Arthroscopy is a surgical method used in the diagnosis and treatment of diseases and injuries involving the joint. The arthroscopy device, the first prototype of which was made by Takagi in Japan in 1931, was first used in a surgical intervention by Watanabe in Japan, and after 1964, this technique began to be used in the United States. In our country, it started to be implemented in the late 1970s and was established in Izmir in 1987 by Prof. Dr. Arthroscopy Association was founded by Veli Lök. Nowadays, in many units in our country, as in many parts of the world, intra-articular interventions can be performed by arthroscopic method.
The word arthroscopy means artros (joint)and skopi (observe).
It is derived from the words strong>. The main device used is called the arthroscope and the one used for the knee is 4 mm. diameter. Thanks to the light source and lens system connected to the arthroscope, the image taken from inside the joint is reflected on the monitor. Arthroscopy is an optical system, and thanks to this optical system located at the tip of the arthroscope, intra-articular structures can be magnified and evaluated in great detail. Another advantage of arthroscopy is that the resulting images can be recorded. In addition, side effects such as postoperative infection, difficulty in movement, and joint limitation that may occur with open surgery are reduced and the opportunity to reach joint areas that are not possible to reach with open surgery is gained.
In which joints can arthroscopy be performed?
Arthroscopy was first applied to the knee joint, and with the development of techniques and devices, it began to be applied to many other joints. Today, the joints that most commonly undergo arthroscopic surgery are the knee and shoulder joints. Apart from these, it can also be applied to ankle, wrist, elbow, hip and even intervertebral joints. 4 mm in the knee and shoulder joints, and 1.9 and 2.7 mm in small joints such as the wrist and elbow. diameter arthroscopes are used.
Which procedures can be performed with arthroscopy?
In the knee joint with arthroscopy,
- Meniscectomy: removal of meniscus tears,
- Meniscus repair,
- Restoration of anterior and posterior cruciate ligaments (reconstruction),
- (calcification) in osteoarthritisjoint debridement (removal of unwanted and increased soft or hard tissues from the joint in the early period),
- In septic arthritis (bacterial inflammation of the knee) evacuation of inflammation and washing of the joint,
- Osteochondritis dissecans (cartilage separation or falling into the joint ): Removal of free body (joint rat),
- Mosaicplasty.(in cases of loss occurring on joint cartilage surfaces, placement of cylindrical cartilage pieces taken from places where there is no load, to the loss area ),
- Synovial resection (removal of the joint membrane called snovia in rheumatic diseases),
- Treatment of some fractures involving the knee joint(auxiliary as),
- Treatment of patella (kneecap bone)dislocation (alone or as an adjunct),
- Removal of movement restrictions that develop after an accident or surgery (alone or with assistance),
- Removal of intra-articular benign tumors and cysts can be performed.
In the ankle joint with arthroscopy,
- Osteochondritis dissecans (cartilage separation or falling into the joint): Free body ( (joint mouse) removal,
- Mosaicplasty. (in case of loss of joint cartilage surfaces, placement of cylindrical cartilage pieces taken from non-loaded areas in the knee joint to the loss area in the wrist),
- Impingement syndrome (tissue compression that occurs after sprains)
- (calcification) in osteoarthritis joint debridement (undesirable and increased removal of soft or hard tissues from the joint),
- In septic arthritis (bacterial inflammation of the wrist)draining the inflammation and washing the joint,
- Synovial resection (removal of the joint membrane called snovia in rheumatic diseases),
How is arthroscopy performed?
Arthroscopy procedures are performed in the operating room. It is performed under masculine conditions and under anesthesia. It can be done with general anesthesia or spinal anesthesia (anesthesia from the waist). After anesthesia is applied, a urinary catheter is placed if necessary, depending on the length of the procedure to be performed. Then, a tourniquet is wrapped around the leg to be operated on to prevent bleeding and the leg is placed in a holder. The use of tourniquet and leg holder depends on the surgeon's preference.
Tools that should be included in the arthroscopy set; optical arthroscope, light source, camera cable, 3 liter fluid bags, fluid inflow and exit pipes, pump and shaving device, evacuation cannula, probe, cutting and holding tools for control of intra-articular structures, arthroscopic scissors and radiofrequency system. In meniscus repair, a set with special cannulas is used, and in cruciate ligament reconstruction, a separate set with special guides is used.
As standard, 2 portals are opened in front of the knee. These portals are 4-5 mm. diameter. Sterile fluids are used to inflate the joint and provide vision, and another portal can be opened, preferably from the upper exterior, to remove the fluid. If desired, in some applications, accessory portals can be opened in the inner and outer parts of the back of the knee.
It is possible to adjust the intensity of the light source and the pressure of the incoming fluid required to visualize the joint.
After the inside of the joint is visualized, the patellofemoral joint (anterior knee joint), medial (inner) dead end, internal meniscus, internal articular cartilage, anterior and posterior cruciate ligament, external meniscus, external articular cartilage and lateral ( external)The impasse is evaluated. This evaluation is made with the probe, which is referred to as the arthroscopist's finger inside the joint.
The probe is a thinner tool than the arthroscope and has a 4 mm diameter at its tip. The strength and integrity of the meniscus and cruciate ligaments are evaluated with its long hook. The part up to this point is called diagnostic arthroscopy and after the diagnosis is made, the necessary procedures are started. (See: Meniscus tears, anterior cruciate ligament tears)
Is there any danger in arthroscopy?
Since arthroscopy is performed with a closed method, the possibility of side effects is very low. Although it is very rare compared to open transactions, However, there are risks such as infection, deep vein thrombosis (blockage in the veins), damage to the joint surfaces with arthroscopic tools, non-healing of the repaired tissue, and nerve injury, which can be seen in every surgery.
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