Arthroscopy
Medical Author: William C. Shiel Jr., MD, FACP, FACR
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Torn ACL (Anterior Cruciate Ligament) of the Knee
Medical Author: Benjamin C. Wedro, MD, FAAEM
Medical Editor: Melissa Conrad Stöppler, MD
 Do people appreciate how amazing it is that Philip Rivers (quarterback for
the San Diego Chargers) played on Sun., Jan. 20, 2008, just six days
after having arthroscopic surgery? Aside from the fact that he likely had some
cartilage debris cleaned out and the rehab time is measured in weeks, he still
had a torn anterior cruciate ligament (ACL).
For regular people and pseudo-athletes, the days after arthroscopic knee
surgery are spent reducing knee swelling and starting range-of-motion exercises.
This process is hampered by a couple of physiologic barriers.
When the knee is invaded, the muscles around it tend to shut down
involuntarily. The quadriceps muscle in the front of the thigh tends to get
immediately weaker, and since it is one of the stabilizing muscles of the knee,
it is a big deal when this muscle decides not to work. The next barrier has to
do with hydraulics. The knee joint has its largest volume of fluid when it's
flexed at 15 degrees. When there is even a little fluid, straightening it out
combats the law of physics that says "you can't compress fluids."
Rivers gets out of surgery and presumably hops into the training room and is
attacked by the physical therapists. Appreciate that for mere mortals, physical
therapists can be kind and gentle, but when they want the patient to do
something, they can become relentless therapists. Pushing the body to its limits is
not something regular patients do. Putting it into perspective, a routine course
of rehabilitation in the first week might have a patient trying to get the
pedals on a stationary bicycle to go around without resistance...once.
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What is arthroscopy?
Arthroscopy is a surgical procedure by which the internal
structure of a joint is examined for diagnosis and/or treatment using a
tube-like viewing instrument called an arthroscope. Arthroscopy was popularized in the 1960s
and is now commonplace throughout the world. Typically, it is performed by
orthopedic surgeons in an outpatient setting. When performed in the outpatient setting, patients can usually return
home after the procedure.
The technique of arthroscopy involves inserting the arthroscope, a small
tube that contains optical fibers and lenses, through tiny incisions in
the skin into the joint to be examined. The arthroscope is connected to a
video camera and the interior of the joint is seen on a television
monitor. The size of the arthroscope varies with the size of the joint
being examined. For example, the knee is examined with an arthroscope that
is approximately 5 millimeters in diameter. There are arthroscopes as small as 0.5
millimeters in diameter to examine small joints such as the wrist.
If procedures are performed in addition to examining the joint
with the arthroscope, this is called arthroscopic surgery. There are a
number of procedures that are done in this fashion. If a procedure can be
done arthroscopically instead of by traditional surgical techniques, it usually causes less tissue trauma,
results in less pain, and may promote a quicker recovery.
For what diseases or conditions is arthroscopy considered?
Arthroscopy can be helpful in the diagnosis and treatment of many
noninflammatory, inflammatory, and infectious types of arthritis as well
as various injuries within the joint.
Noninflammatory degenerative arthritis, or osteoarthritis, can
be seen using the arthroscope as frayed and irregular cartilage. Recently, for
isolated cartilage wear in younger patients, repair of crevasses in the
cartilage, using a "paste" of a patient's own cartilage cells
harvested and grown in the laboratory, has been performed using an
arthroscope.
In inflammatory arthritis, such as rheumatoid arthritis, some patients
with isolated chronic joint swelling can sometimes benefit by arthroscopic removal
of the inflamed joint tissue (synovectomy). The tissue lining the joint
(synovium) can be biopsied and examined under a microscope to determine
the cause of the inflammation and discover infections, such as
tuberculosis. Arthroscopy can provide more information in
situations which cannot be diagnosed by simply aspirating (withdrawing fluid
with a needle) and analyzing the joint fluid.
Common joint injuries for which arthroscopy is considered include
cartilage tears (meniscus tears), ligament strains and tears, and
cartilage deterioration underneath the kneecap (patella).
Arthroscopy is commonly used in the evaluation of knees and
shoulders but can also be used to examine and treat conditions of
the wrist, ankles, and elbows.
Finally, loose tissues, such as chips of bone or cartilage, or foreign
objects, such as plant thorns, that become lodged within the joint can be
removed with arthroscopy.
Next: What is done in preparation for arthroscopy? »
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