Dr. Kevin Yip

Dr Kevin Yip
Orthopaedic Surgeon
MBBS(UK), FRCS(EDIN), FAM(SING), FHKCOS(ORTHO)

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Arthroscopy

Basics
Description
  • Arthroscopy should be performed after a complete history and physical examination and after appropriate imaging studies have been obtained.
  • Most procedures can be performed on an outpatient basis.
  • Knee:
    • Indications:
      • Meniscal repair or debridement
      • Meniscal cyst
      • Treatment of osteochondral lesions
      • ACL or PCL tear debridement or reconstruction
      • Synovial biopsy or synovectomy
      • Determination of uncertain origin of instability or pain
      • Debridement of degenerative joint disease
    • Procedure:
      • 2 or more portal incisions ~0.5 cm in length allow visualization through the arthroscope and instrument placement through another portal.
      • The articular cartilage can be visualized in the 3 compartments of the knee (patellofemoral, medial, and lateral).
      • The medial and lateral menisci, as well as the ACL and OSD, can be visualized and probed to assess stability and integrity.
      • Meniscal tears often can be treated with debridement or repair.
      • ACL and PCL tears also can be reconstructed with arthroscopic assistance.
    • Rehabilitation:
      • Postoperatively, most patients can resume partial to full weightbearing with crutch assistance.
      • The rehabilitation period after arthroscopy varies, depending on the type of procedure performed.
      • Many patients who have undergone arthroscopy have some physical therapy for strengthening of the core, quadriceps, and hamstrings; the duration and method of rehabilitation are specific to the injury.
  • Shoulder:
    • Indications:
      • Treatment of instability
      • Biopsy
      • Removal of loose bodies
      • Treatment of impingement
      • Rotator cuff repair
      • Management of SLAP tears
    • Procedure:
      • Involves 2 or more 0.8-cm portals
      • The articular cartilage of the glenoid and humeral head can be visualized for any pathologic process (e.g., osteoarthritis, osteochondral fragments).
      • The soft-tissue stabilizers of the shoulder also can be assessed: Inferior glenohumeral ligament complex, middle glenohumeral ligament complex, superior glenohumeral ligament complex.
      • The integrity of the labrum also can be determined arthroscopically.
      • If the patient has rotator cuff symptoms, arthroscopy includes visualizing the subacromial space and rotator cuff for causes of impingement.
      • Definitive procedures that can be performed arthroscopically: Soft-tissue stabilization procedures for instability of recurrent dislocations (e.g., Bankart capsulorrhaphy), acromioplasty, rotator cuff repair, and SLAP repairs or debridements (encouraged)
    • Rehabilitation:
      • Physical therapy is a necessary modality for anyone who has undergone shoulder arthroscopy.
      • In general, the emphasis is on regaining motion and strengthening the shoulder girdle muscles and dynamic stabilizers of the shoulder.
      • The duration and mode of rehabilitation vary with the type of injury and surgical procedure.
  • Hip:
    • Indications:
      • Synovial biopsy or synovectomy
      • Loose-body removal
      • Treatment of labral tears
  • Ankle:
    • Indications:
      • Synovial biopsy or synovectomy
      • Loose-body removal
      • Bone-spur removal
      • Treatment of osteochondral lesions
  • Elbow:
    • Indications:
      • Synovial biopsy or synovectomy
      • Loose-body removal
      • Debridement of cartilage lesions and osteophytes
  • Wrist:
    • Indications:
      • Synovial biopsy or synovectomy
      • Loose-body removal
      • Diagnosis or debridement of TFCC injuries
 
Miscellaneous
FAQ
Q: What is arthroscopy?
A: Arthroscopy is a procedure whereby a fiberoptic camera is inserted into a joint via a portal (stab) incision to visualize the articular surfaces and the supporting soft tissues.
 
Q: Is arthroscopy only diagnostic, or can it be used operatively to repair, reconstruct, or remove injured structures?
A: Arthroscopy has evolved from being just diagnostic to having the ability to address most abnormalities of a joint. Accessory portals allow the introduction of additional instruments.
 
Q: Is arthroscopy safer than traditional surgery?
A: Arthroscopy, properly performed, results in less morbidity and pain than traditional open surgical incisions and approaches. Arthroscopy has a steep learning curve and requires additional training to become familiar with the arthroscopic anatomy and facile with the arthroscopic equipment. In inexperienced hands, arthroscopy can be less effective and more dangerous than standard open surgical procedures.

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