Arthroscopy

Synonyms

English: arthroscopy

• Reflection
• Knee mirror
• Shoulder endoscopy
• Keyhole surgery

Definition

An arthroscope is a special endoscope. It consists of an optical system of rod lenses, a light source and usually a rinsing and suction device. In addition, the arthroscope has working channels through which surgical instruments can be inserted for minor surgical procedures.

To make work easier, the optics of this endoscope is often connected to a monitor via a camera. The physician can therefore use this arthroscope to view the joint structures directly, similar to a camera. What is an arthroscopy?

An arthroscopy is a “knee joint endoscopy“, i.e. a view of the inside of the knee using an optical system. The arthroscope consists of a tube (trocar sleeve) and the optics. The trocar sleeve with a tip (trocar) is inserted into the joint through an approximately 5 mm long skin incision below the kneecap.

The trocar is then pulled out of the joint through the sleeve. The optics are then inserted into the joint through the sleeve remaining in the joint. Two additional tubes are connected to the arthroscope.

One tube is used to introduce fluid into the joint, the other is used to aspirate the fluid. For the surgical procedure, a second skin incision, also with a length of approx. 5 mm, is necessary through which the small surgical instruments can be inserted into the joint.

Occasionally, a separate supply line for liquid, a so-called irrigation cannula, is inserted into the joint through a third small skin incision about 5 mm long above the kneecap. The arthroscopic optics consists of a lens system, a light source and a light guide cable. Video cameras of the smallest design and weighing less than 30 g make it possible to record the inside of the joint and display it magnified on a screen (monitor).

The surgeon therefore no longer needs to look through the arthroscope into the inside of the joint, but can work with a view of the monitor (video arthroscopy). The video technique is more complex. However, it has the advantage that the greater distance between the surgeon and the knee joint greatly reduces the risk of inflammation of the knee joint by germs.

In addition, this technique allows the treated person to follow the operation if desired and to document the findings and operation. The supply of fluidIn the normal state, the joint interior between the joint capsule and the bony structures is only a narrow gap. It therefore offers little space for the examination and the surgical procedure.

For arthroscopy, the joint is therefore filled with fluid (e.g. with physiological saline solution) or, in rare cases, with gas. This allows a good view of the individual structures. In order to achieve permanently good visibility, the one-time filling of the joint is not sufficient.

In most cases, the joint must be continuously flushed during the procedure. It is operated under water, so to speak, like in an aquarium. Irrigation can also be used to remove remnants of decayed cells (cell detritus) and small pieces of cartilage.

This can already reduce pain. Arthroscopic surgery of meniscus damage is performed mechanically and/or motor-driven with the smallest surgical instruments specially developed for arthroscopy, which allow palpation, cutting, punching, gripping and suction. On the other hand, experienced surgeons can also use laser beams to remove meniscus tissue. A study from 1996 came to the conclusion that – with regard to the functionality of the knee joint after the operation – complex laser arthroscopy is not superior to mechanical arthroscopy. Laser surgery has been largely abandoned by leading experts due to the danger involved in the treatment of cartilage damage and because of the greater amount of time required.