Arthroscopy
William C. Shiel Jr., MD, FACP, FACR
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
- What is arthroscopy?
- For what diseases or conditions is arthroscopy considered?
- What is done in preparation for arthroscopy?
- How is arthroscopy performed?
- How does the patient recover after arthroscopy?
- Arthroscopy At A Glance
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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.
For what diseases or conditions is arthroscopy considered?
Arthroscopy can be helpful in the diagnosis and treatment of many noninflammatory, inflammatory, and infectious types of arthritis as well as various injuries within the joint.
Noninflammatory degenerative arthritis, or osteoarthritis, can be seen using the arthroscope as frayed and irregular cartilage. Recently, for isolated cartilage wear in younger patients, repair of crevasses in the cartilage, using a "paste" of a patient's own cartilage cells harvested and grown in the laboratory, has been performed using an arthroscope.
In inflammatory arthritis, such as rheumatoid arthritis, some patients with isolated chronic joint swelling can sometimes benefit by arthroscopic removal of the inflamed joint tissue (synovectomy). The tissue lining the joint (synovium) can be biopsied and examined under a microscope to determine the cause of the inflammation and discover infections, such as tuberculosis. Arthroscopy can provide more information in situations which cannot be diagnosed by simply aspirating (withdrawing fluid with a needle) and analyzing the joint fluid.
Common joint injuries for which arthroscopy is considered include cartilage tears (meniscus tears), ligament strains and tears, and cartilage deterioration underneath the kneecap (patella). Arthroscopy is commonly used in the evaluation of knees and shoulders but can also be used to examine and treat conditions of the wrist, ankles, and elbows.
Finally, loose tissues, such as chips of bone or cartilage, or foreign objects, such as plant thorns, that become lodged within the joint can be removed with arthroscopy.
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