Which instrument is used frequently in arthroscopies to examine and manipulate internal structures?

Upper extremityElbow arthroscopy: state of the art

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Due to the minimally invasive nature of arthroscopic surgery, patients recover more quickly and are able to initiate rehabilitation and functional activities sooner than with open approaches. Elbow arthroscopy had initially been considered a tool for loose body removal and diagnostic purposes only. However, as a better understanding of elbow anatomy and pathology has evolved, coincident with better instrumentation, elbow arthroscopy is now being used for an increasing list of indications. Current indications for elbow arthroscopy have expanded to include loose bodies removal, and the treatment of degenerative arthritis, septic arthritis, inflammatory arthritis, lateral epicondylitis, osteochondritis dissecans, synovitis, radial head deformity, post-traumatic arthrofibrosis, posterolateral rotatory instability, posteromedial impingement and plica, in addition to the management of some elbow fractures, including fractures of the capitellum, coronoid and radial head. Elbow arthroscopy does have limitations and particular surgical risks; however, these can be minimised. Elbow arthroscopy can be performed safely with appropriate knowledge of the articular and periarticular anatomy, in addition to precise surgical technique and understanding the limitations of elbow arthroscopy as well as the limitations of the experience of the surgeon.

elbow

arthroscopy

endoscopy

instability

stiff joints

© 2017 THE AUTHORS. Published by Elsevier Inc. on behalf of International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine

What is Arthroscopic Surgery?

Arthroscopic surgery, also known as arthroscopy, is a surgical procedure to visualize, diagnose, and treat problems inside a joint using a specialized instrument known as an arthroscope.

An arthroscope is a flexible fiberoptic tube that contains a small lens or camera and a lighting system to magnify and illuminate structures inside a joint. The camera attached to the arthroscope shows an image of the joint on a television screen allowing the surgeon to examine the affected joint or areas such as cartilage, ligaments, and tendons, and perform the repair.

Different Types of Arthroscopic Surgery

Arthroscopic surgery can be performed on any joint. Shoulder and knee arthroscopy are the most common arthroscopic procedures conducted for repairing meniscus and cartilage problems and fixing rotator cuff tears respectively. Some of the common types of arthroscopic surgery include:

• Shoulder arthroscopy
• Knee arthroscopy
• Ankle arthroscopy
• Hip arthroscopy
• Wrist arthroscopy
• Elbow arthroscopy

Indications for Arthroscopic Surgery

In general, arthroscopic surgery is conducted to diagnose and treat a variety of conditions. Arthroscopic surgery is commonly indicated for:

• Articular cartilage defects and injuries
• Joint debridement and washout for osteoarthritis
• Removal of loose bodies
• Synovectomy
• Meniscal tears
• Anterior cruciate ligament (ACL) tears
• Posterior cruciate ligament (PCL) tears
• Arthroscopic-assisted fixation of tibial plateau fractures
• Evaluation of joints prior to joint replacement

Preparation for Arthroscopic Surgery

Arthroscopic surgery preparation depends on the joint being examined or repaired by your surgeon. However, in general, you are required to:

• Avoid taking certain medications or supplements that may increase the risk of bleeding
• Inform your doctor if you are allergic to any medications or anesthesia
• Avoid consuming liquids or solid foods 6 to 8 hours before surgery
• Wear comfortable clothing to get on and off easily
• Bring assistive devices, such as a walker, cane, or crutches
• Arrange for a ride as you will not be able to drive back yourself

Arthroscopic Surgery Procedure

The surgery is performed under general or local anesthesia. After adequately sterilizing the surgical area, your surgeon makes a few small keyhole incisions through which the arthroscope and tiny specialized instruments are inserted. The joints are irrigated with water to clear debris and aid in visibility. The camera attached to the tip of the arthroscope allows the doctor to view the structures inside the joint through a television screen, and the damaged structures are repaired. The instruments and arthroscope are then withdrawn, and the surgical incisions are closed with sterile dressings or sutures.

Postoperative Care of Arthroscopic Surgery

Before being discharged, your doctor or nurse will give you appropriate postop instructions, such as:

• How to care your incisions and dressing
• Exercises you should do 
• What activities you must avoid
• Use of assistive devices like a sling, splint, or crutches
• Use of pain medications
• Rehabilitation program for a quicker recovery
• Follow-up visit to remove dressings or sutures and monitor your overall progress

Risks and Complications of Arthroscopic Surgery

The risks and complications of an arthroscopic procedure are minimal and occur in less than one percent of all arthroscopic surgeries. Some of the possible risks and complications of arthroscopic surgery include:

• Infection
• Swelling or bleeding
• Blood clots 
• Damage to nerves or blood vessels
• Instrument breakage
• Anesthetic problems

Benefits of Arthroscopic Surgery Over Traditional Open Surgery

Some of the benefits of arthroscopic surgery over traditional open surgery include:

• Can usually be carried out as an outpatient procedure
• Swelling is substantially reduced due to minimal incisions
• Pain is substantially reduced due to minimal manipulation of healthy tissue
• Risk of infection is less due to the minimally invasive approach
• Risk of complications associated with blood loss is notably minimal
• Shorter hospital stay and much lesser recovery time
• Very minimal incisional scarring
• Reduced surgical risk as arthroscopic surgery is a minimally invasive procedure
• Usually more successful than open joint procedures
• Both diagnosis and surgery can be carried out in one approach
• Use of tiny instruments in arthroscopy aids in minimal damage to surrounding tissues compared to large-sized surgical devices 

Related Links

• Elbow Arthroscopy
• Knee Arthroscopy
• Shoulder Arthroscopy
• Ankle Arthroscopy
• Hip Arthroscopy