There are a number of diseases of the joints that require them to be closely examined from the inside. Modern arthroscopy, or joint endoscopy, makes it possible to do just that without the need for major surgery, as was necessary before its invention.
What is arthroscopy?
Schematic diagram of an arthroscopy of the shoulder joint. Click to enlarge. Arthroscopy is a so-called minimally invasive surgery. This refers to a medical procedure in which the living body is penetrated, but not to the extent that is the case in an ordinary operation. Rather, a special instrument is inserted into the body through an incision only a few millimeters in size. The goal of arthroscopy, as its Greek-derived name suggests, is to view the exact condition of a joint from the inside. “Arthros” means “joint” in Greek; “skopien” can be translated as “to look at” or “to examine”. During arthroscopy, the joint is viewed or examined using an endoscope. This is a medical instrument that looks like a tube. The special feature of this “tube” is that a high-resolution camera is installed at the upper end, which sends the optical data to a monitor on which the attending physician can follow the course of the arthroscopy and assess the condition of the joint. Other instruments are also attached, such as hooks as well as cutting tools, in order to be able to treat the joint therapeutically while the arthroscopy is still in progress, should this be necessary. The history of arthroscopy can be traced back to the Swiss surgeon Eugen Bircher, who was the first to practice this procedure in the early 20th century and established it to the present day.
Function, effect and goals
Before arthroscopy can begin, the joint to be examined must be filled with a liquid, or less commonly, a gas. While Bircher used nitrogen at that time, today the golden standard is sodium chloride solution or Ringer’s solution. Less frequently, for example if there is a risk of allergic reactions on the part of the patient, carbon dioxide is used. The chosen solution is then injected into the joint through a syringe. The blood supply to the area of the body where the joint is located is then cut off by means of cuffs. If the patient wishes, the arthroscopy can be performed under general anesthesia; otherwise, which is also more standard, only the affected area is anesthetized. As soon as the anesthesia begins to take effect, the actual operation is performed by cutting a small incision about five millimeters in diameter. The endoscope is inserted through this incision site. With regard to the purpose for which the arthroscopy is intended in the first place, a distinction is made between diagnostic and therapeutic arthroscopy. In diagnostic arthroscopy, the physician limits himself to examining the condition of the joint and checking its functionality. To do this, for example, he uses the hooks attached to the endoscope to check the tear stability of the cruciate ligaments. Therapeutic arthroscopy goes further and performs surgical procedures. To stay with the example of the knee, the instruments attached to the endoscope can be used to remove cornifications or, in the case of a cruciate ligament tear, to replace the ligaments with new ones. After successful arthroscopy, it is essential for the patient to participate in physiotherapy. This is to check and practice – especially in therapeutic arthroscopy – the functionality of the joints and possibly newly inserted ligaments after arthroscopy by a doctor.
Risks and dangers
However, arthroscopy has also been criticized. For example, diagnostic arthroscopy in particular is accused of being obsolete. At the latest since the introduction of computed tomography, it has become superfluous. Furthermore, as with all other operations, observations have been made that the risk of suffering from thrombosis is increased by arthroscopy. Wound healing disorders have also been recorded as a consequence of arthroscopy. Despite the criticism, therapeutic arthroscopy in particular is a particularly gentle measure for treating existing diseases.This is because the same criticisms leveled at arthroscopy also apply to traditional surgery – and to an even greater degree.
