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Arthroscopy
 
     
 
Joint Surgery
 

Arthroscopy (also called arthroscopic surgery) is a minimally invasive surgical procedure in which an examination and sometimes treatment of damage of the interior of a joint is performed using an arthroscope, a type of endoscope that is inserted into the joint through a small incision. Arthroscopic procedures can be performed either to evaluate or to treat many orthopaedic conditions including torn floating cartilage, torn surface cartilage, ACL reconstruction, and trimming damaged cartilage.

The advantage of arthroscopy over traditional open surgery is that the joint does not have to be opened up fully. Instead, for knee arthroscopy for example, only two small incisions are made - one for the arthroscope and one for the surgical instruments to be used in the knee cavity to fully remove the knee cap. This reduces recovery time and may increase the rate of surgical success due to less trauma to the connective tissue. It is especially useful for professional athletes, who frequently injure knee joints and require fast healing time. There is also less scarring, because of the smaller incisions. Irrigation fluid is used to distend the joint and make a surgical space. Sometimes this fluid leaks into the surrounding soft tissue causing extravasation and edema.

The surgical instruments used are smaller than traditional instruments. Surgeons view the joint area on a video monitor, and can diagnose and repair torn joint tissue, such as ligaments and menisci or cartilage

It is technically possible to do an arthroscopic examination of almost every joint in the human body. The joints that are most commonly examined and treated by arthroscopy are the knee, shoulder, elbow, wrist, ankle, foot, and hip.

Knee arthroscopy

Lateral meniscus located between thigh bone (femur, above) and shin bone (tibia, below). The tibial cartilage displays a fissure (tip of teaser instrument).

Knee arthroscopy has in many cases replaced the classic arthrotomy that was performed in the past. Today knee arthroscopy is commonly performed for treating meniscus injury, reconstruction of the anterior cruciate ligament and for cartilage microfracturing. Arthroscopy can also be performed just for diagnosing and checking of the knee; however, the latter use has been mainly replaced by magnetic resonance imaging.

After having a knee arthroscopy you will have swelling around the knee, you must allow this to settle before doing any serious exercise or excessive walking. Swelling can take anywhere from 7–15 days to completely settle. It is important to wait till there is no swelling left around the knee because the knee will not be stable enough to operate on, and may cause pain and in some cases cause the knee to swell more.

During an average knee arthroscopy, a small fiberoptic camera (the arthroscope) is inserted into the joint through a small incision, about 4 mm (1/8 inch) long. A special fluid is used to visualize the joint parts. More incisions might be performed in order to check other parts of the knee. Then other miniature instruments are used and the surgery is performed.

Arthroscopic surgeries of the knee are done for many reasons, but the usefulness of surgery for treating osteoarthritis is doubtful. A double-blind placebo-controlled study on arthroscopic surgery for osteoarthritis of the knee was published in the New England Journal of Medicine in 2002.[9] In this three-group study, 180 military veterans with osteoarthritis of the knee were randomly assigned to receive arthroscopic débridement with lavage, or arthroscopic lavage alone without debridement (a procedure only imitating the surgical debridement, where superficial incisions to the skin were made to give the appearance that the debridement procedure had been performed). For two years after the surgeries, patients reported their pain levels and were evaluated for joint motion. Neither the patients nor the independent evaluators knew which patients had received which surgery (thus the "double blind" notation). The study reported, "At no point did either of the intervention groups report less pain or better function than the placebo group."[10] Because there is no confirmed benefit for these surgeries in cases of osteoarthritis of the knee, many payors are reluctant to reimburse surgeons and hospitals for what can be considered a procedure which seems to create the risks of surgery with questionable or no demonstrable benefit.[11] A 2008 study confirmed that there was no long-term benefit for chronic pain, above medication and physical therapy.[12] Since one of the main reasons for arthroscopy is to repair or trim a painful and torn or damaged meniscus, a recent study in the New England Journal of Medicine which shows that about 60% of these tears cause no pain and are found in asymptomatic subjects, may further call the rationale for this procedure into question.[13]

Shoulder arthroscopy

Arthroscopy is commonly used for treatment of various diseases of the shoulder including subacromial impingement, acromioclavicular osteoarthritis, rotator cuff tears, frozen shoulder (adhesive capsulitis), chronic tendonitis and partial tears of the long biceps tendon, SLAP lesions and shoulder instability.

Wrist arthroscopy

Arthroscopic view showing two of the wrist bones.

Arthroscopy of the wrist is used to investigate and treat symptoms of repetitive strain injury, fractures of the wrist and torn or damaged ligaments. It can also be used to ascertain joint damage caused by arthritis.

The information contained above is for educational purposes only.  If you have
any questions relating to this or to any other orthopedic conditions, please consult
a board-certified orthopedic surgeon.

 
     
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