Arthroscopy, also known as joint endoscopy, is a minimally invasive procedure in orthopaedics and trauma surgery, which can be used both diagnostically and therapeutically in the case of injuries and degenerative changes. Arthroscopy is performed through small incisions (arthrotomies) and with the help of an arthroscope (a special form of endoscope) and is a very popular procedure for all larger joints, but now also for smaller joints such as the wrist. Arthroscopy has been gaining in importance for some years now, particularly in the elbow joint, but is still used far less frequently in this joint than, for example, in the knee or shoulder.
Indication
One area of application for performing arthroscopy is the surgical removal of osteophytes. These are new bone formations that form mainly in the context of wear-related (degenerative) bone changes. An example of this is arthrosis, in which the bone is subjected to increased stress because the pressure and friction acting on the joint surface can no longer be distributed from the cartilage to the entire joint surface.
Their removal is relatively complex, as they can vary greatly in size and shape. Chisels and shavers (rotating knives with a device for sucking off removed material) are used for their removal. Another indication is arthrosis itself.
Unevenness, fraying and cracks due to wear and tear of the cartilage can become trapped when the joint is moved and can be very painful. These can be removed very well with the help of a shaver. Overall, however, lesions of the articular cartilage of the elbow are much less common than in the shoulder or knee joint.
In addition, adhesions or wrinkles, for example of the joint capsule, can form in joints. These structures are called free joint bodies and can also be removed by arthroscopy. Studies have shown that their removal very often leads to a significant reduction in pain. In order not to overlook any free joint bodies, an exact diagnosis of the joint is necessary before and during the operation. Contraindications (contraindications) of arthroscopy in general consist only of infections in the area of the surgical site and a poor general condition of the patient.
Preparation
As with any other operation, the patient must be informed about the procedure itself, as well as possible risks and complications, before the operation. This is done by talking to the surgeon and by means of information sheets. This also includes a neurological examination of the elbow area to exclude any nerve damage that may already be present.
In addition, the patient and doctor must jointly weigh up the risk-benefit ratio of the intervention and consider possible other therapeutic and diagnostic options. This is done before every arthroscopic procedure by taking an X-ray image in two planes (lateral and from behind). If necessary, an MRI (magnetic resonance imaging) or CT (computed tomography) can also be performed, which may even replace the diagnostic use of arthroscopy. Finally, the anaesthetist will give a separate explanation of the anaesthesia and possibly a physical examination to clarify possible risks with general anaesthesia. Further examinations, among others of the ligamentous apparatus of the elbow, can be carried out completely painlessly shortly before the operation after the anaesthetic has been given.
