthroscopy may be performed under general, regional, or local anesthesia. If you have regional or local anesthesia and are awake for the operation, you may be able to watch the monitor. Arthroscopy is used less frequently in the hip, but is sometimes used to diagnose the cause of hip pain. If the surgeon finds a labral tear or loose pieces of bone (from a traumatic injury, for example) or cartilage during the arthroscopy, he or she can remove them during the procedure.

Recovery from arthroscopic surgery is relatively quick. You gradually get back to normal day-to-day living (basic tasks such as bathing, cooking, and walking) during the first week. In the second week, you can return to work if your job is not physically taxing. In the third week, you can begin to do light exercise. Physical therapy is not usually needed.

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Review Date: 2006-09-01

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