Arthroscopy (also called arthroscopic surgery or keyhole ) is a minimally invasive surgical procedure in the joints where examination and sometimes damage treatments are performed using < b> arthroscope , an endoscope inserted into the joint through a small incision. An arthroscopic procedure may be performed during ACL reconstruction. Although commonly used for meniscal injuries to the knee, this use is not supported by evidence that suggests a positive result.
The advantage over traditional open surgery is that the joint does not have to be fully opened. For knee arthroscopy only two small incisions are made, one for the arthroscope and one for the surgical instrument for use in the knee cavity. This reduces recovery time and can increase the success rate due to less trauma to connective tissue. It has gained popularity due to evidence of faster recovery time with fewer scars, due to smaller incisions. Irrigation fluid (most commonly 'normal' saline) is used to enlarge the joints and make surgical space.
Surgical instruments are smaller than traditional instruments. The surgeon sees the joint area on the video monitor, and can diagnose and repair torn joints, such as ligaments. It is technically possible to perform arthroscopic examinations on almost every joint, but is most commonly used for knees, shoulders, elbows, wrists, ankles, feet, and hips.
Video Arthroscopy
Type
Knee
Knee arthroscopy, in most cases, replaces the classical open surgery (arthrotomy) done in the past. Arthroscopy knee surgery is one of the most common orthopedic procedures, performed approximately 2 million times worldwide each year. This procedure is more commonly performed to treat meniscus injuries and to reconstruct anterior krusiatum ligaments.
During the average knee arthroscopy, a small optical fiber camera (arthroscope) is inserted into the joint through a small incision, about 4 mm (1/8 inch) in length. More incisions may be made to visually inspect other parts of the knee and incorporate the mini instruments used to perform surgical procedures.
Osteoarthritis
The BMJ Quick Recommendation Group makes strong recommendations on arthroscopy for osteoarthritis on the basis that there is high-quality evidence that there is no lasting benefit and less than 15% of people have little short-term benefits. There are rare but serious side effects that can occur, including venous thromboembolism, infection, and nerve damage. BMJ Quick Recommendations include infographics and shared decision-making tools to facilitate conversations between doctors and patients about the risks and benefits of arthroscopic surgery.
Two large trials of arthroscopic surgery for knee osteoarthritis found no benefit for this surgery. Many medical insurance providers are now reluctant to replace surgeons and hospitals for what could be considered procedures that seem to create operational risks with questionable or unproven benefits. However, this is still a widely adopted treatment for various conditions associated with osteoarthritis, including labral tears, femoroacetaps collisions, osteochondritis dissecans.
A 2017 meta-analysis confirms that there is only a very small and usually unimportant reduction in pain and increased function at 3 months (eg pain reduction averaging about 5 on a scale from 0 to 100). A separate review found that most people would consider a pain reduction of about 12 on the same 0 to 100 scale - suggesting that for most people, pain relief at 3 months is unimportant. Arthroscopy does not reduce pain or improve function or quality of life at one year. There are important adverse effects.
Meniscal tears
One of the main reasons for doing arthroscopies is to repair or prune the painful and torn or damaged peniscus. The technical term for surgery is partial arthroscopic meniscectomy (APM). Arthroscopic surgery, however, does not seem to result in adult benefit when performed for knee pain in patients with osteoarthritis who have a meniscal tear. This may be due to the fact that the torn meniscus often does not cause pain and symptoms, which may be caused by osteoarthritis alone. Several groups have made strong recommendations for partial arthroscopy of menisectomy in almost all patients, suggesting that the only group of patients who may be - or may not - benefit is the group with the actual locked knee. Professional knee societies, however, highlight other symptoms and related factors that they believe are important, and continue to support the limited use of arthroscopic partial artectomy in carefully selected patients.
Hip
Hip arthroscopy was originally used for the diagnosis of unexplained hip pain, but is now widely used in the treatment of conditions both inside and outside the hip joint. The most common indication today is for the treatment of femoroacetabular (FAI) collisions and associated pathology. The arthroscopically treated hips condition also includes labral tears, removal of foreign bodies, hip washing (for infection) or biopsy, chondral lesions (cartilage), osteochondritis dissecans, ligament injury teres (and reconstruction), Iliopsoas tendinopathy (or ' broken psoas'), trochanteric pain syndrome, iliotibial blister band, osteoarthritis (controversial), sciatic nerve compression (piriformis syndrome), ischiofemoral collision and direct assessment of pelvic replacement.
Shoulders
Arthroscopy is commonly used for the treatment of diseases of the shoulder including subakromial imprints, acromioclavicular osteoarthritis, rotator cuff tears, frozen shoulder (capsulitis adhesive), chronic tendonitis, sagging limbs and partial tears of long biceps tendon, SLAP lesions and shoulder instability. The most common indications include subacromial decompression, repair of banker lesion and rotator cuff repair. All of these procedures are performed by opening the joint through a large incision before the appearance of arthroscopy. Arthroscopic shoulder surgery has gained momentum in the last decade. "Keyhole surgery " of the shoulder as it is known has reduced hospitalization time and rehabilitation requirements and is often a child-care procedure.
Wrist
Wrist arthroscopy is used to investigate and treat recurrent strain injury symptoms, broken wrist bones and torn or damaged ligaments. It can also be used to ascertain joint damage caused by osteoarthritis of the wrist.
Spine
Many invasive spinal procedures involve the removal of bones, muscles, and ligaments to access and treat problematic areas. In some cases, a thoracic (mid-spine) condition requires the surgeon to access the problem area through the ribs, dramatically prolonging the recovery time.
The arthroscopic procedure (also an endoscopic spinal procedure) allows access to and treatment of spinal conditions with minimal damage to adjacent tissues. Recovery time is greatly reduced due to the relatively small incision size, and many patients are treated as outpatients. The rate of recovery and time vary depending on the severity of the condition and overall health of the patient.
Arrhythmic arthroscopy procedure
- Spinal herniation and degenerative discs
- spinal deformity
- tumor
- general spinal trauma
Temporomandibular joint
Arthroscopy of the temporomandibular joint is sometimes used either as a diagnostic procedure for symptoms and signs associated with this joint, or as a therapeutic action in conditions such as temporomandibular joint dysfunction. TMJ arthroscopy can be a pure diagnostic procedure, or it can have its own beneficial effects that may result from joint washing during the procedure, which is thought to remove debris and inflammatory mediators, and may allow the replaced disk to return to the correct position.. Arthroscopy is also used to visualize the inside of the joint during certain surgical procedures involving articular discs or articular surfaces, similar to laparoscopy. Examples include the release of adhesion (for example, with blunt or laser surgery) or disc removal. Biopsy or reduction of the discus can also be performed during arthroscopy. This is done under general anesthesia.
Maps Arthroscopy
History
Professor Kenji Takagi in Tokyo is traditionally credited with performing the first arthroscopic examination of the knee joint, in 1919. He used a 7.3 mm cystoscope for his first arthroscopies. It has recently been found that Danish physician Severin Nordentoft reported on knee joint arthroscopies in 1912 at the Proceedings of the 4Estro Congress of the German Society of Surgeons in Berlin. He calls the procedure (in Latin) genu arthroscopy , and uses a sterile saline or sterile acid solution as its optical medium, and enters the joint by the portal on the outer border of the patella. It is unclear whether this examination is from a patient who has died or lived.
The pioneering work began as early as the 1920s with the work of Eugen Bircher. He published several papers in 1920 on the use of knee arthroscopy for diagnostic purposes. After diagnosing the torn tissue, he uses open surgery to remove or repair damaged tissue. Initially, he used the thoracal electric toraparoskop Jacobaeus for his diagnostic procedure, which produced a bleak view of the joint. Later, he developed a dual contrast approach to improve visibility. He surrendered endoscopy in 1930, and his work was largely ignored for decades.
While he is often considered the inventor of knee arthroscopy, Japanese surgeon Masaki Watanabe, MD, received major credit for using arthroscopy for interventional surgery. Watanabe was inspired by the work and teaching of Dr Richard O'Connor. Then, Dr. Heshmat Shahriaree began experimenting with ways to cut the menisci fragments.
The first operating arthroscope was designed by them, and they worked together to produce the first high quality color intra-articular photography. This field benefited significantly from technological advances, especially advances in flexible optical fibers during the 1970s and 1980s.
Surgical training
Arthroscopic surgical skills have been traditionally taught in laboratory corpses, although the progression of in vivo surgery varies from country to country. The International Arthroscopy Society, Knee Surgery and Orthopedic Orthopedic Medicine (ISAKOS) have a list of approved courses for acquiring surgical skills.
New teaching techniques use medical simulations as an alternative to corpse training. The high-fidelity simulators range from those using real and passive haptic surgeries, such as VirtaMed's ArthroS (TM), to those who rely on active haptic feedback, such as Arthro Mentor (TM) from Simbionix. When studied, passive haptics have shown "high scores in terms of realism" and the ability to differentiate between "different levels of arthroscopic experience". Reference materials, such as applications developed by Touch Surgery, also contain minimally invasive visualization techniques.
Complications
Arthroscopy is considered a low-risk procedure with a very low level of serious complications. Generally, irrigation fluids can leak (extravasates) to the surrounding soft tissues, causing edema which is generally a temporary phenomenon, lasting from 7-15 days to completely settling. Rarely, this fluid can be a cause of serious complications, compartment syndrome. However, Postarthroscopic glenohumeral chondrolysis (PAGCL) is a rare complication of arthroscopic surgery and involves chondrolysis in which the articular cartilage of the shoulder undergoes rapid degenerative changes shortly after arthroscopic surgery.
See also
Arthroscopic and Related Surgery
Note
External links
- North American Arthroscopy Association
- Arthroscopy: Journal of Arthroscopic and Related Surgery
- SpineUniverse Invasive Minimally Invasive Spinal Feedback Information Center - Articles from different institutes, organizations and professionals of the spine
Source of the article : Wikipedia
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