Objectives

Arthroscopy

Arthroscopic surgery involves the use of fiberoptic cameras and small surgical instruments to visualize and treat intraarticular structures of the joint (Figure 18-1). The most common arthroscopic procedures include removal of loose bodies, trimming of articular cartilage flaps and meniscal tears, and débridement of scar tissue. Arthroscopic procedures can also be used to obtain a more accurate diagnosis through visual inspection of the joint. Although many of today’s magnetic resonance images are of very high quality, at times a visual inspection through arthroscopy is needed to make an accurate diagnosis. In particular, arthroscopy can be used to diagnose the size, depth, and condition of articular cartilage lesions.

The technique of arthroscopic surgery involves the placement of three to four small incisions (portals) around the joint. Standard arthroscopic incisions create small, approximately 1 to 2 cm, portals. Fluid is introduced in the joint to allow better visualization and separation of structures and to remove any blood that might be present from surgical incisions or injuries.

The portals are used for placement of the arthroscopic camera to visualize the work inside the joint. A beam of light and a small camera are used to project an image of the interior of the joint onto a video monitor.

Sterile fluid is used to expand the joint, and a probe is frequently used to manipulate and investigate joint structures. Because the portal incisions are so small, stitches usually are not required to close the surgical wounds (Figure 18-2).

Arthroscopy can be used to examine and repair the damaged joint in a single operation. First used primarily on the knee joint, arthroscopy now can diagnose and treat problems in the shoulder, elbow, wrist, hip, and ankle. Whether joint problems are the result of an acute event, such as a sports injury, or a chronic condition, such as arthritis, arthroscopy has improved the quality of patient care and can be performed on individuals of all ages.

Arthroscopy not only makes joint surgery less invasive, it also reduces recovery time. Because less disruption of joint structures occurs, pain and swelling to surrounding structures are lessened. This can allow earlier return to range-of-motion and strengthening exercises.

Although some complex procedures still require traditional open surgery, many procedures can be performed by using arthroscopy.

As with any surgical procedure, risks are associated with arthroscopy, including the following:

Almost all arthroscopic surgeries now are performed on an outpatient basis. Steri-Strips are frequently used to close the arthroscopic portals, allowing skin incisions to heal and minimizing scarring. A loose, sterile dressing is applied for 3 to 4 days. Depending on the procedure, patients may be allowed to bear weight as tolerated with the use of crutches and may wean off the crutches when they can walk without a limp. Rehabilitation should begin as soon as the surgeon permits so that the joint does not lose range of motion and so that muscle atrophy can be reduced. Showers generally are allowed at 3 or 4 days after surgery. Most patients recover fully.

Massage Application

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