What is arthroscopy?
Arthroscopy is a surgical procedure by which the internal structure of a joint is examined for diagnosis and/or treatment using a tube-like viewing instrument called an arthroscope. Arthroscopy was popularized in the 1960s and is now commonplace throughout the world. Typically, it is performed by orthopedic surgeons in an outpatient setting. When performed in the outpatient setting, patients can usually return home after the procedure.
The technique of arthroscopy involves inserting the arthroscope, a small tube that contains optical fibers and lenses, through tiny incisions in the skin into the joint to be examined. The arthroscope is connected to a video camera and the interior of the joint is seen on a television monitor. The size of the arthroscope varies with the size of the joint being examined. For example, the knee is examined with an arthroscope that is approximately 5 millimeters in diameter. There are arthroscopes as small as 0.5 millimeters in diameter to examine small joints such as the wrist.
If procedures are performed in addition to examining the joint with the arthroscope, this is called arthroscopic surgery. There are a number of procedures that are done in this fashion. If a procedure can be done arthroscopically instead of by traditional surgical techniques, it usually causes less tissue trauma, results in less pain, and may promote a quicker recovery.
What parts of the body can undergo arthroscopic surgery?
Arthroscopic surgery is most commonly performed on the knee and shoulder joints. Less commonly arthroscoped joints include the wrist, elbow, ankle and hip. The reason the knee and shoulder are the most commonly arthroscoped joints is that they are large enough to manipulate the instruments around, and they are amenable to arthroscopic surgery treatments.
Technically speaking, any joint can be arthroscoped. However, the practicality and the instrumentation available limit our ability to arthroscope every joint for all types of problems. The most common arthroscopic procedures include repairing cartilage and meniscus problems in the knee, and removing inflammation and repairing rotator cuff tears in the shoulder.
How is arthroscopic surgery performed?
When a knee arthroscopy is performed, a camera is inserted into the joint through a small incision (about one centimeter). The arthroscopic surgery camera is attached to a fiberoptic light source and shows a picture of the inside of the joint on a television monitor. The surgeon uses water under pressure to "inflate" the knee allowing more maneuverability and to remove any debris. One or more other incisions are made to insert instruments that can treat the underlying problem. For example, a shaver can be inserted to trim the edges of a meniscus tear.
What is done in preparation for arthroscopy?
Arthroscopy is essentially a bloodless procedure and generally has few complications. The underlying health of the patient is considered when determining who is a candidate for arthroscopy. Most importantly, the patient should be able tolerate the anesthetic that is used during the procedure. A person's heart and lung function should be adequate.
If there are existing problems such as heart failure or emphysema, these should be optimized as possible prior to surgery. Patients who are on anticoagulants (blood thinners) should have these medications carefully adjusted prior to surgery. Other medical problems should also be controlled prior to surgery, such as diabetes and high blood pressure.
How is arthroscopy performed?
Arthroscopy is most often performed as an outpatient procedure. The patient will check into the facility where the procedure is being performed and an intravenous line (IV) established in order to administer fluids and medication. The type of anesthesia used varies depending on the joint being examined and the medical health of the patient.
Revision ACL Reconstruction can be performed under a general anesthetic, a spinal or epidural anesthetic, a regional block (where only the extremity being examined is numbed), or even a local anesthetic. After adequate anesthesia is achieved, the procedure can begin. An incision is made on the side of the joint to be examined and the arthroscope is inserted into the incision.
Other instruments are sometimes placed in another incision to help maneuver certain structures into the view of the arthroscope. In arthroscopic surgery, additional instruments for surgical repairs are inserted into the joint through the arthroscope. These instruments can be used to cut, remove, and sew damaged tissues. Once the procedure is completed, the arthroscope in removed and the incisions are sutured (sewn) closed. A sterile dressing is placed over the incision and a brace or ACE wrap may be placed around the joint.
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