The term “arthroscopy” originated as a derivative of the Greek words “arthron,” meaning joint, and “skopein,” meaning to look at. Interest in exploring the interior body cavities dates back to references to the vaginal speculum in the ancient Hebrew literature and by a discovery of proctoscopes in the ruins of Pompeii. Initially, the bladder was the most desired organ to explore and provided a major impetus in development of endoscopic devices. The major challenge was to determine how to introduce light into a body cavity in order to visualize the inside. In 1806, Philip Bozzini (1773-1809) used an instrument called a “Lichtleiter,” which was designed to look into the bladder¹ (Figs. 1-1 and 1-2). This apparatus consisted of two simple tubes and a candle as a light source and represented the first endoscopic procedure. Subsequently, Desormaux (1815-1882) developed the gazogene endocystoscope. This device provided light based on the combustion of gasoline and turpentine. The light was reflected into the bladder by a mirror.²

The next major advancement in endoscopy was Thomas Edison’s development of the incandescent lightbulb in 1879. A few years later, Leiter and Max Nitze (1848-1906) developed the first modern cystoscope using an incandescent lightbulb, and endoscopic techniques started to flourish. Arthroscopy, originally called arthroendoscopy, or the exploration of joint cavities, was the natural evolution of the success of the cystoscope.

In 1910, Hans Christian Jacobaeus (1879-1937), a Swedish physician, started exploring the abdomen and thoracic cavity with the use of a “laparo-thoracoscope”³ (Fig. 1-3).

Danish surgeon Severin Nordentoft (1866-1922) was the first to apply endoscopic instrumentation to a knee joint. His paper at the German Society of Surgeons in Berlin in 1912 was the first manuscript to use the term “arthroscopy” from the Latin term arthroscopia genu (Fig. 1-4).

In 1918, Kenji Takagi (1888-1963) initiated efforts at endoscopic examination of cadaver tuberculosis knees at the University of Tokyo, using a No. 22 French cystoscope⁴ (Fig. 1-5). In Switzerland, Eugen Bircher (1882-1956) advanced the technique in 1921 by using gas (carbon monoxide) distention of the knee⁵ (Figs. 1-6 and 1-7). He used a modified Jacobaeus scope made by the Wolf Company in Berlin and called the technique “arthroendoscopy.” He reported on his first 60 patients and was the first to describe arthroscopy as a diagnostic tool and treat actual patients.⁶ Phillip Kreuscher (1883-1943) reported in the United States the first clinical results doing diagnostic knee arthroscopy for meniscus disorders in 1925⁷ (Fig. 1-8). The large diameter of the cystoscope limited its utility, but in 1931, Takagi
developed an arthroscope 3.5 mm in diameter that incorporated a lamp and magnifying optics and provided a clearer visual field. With this device, he compiled unprecedented clinical experience in endoscopic examination of the knee, and in 1936, he obtained color pictures and a movie film.

In New York, Michael Burman (1901-1975) made significant arthroscopic advances. While working at the Hospital for Joint Disease, he obtained a scholarship to spend a fellowship year in Berlin studying endoscopic techniques. In 1931, he reported using a 4-mm scope of his own design to examine 100 cadaver knee joints, but he extended his examinations to 25 shoulders, 20 hips, 15 elbows, 3 ankles, and 6 wrists⁸ (Fig. 1-9).

After World War II, Masaki Watanabe (1911-1994), a student of Professor Takagi’s, continued the development of the arthroscope, and he presented the first color video at the
SICOT Congress in Spain in 1957 (Fig. 1-10). In 1958, he released the Watanabe No. 21 arthroscope, which proved to be the first truly successful production arthroscope because it had a wonderful lens with an angle of vision of 102° and an excellent depth of focus. The primary problem with this arthroscope was that the incandescent lightbulb would frequently catch on synovial folds within the joint, causing it to bend away from the lens or sometimes break inside the joint.

In 1967, he introduced the No. 22 arthroscope, which had a fiber light or “cold light” for illumination and was a major advancement in the development of arthroscopy. He published the first Atlas of Arthroscopy in English in 1957 and the second edition in 1969, illustrated with color photographs of the interior of the knee joint.⁴ He was also the first to develop the concept of “triangulation,” which involved bringing in instruments from different portal sites in the knee.

In 1964, Robert Jackson (1932-2010) went to Tokyo University to study tissue culture techniques (Fig. 1-11). However, after meeting Watanabe and observing his arthroscopic procedures, he became convinced that the technique would revolutionize the diagnosis and treatment of joint disorders. He returned to Toronto General Hospital in 1965 and used the Watanabe No. 21 arthroscope to develop his technique. He gave the first instructional course on arthroscopy at the AAOS Annual Meeting in 1968. Watanabe also attracted the attention and enthusiasm of several other North American surgeons, including S. Ward Casscells of Wilmington, Delaware; John Joyce of Philadelphia, Pennsylvania; Jack McGinty of Boston, Massachusetts; and Richard O’Connor of West Covina, California (Figs. 1-12, 1-13, 1-14 and 1-15). Using the improved Watanabe arthroscopes, these surgeons and others established the application of Watanabe’s techniques for knee arthroscopy in the United States and Canada. In various publications, they reported their experience with the numerous advantages of arthroscopy for diagnostic purposes, as well as for early arthroscopic surgery in the knee.⁹, ¹⁰, ¹¹, ¹², ¹³