Arthroscopy is a minimally invasive procedure performed to diagnose and treat pathological processes affecting the inner part of the joint. It is performed using special endoscopic equipment (arthroscope), the movable parts of which are inserted into the joint through a small incision or several incisions. The technique allows for visual inspection of the joint, performing various diagnostic and therapeutic manipulations under the direct control of vision with minimal traumatization of surrounding tissues.
History of the method
The founder of arthroscopy is considered to be a Japanese doctor Kenji Takagi, who for the first time used a cystoscope to study the joints of living animals and human corpses. In 1921, Takagi created the first arthroscope for the diagnosis of joint diseases in living people and put it into practice. The subsequent years of the researcher were devoted to improving the device. As a result, the arthroscope tripled in size and began to move freely inside the joint. Additional oblique and side lenses provided an increase in the viewing area. In 1932, Takagi took the first photograph of the inner surface of the joint.
Most specialists were initially unable to assess the practical value of the invention and took the arthroscope lightly. In Europe, the device began to be used only in the 60s of the last century. A little later, new developments appeared, including a reduced-size arthroscope with optical fiber. The first professional communities of arthroscopists began to form. The first special atlases were created and some fundamental principles of arthroscopic manipulations and operations were formulated.
In general clinical practice, arthroscopy has been used since the 90s of the last century. Over the past quarter century, specialists in the field of traumatology, orthopedics, rheumatology and other fields of medicine have appreciated the advantages of this technology. Currently, diagnostic and therapeutic manipulations using an arthroscope have become routine. Arthroscopic equipment is installed in many public hospitals and private medical centers. The technique made it possible to speed up the process of diagnosis, ensure high accuracy of differential diagnosis, reduce joint injury and shorten the recovery period after surgical interventions.
Methodology of conducting
The study is carried out using an arthroscope – a modern optical device, which is a rigid metal tube, at one end of which there is a lens with an observation angle of 30 or 70 degrees, at the other end there is an adapter for connecting a light cable and a camera transmitting an image from the lens to the monitor screen. Through a small incision, the tube is inserted into the joint and the light is turned on. During arthroscopy, the doctor moves the lens and studies the condition of various joint structures on the monitor screen. If necessary, the image is recorded on videotape or electronic media.
In most cases, 30-degree equipment is sufficient for a detailed study of intra-articular structures. To study some anatomical formations (for example, the patella or the posteromedial part of the inner meniscus), a 70-degree arthroscope is used. The device is equipped with additional devices, including a trocar, which is used to puncture the skin, and a system for supplying saline solution, which allows increasing the distance between intra-articular structures and providing the best conditions for their visual inspection.
In the process of arthroscopy, saline is supplied through one tube and discharged through another, which allows you to remove excess fluid and wash out loose small fragments. In addition, during diagnostic and therapeutic measures, the surgeon can use a probe for manipulating intra-articular anatomical formations, a shaver for removing damaged parts of cartilage (it is a kind of cutter), as well as pliers for removing menisci, damaged areas of ligaments, etc.
Types of research
Taking into account the objectives of the study, there are three types of arthroscopy: diagnostic, therapeutic and diagnostic. In the process of diagnosis, arthroscopy of the knee, shoulder and ankle joint is most often prescribed. At the same time, the study of the knee joint is the undisputed leader in the list of arthroscopies and is widely used in the detection of traumatic injuries and degenerative-dystrophic lesions. Arthroscopy of the shoulder and ankle joint is used several times less often.
Other types of arthroscopy are used quite rarely, due to either the small size of the joint, or the complexity of the procedure and the need for special preliminary preparation. Under certain conditions, during the examination, patients may be prescribed arthroscopy of the elbow, wrist and hip joints, as well as arthroscopy of the joints of the spine.
Indications
Arthroscopy is considered a complementary and clarifying diagnostic technique and is prescribed at the final stage of the examination. Indications for the procedure are pain of unclear genesis, hemarthrosis, recurrent effusion and other symptoms, the origin of which cannot be established by radiography, MRI of the joint, CT of the joint and other studies. In addition, arthroscopy is used when damage to the capsule, ligaments, menisci and hyaline cartilage covering the articular surfaces is suspected.
Arthroscopy of the knee joint is prescribed to assess the condition of the external and internal menisci, cruciate ligaments, synovial membrane, hyaline cartilage of the articular surfaces of the femur and tibia and the posterior surface of the patella. Arthroscopy is necessary in cases where the pathology cannot be differentiated based on the data of the knee joint radiography. Indications for the study are fresh traumatic injuries (cruciate ligament rupture, meniscus rupture) and long-term consequences of injuries.
In addition, patients with suspected synovitis, diseases caused by increased stress on the joint in athletes (for example, hyperplasia of the adipose body), aseptic necrosis of the femoral condyles and degenerative-dystrophic processes (gonarthrosis) are referred for arthroscopy. Arthroscopy is used in the process of diagnosis, in the course of differential diagnosis, in determining the severity of damage and drawing up a surgical intervention plan, as well as to monitor the condition of the internal structures of the joint in the postoperative period.
Arthroscopy of the shoulder joint is used to detect pathology of the articular ends of bones, muscles, tendons and ligaments of the shoulder joint area. The study is carried out with insufficient information content of CT, MRI, electromyography and other techniques. Arthroscopy is prescribed for chronic pain of unclear genesis, suspected chondromatosis, traumatic and non-traumatic damage to the cartilaginous lip, rotator cuff of the shoulder and ruptures of the long biceps head. The method is used at the final stage of diagnosis, during treatment and postoperative follow-up.
Arthroscopy of the ankle joint is performed to assess the condition of the ligaments, synovial membrane and bone structures of the joint. The study is prescribed for ambiguous results of radiography, CT and MRI. Arthroscopy is used for suspected damage to articular cartilage, chondromatosis, impeachment syndrome, post-traumatic arthrosis and arthrofibrosis. The procedure is used to clarify the diagnosis, remove pathological fluid and fragments of cartilage tissue, determine treatment tactics and follow-up in the postoperative period.
Hip arthroscopy is a complex diagnostic procedure due to the need for preliminary distraction of the joint using special devices. The study is carried out if it is impossible to establish an accurate diagnosis and determine treatment tactics based on radiography, MRI and CT data. Arthroscopy allows you to assess the condition of the acetabulum, acetabulum, femoral head, femoral neck, ligaments and synovial membrane. It is used for traumatic injuries, malformations and degenerative-dystrophic diseases of the joint.
Contraindications
Contraindications to arthroscopy are severe general condition of the patient, acute infectious diseases, infected wounds, abrasions and pustular skin lesions in the joint area. In the presence of joint contractures, bone or fibrous ankylosis, the informative value of the technique decreases, therefore, such conditions are considered as relative contraindications to the procedure. Hip arthroscopy is performed under endotracheal anesthesia, therefore, the list of relative contraindications to this study includes pathological processes in the trachea, larynx and pharynx (acute inflammatory diseases, malignant tumors, tuberculosis).
Preparation for arthroscopy
Before the procedure, the doctor conducts a survey of the patient to identify possible allergic reactions to the anesthetic. Most arthroscopies can be performed under local, conductive or epidural anesthesia, in the presence of allergies, a specialist can choose an alternative version of anesthesia. In addition, the doctor finds out whether the patient suffers from somatic diseases and, if necessary, directs the patient to consult other specialists. Severe disorders of the functions of various organs and disorders of the blood coagulation system are corrected before the start of arthroscopy. The examination plan includes blood and urine tests. Patients over 50 years of age are prescribed for chest X-ray and ECG.
The procedure is performed on an empty stomach. The patient is recommended to choose loose clothing and shoes to ensure the comfort of the limb after the examination. Arthroscopy is performed in compliance with the rules of asepsis and antiseptics. The patient is asked to undress, put on a gurney and taken to a specially equipped room. Anesthesia is performed, one or more punctures are performed using a trocar and the internal structures of the joint are studied using an arthroscope.
At the end of the procedure, 1-2 stitches are applied to the wounds and the puncture sites are closed with an aseptic bandage. As a rule, after arthroscopy, they are allowed to lean freely on the limb. For several days, it is advised to limit the load (do not make sudden movements, do not carry weights, do not squat, etc.). The list of restrictions is determined by the joint under study. The specialist draws up a conclusion and passes the document to the attending physician or issues the results of the study to the patient’s hands.
