Developed in the 1970's this procedure enables visualization of the joint through small incisions with a pencil-sized scope mounted to a small video camera. A fiber optic cord transmits light to the joint or bursa that is expanded by intravenous fluid enabling the image to be seen on a television monitor.
At first this was for diagnoses and a traditional open procedure followed.
Now techniques have evolved to have instruments for performing the surgical procedure through small skin incisions as well.
Arthroscopy is highly effective in diagnoses and treatment of most knee and shoulder problems and has become the most common orthopaedic procedure in the United States.
Dr.Glidden performs both knee and shoulder Arthroscopy and a brief overview of these will follow.
Being the largest joint in the body it follows that arthroscopy first developed with this joint. With the joint expanded with IV fluid the surfaces (Hyalan cartilage) interposed meniscus (fibrocartilage), ligaments (anterior and Posterior cruciate) and lining (synovium) can be visualized. The following can be diagnosed and treated.
- Torn meniscal cartilage.
- Loose fragments of bone or cartilage damaged joint surfaces,
often called Chondromalacia.
- Abnormal alignment of the kneecap (patella).
- Torn cruciate ligaments.
- Inflamed Synovium (lining).
Besides the internal anatomy, the procedure affords the surgeon the chance to examine the knee under anesthesia with comparison to the other knee.
By minimizing the incisions and thus trauma to normal tissues, the procedure is performed as an outpatient and significantly lessens the morbidity afterwards.
Historically shoulder arthroscopy evolved after the knee and has replaced (as well)
open procedures as the standard surgical approach to various shoulder conditions.
In contrast to the knee the shoulder has a large bursa outside and on top of the joint and therein is where the most common conditions are treated.
- Acromioclavicular arthritis
- Rotator Cuff tears
Shoulder bursitis, tendonitis is often called impingement and often occurs with crowding of the bursa by bone spurs off of the acromion. Chronically most rotator cuff tears occur from this persisting crowding or impingement. Arthroscopic surgery in the bursa can remove the inflamed bursal tissue and the spurs (I call "raising the roof").
Painful arthritis of the acromioclavicular joint (at the top of the shoulder) can be treated through the bursal approach as well.
Recent technological advances have enabled surgeons to repair most rotator cuff tears.
Within the shoulder joint torn tissue (labrum) and inflamed synovium can be removed and labral repairs performed. (Often correcting shoulder instability.)
Again shoulder arthroscopy offers the best setting to be able to access shoulder stability.