The arthroscope is an instrument which permits the surgeon to view inside a joint, using specially designed instruments to perform operations to repair or remove damaged areas within the joint.
The instrument was first conceived in Japan in 1930s and then its design was further improved and made more useful after World War 2. At first the surgical community viewed the device as “of interest” but felt that it offered little to really assist the surgeon. However, with much improved optics and fibre optic light sources it is now possible to insert a thin metal tube into a joint and to view the internal workings of that joint on a high definition colour screen. This allows the operator to manoeuvre the scope around the joint and by using the 30 degree end view to actually see around the various curves within.
Then through other portals placed around the joint it is possible to introduce probes, shavers and anchors to respectively examine, remove and repair the tissues and surfaces of that articulation.
Where in the body can an arthroscope be used?
At The Horder Center we are equipped with instruments to successfully view inside the knee, shoulder, elbow, ankle and wrist with arthroscopes, which range from 3.5mm to 2.0 mm in diameter.
Which patients benefit from this procedure?
Those who suffer from shoulder pain with overhead movements, lying on their side or reaching behind the back may have developed some pinching of a tendon beneath a small overgrowth of bone. Shaving off of this area of bone can be very helpful in relieving these symptoms and also allows the surgeon to inspect all other areas of the joint at the same time. Individuals are back to light manual tasks, driving and keyboard work within 2-3 weeks though heavier activities may take a little longer.
In the knee, clicking, grating and locking of the joint may indicate a torn cartilage within the joint. Shaving out the torn part, which is jamming within the joint, is often a very straightforward procedure allowing the joint to move more normally afterwards.
How long does the procedure take and is it painful afterwards?
Typically the patient would have their operation done under a general anaesthetic but often go home the same day as the surgery. Pain afterwards is easier to control with little disruption to the surrounding muscles and with such limited surgical scars. The benefits to the patient are that they are in and out of hospital within the same day usually without the need for a sling or crutches. Return to normal activities at home is swift, return to work (depending on the physicality) is faster than with open surgery.
For the more active person return to sports is accelerated and with the benefit of being able to actually the photographs taken at the time of surgery a real understanding of the problem is gained.
Sadly not all joint conditions can be effectively treated with arthroscopic surgery. If a joint is damaged beyond the limits of what can be achieved with this instrument, then the surgeon will advise you based on the x-rays or scans what are the alternatives.
Mr Jamie Buchanan, MB BS, FRCS (Orth) is an Orthopaedic Consultant at The Horder Centre