All About Arthroscopy

Arthrocopy is a minimally invasive surgery that orthopaedic surgeons use to visualize, diagnose and treat problems inside a joint. A pencil-sized instrument is inserted into the joint through a small incision in the skin. The instrument contains a small lens and lighting system to magnify and illuminate the structures inside the joint. The image is then displayed on a television screen allowing the surgeon to see the interior of the joint through this very small incision. This allows the surgeon to determine the type and extent of injury, and then repair or correct the problem if necessary.

Arthroscopy may be used to obtain a final diagnosis, after obtaining a thorough medical history, physical examination, and usually X-rays. The following six joints are most frequently examined using an arthroscope: the knee, shoulder, elbow, ankle, hip, and wrist.

Arthroscopy is an extremely valuable tool for all orthopaedic patients and is generally easier on the patient than "open" surgery.

Common Conditions

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 - inflamed lining (synovium) in knee, shoulder, elbow, wrist, or ankle.
• Injury
  • 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

About the Surgery

While much easier in terms of recovery than "open" surgery Arthroscopic surgery still requires the use of anesthetics. You will be given an local anesthetic appropriate for your condition. The surgery is performed in a hospital operating room or outpatient surgical suite using specialized equipment.

A small incision (about the size of a buttonhole) will be made to insert the arthroscope. Initially, arthroscopy was simply a diagnostic tool for planning standard open surgery. However, instrumentation and surgical techniques have been developed to treat conditions arthroscopically. When indicated, corrective surgery is performed with specially-designed instruments that are inserted into the joint through additional incisions.

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. The 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.

After arthroscopic surgery, the small incisions will be covered with a dressing and 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.

Are there possible complications?

Complication are uncommon (less that 1 percent of all arthroscopic procedures) but can and occassionally do occur. Possible complications include infection, phlebitis (blood clots of a vein), excessive swelling or bleeding, damage to blood vessels or nerves, and instrument breakage.

Recovery after arthroscopy

The recovery period depends on the extent of your surgery. However there are some common patterns:

• The small puncture wounds take several days to heal
• The operative dressing can usually be removed the morning after surgery
• Apply adhesive strips to cover the small healing incisions once the dressing is removed
• It is not unusual for patients to go back to work or school or resume daily activities 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.

It takes several weeks for the joint to maximally recover. Remember, however, that people who have arthroscopy can have many different diagnoses and preexisting conditions, so each patient's arthroscopic surgery is unique to that person. A specific activity and rehabilitation program may be suggested to speed your recover and protect future joint function.