Arthroscopy, or Arthroscopic Surgery, is a minimally invasive joint surgery. It's typically performed as a day-case procedure under general or regional anesthesia, lasting anywhere from 15 minutes to two hours depending on the specific surgery. Recovery, however, can take several months, based on the severity of the injury and the treatment performed. Patients are often referred to physical therapy as part of their recovery.

During an arthroscopic procedure, small incisions are made on the sides of the joint. A tiny camera is inserted through these cuts, which projects a view of the joint's interior onto a screen. Specialized surgical instruments are also inserted to perform actions like cutting, fusing, and other necessary procedures. This technique allows for the diagnosis and treatment of a wide range of joint injuries.

Advantages and Disadvantages

Before arthroscopy, all joint surgeries were performed using the traditional "open" approach. The arthroscopic method has several significant advantages over open surgery:

• Smaller incisions

• Reduced risk of inflammation

• Less pain

• Faster recovery and an earlier return to activity

• Reduced risk of unintended damage to surrounding tissues (nerves, blood vessels, and muscles)

• Shorter hospital stay (as it's a day-case surgery)

• Low complication rate

• Accurate diagnosis due to access to the entire joint space

On the other hand, the primary drawbacks of this method relate to the surgeon: it requires a significant amount of time to learn the technique and achieve full mastery of the equipment.

Complications

Although arthroscopy has a lower rate of complications compared to open surgery, it is still an invasive procedure with potential risks. Complications are uncommon and usually minor, and most can be prevented with proper pre-operative planning, a solid understanding of anatomy, and correct technique.

The most common complication during the surgery is damage to the cartilage from the instruments, which can happen due to the surgeon's inexperience, a tight joint, or a lengthy and difficult operation. In very rare cases, other structures of the joint, such as nerves and major blood vessels, can be damaged. A relatively common post-operative complication is bloody fluid in the joint. As with any surgery, there is a risk of infection, but the chance is less than 1%. The risk of blood clots or embolisms is also very low.

Types of Surgeries

Knee Arthroscopy

Before arthroscopy was developed, a torn meniscus was treated by removal, with the mistaken belief that it would regrow. It was later found that partial removal using an arthroscopic method leads to improved clinical outcomes and reduced future joint wear. Today, this is the most common orthopedic surgery.

Knee arthroscopy is also performed to remove loose bodies, repair early cartilage damage, treat infections and diseases within the joint space, and remove tumors, among other things.

Shoulder Arthroscopy

The shoulder is the second most common joint for arthroscopic procedures. Surgeries to address joint instability and tendon problems were performed using the classic open surgical approach throughout the 20th century. With the development of minimally invasive techniques, surgeons began to try arthroscopy on the shoulder joint, but because of the joint's complex anatomy, it took longer for the procedure to become a standard treatment.

The shoulder is surrounded by many muscles, making it difficult to feel the joint bones, and the approach to the joint passes near major nerves and blood vessels. Despite this, arthroscopic procedures have contributed significantly to understanding the pathology of the joint and have, over time, become a therapeutic option with results comparable to classic open surgery.

Ankle Arthroscopy

Ankle joint diseases can also be treated with arthroscopic surgery. Currently, most arthroscopic procedures performed on the ankle are done to treat osteochondritis dissecans (a condition where small pieces of bone and cartilage break off into the joint, causing pain, swelling, and limited movement) or impingement syndromes. However, arthroscopy can also be used to treat degenerative ankle diseases, remove bone spurs from the tibia and talus, release the Achilles tendon from adhesions after ankle trauma, and remove an Os Trigonum (a superfluous bone that sometimes grows behind the talus), among other conditions.

Hip Arthroscopy

The hip joint is particularly difficult to access arthroscopically because it is deep, stable, and tight. However, in recent years, there has been an increase in the number of arthroscopic surgeries on this joint. Common reasons for surgery include a torn labrum, removal of loose bodies from the joint, infection, cartilage damage, disease of the joint space, and diagnostic procedures to investigate the source of joint pain.