Editors: Frassica, Frank J.; Sponseller, Paul D.; Wilckens, John H.
Title: 5-Minute Orthopaedic Consult, 2nd Edition
Copyright ©2007 Lippincott Williams & Wilkins
> Table of Contents > Arthroscopy
Arthroscopy
Marc Urquhart MD
John H. Wilckens MD
BasicsDescription
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Arthroscopy should be performed after a
complete history and physical examination and after appropriate imaging
studies have been obtained. -
Most procedures can be performed on an outpatient basis.
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Knee:
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Indications:
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Meniscal repair or débridement
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Meniscal cyst
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Treatment of osteochondral lesions
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ACL or PCL tear débridement or reconstruction
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Synovial biopsy or synovectomy
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Determination of uncertain origin of instability or pain
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Débridement of degenerative joint disease
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-
Procedure:
-
2 or more portal incisions ~0.5 cm in
length allow visualization through the arthroscope and instrument
placement through another portal. -
The articular cartilage can be visualized in the 3 compartments of the knee (patellofemoral, medial, and lateral).
-
The medial and lateral menisci, as well as the ACL and OSD, can be visualized and probed to assess stability and integrity.
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Meniscal tears often can be treated with débridement or repair.
-
ACL and PCL tears also can be reconstructed with arthroscopic assistance.
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Rehabilitation:
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Postoperatively, most patients can resume partial to full weightbearing with crutch assistance.
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The rehabilitation period after arthroscopy varies, depending on the type of procedure performed.
-
Many patients who have undergone
arthroscopy have some physical therapy for strengthening of the core,
quadriceps, and hamstrings; the duration and method of rehabilitation
are specific to the injury.
-
-
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Shoulder:
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Indications (1):
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Treatment of instability
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Biopsy
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Removal of loose bodies
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Treatment of impingement
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Rotator cuff repair
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Management of SLAP tears
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Procedure:
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Involves 2 or more 0.8-cm portals
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The articular cartilage of the glenoid
and humeral head can be visualized for any pathologic process (e.g.,
osteoarthritis, osteochondral fragments). -
The soft-tissue stabilizers of the
shoulder also can be assessed: Inferior glenohumeral ligament complex,
middle glenohumeral ligament complex, superior glenohumeral ligament
complex. -
The integrity of the labrum also can be determined arthroscopically.
-
If the patient has rotator cuff symptoms,
arthroscopy includes visualizing the subacromial space and rotator cuff
for causes of impingement. -
Definitive procedures that can be
performed arthroscopically: Soft-tissue stabilization procedures for
instability of recurrent dislocations (e.g., Bankart capsulorrhaphy),
acromioplasty, rotator cuff repair, and SLAP repairs or débridements
(encouraged)
-
-
Rehabilitation:
-
Physical therapy is a necessary modality for anyone who has undergone shoulder arthroscopy.
-
In general, the emphasis is on regaining
motion and strengthening the shoulder girdle muscles and dynamic
stabilizers of the shoulder. -
The duration and mode of rehabilitation vary with the type of injury and surgical procedure.
-
-
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Hip:
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Indications (2):
-
Synovial biopsy or synovectomy
-
Loose-body removal
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Treatment of labral tears
-
-
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Ankle:
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Indications (3):
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Synovial biopsy or synovectomy
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Loose-body removal
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Bone-spur removal
-
Treatment of osteochondral lesions
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-
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Elbow:
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Indications (4):
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Synovial biopsy or synovectomy
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Loose-body removal
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Débridement of cartilage lesions and osteophytes
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-
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Wrist:
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Indications (5):
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Synovial biopsy or synovectomy
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Loose-body removal
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Diagnosis or débridement of TFCC injuries
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P.33
References
1. Ellman H. Shoulder arthroscopy: current indications and techniques. Orthopaedics 1988;11:45–51.
2. Byrd JWT. Hip arthroscopy. The supine position. Clin Sports Med 2001;20:703–731.
3. Drez D, Jr, Guhl JF, Gollehon DL. Ankle arthroscopy. Technique and indications. Clin Sports Med 1982;1:35–45.
4. Poehling GG, Ekman EF. Arthroscopy of the elbow. J Bone Joint Surg 1994;76A:1265–1271.
5. Whipple TL. The role of arthroscopy in the treatment of wrist injuries in the athlete. Clin Sports Med 1998;17:623–634.
MiscellaneousFAQ
Q: What is arthroscopy?
A:
Arthroscopy is a procedure whereby a fiberoptic camera is inserted into
a joint via a portal (stab) incision to visualize the articular
surfaces and the supporting soft tissues.
Arthroscopy is a procedure whereby a fiberoptic camera is inserted into
a joint via a portal (stab) incision to visualize the articular
surfaces and the supporting soft tissues.
Q: Is arthroscopy only diagnostic, or can it be used operatively to repair, reconstruct, or remove injured structures?
A:
Arthroscopy has evolved from being just diagnostic to having the
ability to address most abnormalities of a joint. Accessory portals
allow the introduction of additional instruments.
Arthroscopy has evolved from being just diagnostic to having the
ability to address most abnormalities of a joint. Accessory portals
allow the introduction of additional instruments.
Q: Is arthroscopy safer than traditional surgery?
A:
Arthroscopy, properly performed, results in less morbidity and pain
than traditional open surgical incisions and approaches. Arthroscopy
has a steep learning curve and requires additional training to become
familiar with the arthroscopic anatomy and facile with the arthroscopic
equipment. In inexperienced hands, arthroscopy can be less effective
and more dangerous than standard open surgical procedures.
Arthroscopy, properly performed, results in less morbidity and pain
than traditional open surgical incisions and approaches. Arthroscopy
has a steep learning curve and requires additional training to become
familiar with the arthroscopic anatomy and facile with the arthroscopic
equipment. In inexperienced hands, arthroscopy can be less effective
and more dangerous than standard open surgical procedures.