arthroscopy

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Arthroscopy

 

Definition

Arthroscopy is the examination of a joint, specifically, the inside structures. The procedure is performed by inserting a specifically designed illuminated device into the joint through a small incision. This instrument is called an arthroscope. The procedure of arthroscopy is primarily associated with the process of diagnosis. However, when actual repair is performed, the procedure is called arthroscopic surgery.

Purpose

Arthroscopy is used primarily by doctors who specialize in treating disorders of the bones and
Arthroscopy is primarily used to help diagnose joint problems. This procedure, most commonly associated with knee and shoulder problems, allows accurate examination and diagnosis of damaged joint ligaments, surfaces, and other related joint structures. The illustration above indicates the most common entry sites, or portals, in knee arthroscopy.
Arthroscopy is primarily used to help diagnose joint problems. This procedure, most commonly associated with knee and shoulder problems, allows accurate examination and diagnosis of damaged joint ligaments, surfaces, and other related joint structures. The illustration above indicates the most common entry sites, or portals, in knee arthroscopy.
(Illustration by Electronic Illustrators Group.)
related structures (orthopedics) to help diagnose joint problems. Once described as essential for those who primarily care for athletic injuries, arthroscopy is now a technique commonly used by orthopedic surgeons for the treatment of patients of all ages. This procedure is most commonly used to diagnose knee and shoulder problems, although the elbow, hip, wrist, and ankle may also be examined with an arthroscope.
A joint is a complex system. Within a joint, ligaments attach bones to other bones, tendons attach muscles to bones, cartilage lines and helps protect the ends of bones, and a special fluid (synovial fluid) cushions and lubricates the structures. Looking inside the joint allows the doctors to see exactly which structures are damaged. Arthroscopy also permits earlier diagnosis of many types of joint problems which had been difficult to detect in previous years.

Precautions

Most arthroscopic procedures today are performed in same-day surgery centers where the patient is admitted just before surgery. A few hours following the procedure, the patient is allowed to return home, although usually someone else must drive. Depending on the type of anesthesia used, the patient may be told not to eat for several hours before arriving. Before the procedure, the anesthesiologist will ask if the patient has any known allergies to local or general anesthetics. Airway obstruction is always possible in any patient who receives a general anesthesia. Because of this, oxygen, suction, and monitoring equipment must be available. The patient's cardiac status should always be monitored in the event that any cardiac abnormalities arise during the arthroscopy.

Description

The arthroscope is an instrument used to look directly into the joint. It contains magnifying lenses and glass-coated fibers that send concentrated light into the joint. A camera attached to the arthroscope allows the surgeon to see a clear image of the joint. This image is then transferred to a monitor located in the operating room at the time of the arthroscopy. This video technology is also important for documentation of the arthroscopic procedure. For example, if the surgeon decides after the arthroscopic examination that a conventional approach to surgically expose or "open" the joint (arthrotomy) must be used, a good photographic record will be useful when the surgeon returns to execute the final surgical plan.
The procedure requires the surgeon to make several small incisions (portals) through the skin's surface into the joint. Through one or two of the portals, a large-bore needle, called a cannula, is attached to tubing and inserted into the joint. The joint is inflated with a sterile saline solution to expand the joint and ensure clear arthroscopic viewing. Often, following a recent traumatic injury to a joint, the joint's natural fluid may be cloudy, making interior viewing of the joint difficult. In this condition, a constant flow of the saline solution is necessary. This inflow of saline solution may be through the cannula with the outflow through the arthroscope, or the positions may be reversed. The arthroscope is placed through one of the portals to view and evaluate the condition of the joint.

Preparation

Before an arthroscopy can take place, the surgeon completes a thorough medical history and evaluation. Important for the accuracy of this diagnostic procedure, a medical history and evaluation may discover other disorders of the joint or body parts, proving the procedure unnecessary. This is always an important preliminary step, because pain can often be referred to a joint from another area of the body. Anatomical models and pictures are useful aids to explain to the patient the proposed arthroscopy and what the surgeon may be looking at specifically.
Proper draping of the body part is important to prevent contamination from instruments used in arthroscopy, such as the camera, light cords, and inflow and outflow drains placed in the portals. Draping packs used in arthroscopy include disposable paper gowns and drapes with adhesive backing. The surgeon may also place a tourniquet above the joint to temporarily block blood flow to the area during the arthroscopic exam.
General or local anesthesia may be used during arthroscopy. Local anesthesia is usually used because it reduces the risk of lung and heart complications and allows the patient to go home sooner. The local anesthetic may be injected in small amounts in multiple locations in skin and joint tissues in a process called infiltration. In other cases, the anesthetic is injected into the spinal cord or a main nerve supplying the area. This process is called a "block," and it blocks all sensation below the main trunk of the nerve. For example, a femoral block anesthetizes the leg from the thigh down (its name comes from femur, the thighbone). Most patients are comfortable once the skin, muscles, and other tissues around the joint are numbed by the anesthetic; however, some patients are also given a sedative if they express anxiety about the procedure. (It's important for the patient to remain still during the arthroscopic examination.)

Key terms

Hemarthrosis — A condition of blood within a joint.
Pulmonary embolus — Blockage of an artery of the lung by foreign matter such as fat, tumor, tissue, or a clot originating from a vein.
Thrombophlebitis — Inflamation of a vein with the formation of a thrombus or clot.
General anesthesia, in which the patient becomes unconcious, may be used if the procedure may be unusually complicated or painful. For example, people who have relatively "tight" joints may be candidates for general anesthesia because the procedure may take longer and cause more discomfort.

Aftercare

The portals are closed by small tape strips or stitches and covered with dressings and a bandage. The patient spends a short amount of time in the recovery room after arthroscopy. Most patients can go home after about an hour in the recovery room. Pain medication may be prescribed for a short period; however, many patients find various over-the-counter pain relievers sufficient.
Following the surgical procedure, the patient needs to be aware of the signs of infection, which include redness, warmth, excessive pain, and swelling. The risk of infection increases if the incisions become wet too early following surgery. Because of this, it is good practice to cover the joint with plastic (for example, a plastic bag) while showering after arthroscopy.
The use of crutches is commonplace after arthroscopy, with progression to independent walking on an "as tolerated" basis by the patient. Generally, a rehabilitation program, supervised by a physical therapist, follows shortly after the arthroscopy to help the patient regain mobility and strength of the affected joint and limb.

Risks

The incidence of complications is low compared to the high number of arthroscopic procedures performed every year. Possible complications include infection, swelling, damage to the tissues in the joint, blood clots in the leg veins (thrombophlebitis), leakage of blood into the joint (hemarthrosis), blood clots that move to the lung (pulmonary embolus), and injury to the nerves around the joint.

Normal results

The goal of arthroscopy is to diagnose a joint problem causing pain and/or restrictions in normal joint function. For example, arthroscopy can be a useful tool in locating a tear in the joint surface of the knee or locating a torn ligament of the shoulder. Arthroscopic examination is often followed by arthroscopic surgery performed to repair the problem with appropriate arthroscopic tools. The final result is to decrease pain, increase joint mobility, and thereby improve the overall quality of the patient's activities of daily living.

Abnormal results

Less optimal results that may require further treatment include adhesive capsulitis. In this condition, the joint capsule that naturally forms around the joint becomes thickened, forming adhesions. This results in a stiff and less mobile joint. This problem is frequently corrected by manipulation and mobilization of the joint with the patient placed under general anesthesia.

Resources

Periodicals

Glassman, Scott. "Advances in Treating Shoulder Injuries." Advanced Magazine for Physical Therapists (December 1997): 10-12.

arthroscopy

 [ahr-thros´kah-pe]
examination of the interior of a joint with an arthroscope.

ar·thros·co·py

(ar-thros'kŏ-pē), Avoid the incorrect form orthoscopy.
Endoscopic examination of the interior of a joint.
Synonym(s): arthroendoscopy
[arthro- + G. skopeō, to view]

arthroscopy

/ar·thros·copy/ (ahr-thros´kah-pe) examination of the interior of a joint with an arthroscope.

arthroscopy

(är-thrŏs′kə-pē)
n. pl. arthrosco·pies
Examination of the interior of a joint, such as the knee, using a type of endoscope that is inserted into the joint through a small incision.

ar′thro·scope′ (är′thrə-skōp′) n.
ar′thro·scop′ic (-skŏp′ĭk) adj.
ar′thro·scop′ic·al·ly adv.

arthroscopy

[ärthros′kəpē]
Etymology: Gk, arthron + skopein, to watch
the examination of the interior of a joint, performed by inserting a specially designed endoscope through a small incision. The procedure, used chiefly in knee problems, permits biopsy of cartilage or synovium, diagnosis of a torn meniscus, and, in some instances, removal of loose bodies in the joint space. arthroscopic, adj.
enlarge picture
Arthroscopy

arthroscopy

Orthopedics The direct examination of a joint–eg, shoulder, wrist, knee, ankle, with an arthroscope Indications Diagnose and/or biopsy lesions of the meniscus, synovium, and extrasynovial tissues, and manage intraarticular lesions–eg, torn ligaments and cartilage Abnormal findings Baker's cyst, chondromalacia, chondromatosis, fractures, osteochondral disruption, fractures, osteochondritis dissecans, rheumatic disease, synovial defects, capsular or ligament tears Complications Nerve damage related to portal placement, postoperative joint infection, soft tissue or bone infections. See Arthroscope, Arthroplasty.

ar·thros·co·py

(ahr-thros'kŏ-pē)
Endoscopic examination of the interior of a joint.
Synonym(s): arthroendoscopy.
[arthron, joint + G. skopeō, to view]

arthroscopy

(ar-thros′kŏ-pē) [ arthro- + -scopy]
Enlarge picture
ARTHROSCOPY OF KNEE
Direct joint visualization by an arthroscope, usually to remove, repair, or replace tissue, such as cartilage fragments or torn ligaments, or to anneal injured tissues. arthroscopic (ar″thrŏ-skop′ik), adjective See: illustration

Patient care

Preoperative: The patient is prepared physically and emotionally for the procedure. Baseline data (e.g., range of motion, girth measurements) are gathered. The operative site is prepared according to protocol and type of anesthesia.

Postoperative: Vital signs are monitored until stable, and intravenous or oral fluids are provided, depending on the type of anesthesia used. Neurovascular status is assessed. The surgical dressing is inspected for drainage, and the presence of any drainage devices and their contents are documented. Postoperative teaching stresses expected sensations, such as joint soreness and grinding; the application of ice to relieve pain and swelling; use of analgesics; restrictions on activity or walking; weight-bearing exercises; and use of crutches or other such devices. The patient is instructed to report any unusual drainage, redness, joint swelling, unusual softness in the joint, severe or persistent pain, or fever, because these may indicate infection, effusion, hemarthrosis, or a synovial cyst. The patient is referred for outpatient follow-up care as necessary.

arthroscopy

Examination of the inside of a joint by an optical device, usually a fine bore fibreoptic endoscope.

arthroscopy

procedure for visualizing the interior of a joint, using an intra-articular camera to assess, repair or reconstruct various tissues within and around it.

arthroscopy

an endoscopic technique for the examination or treatment of the interior of a joint

ar·thros·co·py

(ahr-thros'kŏ-pē)
Endoscopic examination of the interior of a joint.
[arthro- + G. skopeō, to view]

arthroscopy

examination of the interior of a joint with an arthroscope, usually for diagnostic purposes.

second-look arthroscopy
repeated arthroscopic examination of a joint.
References in periodicals archive ?
There are certain things you can do arthroscopically, but not everything.
An allograft reconstruction can be done arthroscopically in about 20 to 30 minutes.
If they repair the torn anterior cruciate ligament arthroscopically, Davis may be ready for practice in October.
Nowadays most knee surgery is carried out arthroscopically, a procedure developed about 15 years ago, which uses a steel tube containing a camera, known as an arthroscope, inserted into the joint through a small skin incision so there is no need to cut the knee open.
Synovis filed a 510(k) application with the FDA during the second quarter for this arthroscopically delivered device to reinforce rotator cuff and other tendon repairs.
All tears were arthroscopically debrided, and those with complete ruptures were indicated for secondary reconstruction at a later date.
This prospective clinical trial included 58 male patients who underwent elective unilateral, arthroscopically assisted ACL reconstruction and received a bone-patellar tendon-bone graft.
ACL reconstructions are done arthroscopically, using small incisions that make recovery easier, but healing and rehabilitation will still likely take six to nine months.
2003a) cited a series where preoperative GIRD was noted all pitchers in a series of type II SLAP tears confirmed arthroscopically.
Then, a season later, Hall had his sore right elbow arthroscopically examined, and no structural damage was found.
In the fiscal 2011 second quarter, Synovis expects to file a 510(k) application with the FDA for the anchoring system and instrumentation for this arthroscopically delivered device to reinforce rotator cuff and other tendon repairs.
Unlike ACI, this technique can be performed entirely arthroscopically as a single-stage procedure (Fig.