Arthroscopy

(Arthroscopic Surgery, Arthroscopic Examination, Joint Endoscopy, Knee Arthroscopy, Shoulder Arthroscopy, Fiberoptic Joint Examination)

Procedure Overview

What is arthroscopy?

Arthroscopy is a minimally-invasive procedure used for the diagnosis and treatment of conditions affecting joints. The physician can directly view the internal structures of a joint using an instrument called an arthroscope.

An arthroscope is a small tube-shaped instrument that is inserted into a joint. It consists of a system of lenses, a small video camera, and a light for viewing. The camera is connected to a monitoring system that allows the physician to view a joint through a very small incision. The arthroscope is often used in conjunction with other tools that are inserted through another incision.

The joint most frequently examined using arthroscopy is the knee. However, arthroscopy can be used to examine other joints, including the following:

• shoulder
• elbow
• ankle
• hip
• wrist

Other related procedures that may be used to help diagnose joint disorders include joint aspiration, x-ray, magnetic resonance imaging (MRI), computed tomography (CT scan), bone scan, and arthrography. Please see these procedures for additional information.

Anatomy of the knee:

Click Image to Enlarge

Joints are the areas where two or more bones meet. Most joints are mobile, allowing the bones to move. Basically, the knee is two long leg bones held together by muscles, ligaments, and tendons. Each bone end is covered with a layer of cartilage that absorbs shock and protects the knee.

There are two groups of muscles involved in the knee, including the quadriceps muscles (located on the front of the thighs), which straighten the legs, and the hamstring muscles (located on the back of the thighs), which bend the leg at the knee.

Tendons are tough cords of tissue that connect muscles to bones. Ligaments are elastic bands of tissue that connect bone to bone. Some ligaments of the knee provide stability and protection of the joints, while other ligaments limit forward and backward movement of the tibia (shin bone).

The knee consists of the following:

• tibia - shin bone or larger bone of the lower leg.
• femur - thighbone or upper leg bone.
• patella - kneecap.
• cartilage - a type of connective tissue made up of cells and fibers that covers the surface of a bone at a joint. Cartilage is wear-resistant and helps reduce the friction of movement within a joint.
• synovial membrane - a tissue that lines the joint and seals it into a joint capsule. The synovial membrane secretes synovial fluid (a clear, sticky fluid) around the joint to lubricate it.
• ligament - a type of tough, elastic connective tissue that surrounds the joint to give support and limits the joint's movement.
• tendon - a type of tough connective tissue that connects muscles to bones and helps to control movement of the joint.
• meniscus - a curved part of cartilage in the knees and other joints.

Reasons for the Procedure

An arthroscopic procedure may be used to diagnose and assist in the treatment of the following conditions:

• inflammation in the knee, shoulder, elbow, wrist, or ankle
• injuries, such as shoulder rotator cuff tendon tears or impingement syndrome (pinching of tendons in the shoulder caused by the excessive squeezing or rubbing of the rotator cuff and shoulder blade)
• cartilage damage, such as tears, injury, or wear
• ligament tears with instability in the knee
• tendon damage
• carpal tunnel syndrome in the wrist
• loose bone and/or cartilage, particularly in the knee, shoulder, elbow, ankle, or wrist
• abnormal growths on a joint, such as scar tissue or a tumor
• rheumatoid and degenerative arthritis

Corrective surgery or a biopsy may be performed using arthroscopy. For example, torn ligaments can be repaired or reconstructed. Arthroscopic surgery may eliminate the need for an open surgical procedure.

There may be other reasons for your physician to recommend an arthroscopy.

Risks of the Procedure

As with any surgical procedure, complications can occur. Some possible complications may include, but are not limited to, the following:

• bleeding
• infection
• blood clots in the legs or lungs

Nerves or blood vessels in the area of surgery may be injured, resulting in weakness or numbness.

There may be other risks depending upon your specific medical condition. Be sure to discuss any concerns with your physician prior to the procedure.

Before the Procedure

• Your physician will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.
• You will be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear.
• In addition to a complete medical history, your physician may perform a complete physical examination to ensure you are in good health before undergoing the procedure. You may undergo blood tests or other diagnostic tests.
• Notify your physician if you are sensitive to or are allergic to any medications, latex, tape, and anesthetic agents (local and general).
• Notify your physician of all medications (prescribed and over-the-counter) and herbal supplements that you are taking.
• Notify your physician if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop these medications prior to the procedure.
• If you are pregnant or suspect that you are pregnant, you should notify your physician.
• You will be asked to fast for eight hours before the procedure, generally after midnight.
• You may receive a sedative prior to the procedure to help you relax. Because the sedative may make you drowsy, you will need to arrange for someone to drive you home.
• The area around the surgical site may be shaved.
• Based upon your medical condition, your physician may request other specific preparation.

During the Procedure

Arthroscopy may be performed on an outpatient basis or as part of your stay in a hospital. Procedures may vary depending on your condition and your physician’s practices.

Knee Arthroscopy

Arthroscopy may be performed while you are asleep under general anesthesia, or while you are awake under local or spinal anesthesia. If spinal anesthesia is used, you will have no feeling from your waist down. The type of anesthesia will depend upon the specific procedure being performed. Your physician will discuss this with you in advance.

Generally, an arthroscopic procedure follows this process:

1. You will be asked to remove clothing and will be given a gown to wear.
2. An intravenous (IV) line may be started in your arm or hand.
3. You will be positioned on an operating table, in a manner that provides the best access to the joint being operated on.
4. The anesthesiologist will continuously monitor your heart rate, blood pressure, breathing, and blood oxygen level during the surgery.
5. The skin over the surgical site will be cleansed with an antiseptic solution.
6. The physician may drain blood from the surgical area by elevating the extremity and/or applying an elastic wrap to the extremity. The physician may instill a fluid solution (generally a saline solution) before the arthroscope is inserted to help distend the joint and reduce swelling.
7. The physician will make an incision in the joint area.
8. The arthroscope will be inserted through the incision, into the joint.
9. Other incisions may be made to introduce other small grasping, probing, or cutting tools.
10. Corrective surgery, if necessary, may be performed.
11. The incision will be closed with stitches or adhesive strips.
12. A sterile bandage/dressing will be applied.

After the Procedure

After surgery, you will be taken to the recovery room for observation. Your recovery process will vary depending upon the type of anesthesia that is given. The circulation and sensation of the affected extremity will be monitored. Once your blood pressure, pulse, and breathing are stable and you are alert, you will be taken to your hospital room or discharged to your home. Arthroscopic surgery is usually done on an outpatient basis.

Once you are home, it is important to keep the incision site clean and dry. Your physician will give you specific bathing instructions. If stitches are used, they will be removed during a follow-up office visit. If adhesive strips are used, they should be kept dry and generally will fall off within a few days.

Take a pain reliever for soreness as recommended by your physician. Aspirin or certain other pain medications may increase the chance of bleeding. Be sure to take only recommended medications.

Activity and the use of the joint may be limited for 24 to 48 hours after a diagnostic arthroscopy. If other procedures are performed, such as a ligament repair, your activity and use of your joint may be limited for a longer period of time. Your physician will give you specific instructions. For knee surgery, you may be given an immobilizer to wear. Your physician may also instruct you to apply ice to the surgical site and to elevate the knee when sitting. Specific instructions will depend upon the exact procedure performed.

Notify your physician to report any of the following:

• fever
• redness, swelling, bleeding, or other drainage from the incision site
• increased pain around the incision site
• numbness and/or tingling in the affected extremity

You may resume your normal diet unless your physician advises you differently.

Your physician may give you additional or alternate instructions after the procedure, depending on your particular situation.