Arthroscopy is a surgical procedure that orthopaedic surgeons use to visualize, diagnose and treat problems inside a joint. Since this technique became available in the 1970's, hundreds of thousands of patients have chosen it over other types of surgery because the scar is smaller, the hospital stay is shorter and recovery is faster.

In an arthroscopic examination, an orthopaedic surgeon makes a small incision in the patient's skin and then inserts the arthroscope. This is a miniature lens and lighting system that magnifies and illuminates the structures inside the joint.

This small instrument varies from 1/10 to 1/4 inch in diameter. Light is transmitted through fiberoptic cables to the end of the arthroscope that is inserted into the joint. By using a miniature television camera and screen combination, the surgeon is able to see the interior of the joint.

The television camera attached to the arthroscope displays the image of the joint on a television screen. The large image on the screen allows the surgeon to look directly at the joint, determine the extent of injuries, and then perform the particular surgical procedure, if one is necessary.

Why is arthroscopy necessary?

Diagnosing joint injuries and disease begins with a thorough medical history and physical examination, and sometimes, x-rays. Further diagnosis, using arthroscopy may be required because it gives a precise, direct view of the affected bones and "soft tissues" (ligaments and cartilage).

With the arthroscope, our surgeons can see more of the joint than is possible even with a large incision made during an "open" operation. In addition, areas that sometimes are difficult to see on an x-ray can be seen during arthroscopy.

A joint usually contains dense, pad-like tissue called cartilage and fiber-like connecting tissue called ligaments. The cartilage and ligaments cushion the bones and stabilize the joint so the joint can move easily without pain. Additional stability and the ability to control movement are provided by tendons and muscles.

Disease and injuries can damage bones, cartilage, ligaments, muscles and tendons. Some of the most frequent conditions found during arthroscopic examinations of joints are:

• torn or abnormal cartilage
• torn ligaments
• loose fragments of bone or cartilage
• damaged joint surfaces
• inflammation of the joint lining
• misaligned bones (such as the kneecap).

Although uncommon, complications do occur occasionally during or following arthroscopy. They include phlebitis (inflammation of a vein), excessive swelling or bleeding, blood clots, and damage to blood vessels or nerves. There are also risks posed by anesthesia - both during its administration and after the surgery. Again, these potential complications are uncommon or rare.

How is arthroscopy performed?

Arthroscopy requires the use of a hospital operating room or outpatient surgical suite. Before the procedure, you, our patient will be given an anesthetic - either general or spinal. The skin surrounding the affected joint will then be sterilized. A sterile solution is then injected into the joint to expand it, making room for the insertion of the arthroscope.

Your surgeon will make an incision (about the size of a buttonhole) in the skin and insert the arthroscope. Three of these small incisions are usually needed to complete the operation.

After arthroscopic surgery is over, the small incisions are closed and covered with a dressing. You will then be moved from the operating room to a recovery room where ice packs may be applied to the wounds to reduce swelling. Medication may also be administered in the recovery room to minimize pain.

Before being discharged you will learn how you should take care of your incision, what activities you should avoid, and which exercises you should do to aid in your recovery. At a follow-up visit your surgeon will inspect your incision, remove sutures, and discuss your rehabilitation program. If you develop a fever, excessive pain, or drainage from the wound when you return home, you should contact your surgeon immediately.

The amount of surgery required and recovery time will depend on the joint problem. Recovery time varies markedly from patient to patient, but usually is in the range of 2 - 6 weeks.

What are the advantages?

Arthroscopic surgery is an extremely valuable tool and is generally easier on the patient than "open" surgery. Patients have their arthroscopic surgery as outpatients - either in the hospital or in a surgery center. They have the procedure and are able to go home the same day.

The small surgical wounds from arthroscopy - often closed with only one or two stitches, sometimes with none - ensure a more pleasing appearance than the scars caused by open surgery. Because the wounds are small, patients' immediate postoperative pain is less than that associated with the standard operation; this allows a more rapid healing time and rehabilitation.