History of Arthroscopy
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The use of an endoscopic device for internal examination dates back to the early 1800s but it wasn’t until a century later that the first documented knee joint examination was performed.
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The clinical use of arthroscopy, originally referred to as “arthro-endoscopy,” is generally thought to have been simultaneously developed by Dr. Eugen Bircher of Switzerland and a Japanese professor named Kenji Takagi.
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The first paper in the United States on the topic of arthroscopy was published by Dr. Phillip Kreuscher on the diagnosis and treatment of meniscal tears.
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In the 1930s, Dr. Michael Burman from the Hospital for Joint Diseases in New York published the first arthroscopic images in his paper “Arthroscopy or the Direct Visualization of Joints.”
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World War II slowed progress in the field for the next few decades but after the war Dr. Masake Watanabe took over previous work and introduced the first fiberoptic arthroscope, introduced the concept of triangulation using various portals, and performed the first arthroscopic meniscectomy.
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Largely due to his efforts in teaching, he was later elected the first chairman of the International Arthroscopy Association (IAA) when it was founded in 1972.
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Robert W. Jackson, a Canadian surgeon who visited Dr. Watanabe, brought interest and experience back to other surgeons in North America. He gave the first instructional course lecture on arthroscopy at the American Academy of Orthopaedic Surgeons in 1968.
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Dr. Richard O’Connor also visited Dr. Watanabe and pioneered some of the early advances in indications and techniques for arthroscopy.
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Ward Casscells and Jack McGinty were among the early North American advocates for arthroscopy who continued to develop this surgical field after spending time with Dr. Jackson.
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These men were among the founders of the Arthroscopy Association of North American (AANA) which was established in 1981 as a subgroup of the IAA. Its primary goal was and still is “to promote, encourage, support and foster through continuing medical education functions, the development and dissemination of knowledge in the discipline of arthroscopic surgery.”
Arthroscopic Equipment
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Arthroscope
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Fiberoptic instrument which is introduced into a joint via a cannula.
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A fiberoptic cable and camera attached to the arthroscope allow visualization of the interior joint structures.
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Arthroscopes are classified by their diameter and viewing angle.
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View is magnified.
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Variable amount is based on distance to object being viewed.
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It is best to compare against a known reference.
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Lens is angled ( Fig. 1-1 ) .
Figure 1-1
The angled lens of the arthroscope.
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View is typically opposite the light cord.
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30-degree lens is used most often.
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70-degree lens can be helpful to look “around corners.”
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Different sizes are available.
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4 mm is used for larger joints (knee and shoulder).
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2.5 mm is used for intermediate joints (ankle).
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1.9 mm is used for smaller joints (wrist).
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Cannulas ( Fig. 1-2 )
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Arthroscopic cannula allows fluid ingress/egress and arthroscope locks into it.
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Typically, they are introduced with a blunt trocar to minimize iatrogenic injury.
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Disposable cannulas can be used in established portals.
Figure 1-2
The arthroscopic cannula.
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Camera
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Becoming increasingly precise
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Number of “chips” related to resolution of image
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Light Source
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Allows maximum lumens
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Connected via fiberoptic cord
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Monitor ( Fig. 1-3 )
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Television
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Resolution continues to improve.
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Monitor should be placed on the top of the tower to allow the best visualization from the surgical field.
Figure 1-3
The arthroscopic monitor sits on top of the tower to allow easy visual access by the surgeon.
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Image Capture System ( Fig. 1-4 )
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Digital and video images can be captured and stored electronically.
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They can be stored and edited for clinical and educational purposes.
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Editing and archiving requires constant attention.
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Software and options continue to improve.
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