Arthroscopy

Definition

Arthroscopy is a method of viewing a joint, and, if needed, to perform surgery on a joint. An arthroscope consists of a tiny tube, a lens, and a light source. The device is inserted into a small incision and allows a surgeon to look for joint damage or disease. The device also allows the surgeon to perform reconstructive procedures on the joint, if needed.

See also knee arthroscopy, shoulder arthroscopy, and rotator cuff repair.

Why the Test is Performed

This test is performed when there is:

• Suspected ligament tear
• Damaged meniscus cartilage
• Evidence of bone fragments from a fracture
• Joint pain from an injury
• Unexplainable joint pain
• Lesions or other problems detected by x-rays
• Joint disease
• A need for joint surgery

Arthroscopy can help monitor the progression of a disease or determine whether a treatment is working.

How the Test is Performed

This procedure is typically performed on the knee, shoulder, elbow, or wrist. The type of anesthesia depends on the particular joint and other factors. A regional anesthetic numbs the affected area, but the patient may remain awake, depending on whether other medications are used. For more extensive surgery, general anesthesia may be used. In this case the patient is unconscious.

The area is cleaned with antiseptic soap. A pressure band may be applied to restrict blood flow (tourniquet). An incision is made into the joint, and sterile fluid is introduced into the joint space to provide a better view. The arthroscope is then inserted, and the inside of the joint is viewed by displaying the image on a monitor.

One or two small additional incisions may be needed, in order to use other instruments. These instruments can be used to remove bits of cartilage or bone, take a tissue biopsy, or perform other minor surgery. In addition, ligament reconstruction can be performed using the arthroscope in many cases.

How to Prepare for the Test

You should not consume any food or fluid for 12 hours before the procedure. You may be instructed to shave your joint area. You may be given a sedative before leaving for the hospital. You will be given a hospital gown at the time of surgery so the body part for surgery is accessible.

You must sign an informed consent form. Make arrangements for transportation from the hospital and for work, child care, and other commitments immediately after the procedure.

How the Test Will Feel

The injection of local anesthesia may sting, but once the anesthetic has taken effect, there is no pain.

The joint may need to be manipulated to provide a better view, so there may be some tugging on the leg (or arm, if done on the shoulder).

After the test, the joint will probably be stiff and sore for a few days. Slight activity such as walking can be resumed immediately, however excessive use of the joint may cause swelling and pain and may increase the chance of injury.

Depending on your diagnosis, there may be other exercises or restrictions.

Risks

• Swelling
• Increased pain
• Localized inflammation
• Infection (fever)
• Joint stiffness

Considerations

The diagnostic accuracy of an arthroscopy is about 98%, although x-rays and sometimes MRI scans are taken first because they are a noninvasive.

Ice is commonly recommended after arthroscopy to help relieve swelling and pain.

The incision made for inserting the arthroscope is very small, and stitches may not be required. If a bandage is applied, you may be given instructions for changing the dressing.

Normal activity should not be resumed for several days or longer. Special preparations may need to be made concerning work and other responsibilities. Physical therapy may also be recommended.

What Abnormal Results Mean

• Torn ligaments
• Bleeding
• Damaged meniscus cartilage
• Bone fragments
• Lesions
• Dislocation
• Rotator cuff tendonitis