Arthroscopy

Anatomy

A joint is an articulation or connection between two bones that allows for movement. The type and structure of the joint will determine the level of movement allowed. For example, the knee is a hinge joint that allows bending (flexion) and straightening (extension) in the leg, whereas the shoulder is a ball-and-socket joint that allows arm motion in any direction. While each joint contains unique components related to its specific function, there are baseline similarities between joints that allow the concepts of arthroscopic surgery to be applied.

Joints are surrounded by a thick tissue called the capsule, which forms an enclosed space. The inner layer of the capsule is lined by synovium, which serves as a filter. The synovium secretes joint fluid, which lubricates the joint. There is cartilage attached to the ends of each bone in the joint. The cartilage is a form of connective tissue that resembles the shiny white portion of a chicken bone; it provides a smooth surface for joint movement. There are often ligaments (bundles of fibrous tissue) and tendons (ropelike muscle attachments to bone) that are around and inside joints and serve to stabilize them.

Indications

The indications for arthroscopic surgery include a wide range of conditions that involve the joints and the ligaments inside them. Arthroscopy is primarily performed for diagnostic purposes. In cases where the diagnosis is unclear after physical exam and imaging, some surgeons may opt to perform an arthroscopy to visualize the joint and locate the problem. Generally, the source of the pain can be found and addressed during the arthroscopy.

Debridement is a term used to describe the cleaning of a surface, and it can be applied to the joint. Often, a patient will have an arthroscopy due to pain or limitation of mobility. With arthroscopic debridement, the surgeon can smooth the roughened surfaces that may be causing the pain or excise any tissues that may be causing painful symptoms. Debridement can also be used to wash out a joint infection.

Many types of repairs of ligaments and tendons can be done through arthroscopy. Tears of ligaments or cartilage in the knee, such as anterior cruciate ligament or meniscus tears, can be repaired with the aid of arthroscopy. Shoulder injuries involving torn cartilage or tendons, such as rotator cuff tears and biceps tendon injuries, can also be repaired through arthroscopy. The requirement for arthroscopic repair is that the structure in question be within the joint space and in an area accessible by the arthroscopic tools.

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