What is an arthroscopy?
Arthroscopy is a minimally invasive surgical procedure that is used to diagnose and treat joint problems.
It involves making small incisions, approximately half a centimetre wide (0.5cm), through which a camera is inserted. The image of the inside of the joint is transmitted to a video monitor. Specific surgical instruments can also be inserted through the incision to treat any injury inside the joint.
When is an arthroscopy necessary?
Arthroscopy is necessary to treat a wide variety of injuries in any joint, especially sports injuries.
The most commonly affected joints are the:
The most frequently injured structures in the knee are the meniscus, cartilage and cruciate ligament. In the shoulder, on the other hand, the rotator cuff tendons and the labrum (a ring of soft tissue surrounding the shoulder joint) are often injured.
As a minimally invasive procedure, more and more joint injuries, not just to the knee and shoulder, are being treated using arthroscopy. For example, hip impingement, wrist fractures, tendon diseases and cartilage injuries to the ankle, and so on.
An orthopaedic surgeon is the best person to determine when an arthroscopy is necessary.
What preparations are needed?
No specific preparation is required for an arthroscopy, except for the general preparation needed for any surgical procedure.
General preparation consists of:
Fasting for six hours.
Not taking any psychotropic substances.
Stopping oral anticoagulants if you are taking them.
Following the instructions given by the anaesthesia department.
Each patient will undergo a series of preoperative tests that may include: an electrocardiogram, blood tests and a chest x-ray.
Ideally, the specific surgical area to be operated on, i.e., the injured knee, shoulder, hip, etc., should be shaved one or two hours before surgery.
How is an arthroscopy performed?
This is a minimally invasive surgical technique that is performed through small skin incisions called portals. A small camera is introduced through the incisions and the operation begins by checking the state of the joint to identify the problem and its extent. From this point, the injury is repaired in the most appropriate way in each case.
Depending on the joint affected, the arthroscopy is used for one purpose or another. In some cases, it allows the joint space to be cleaned, the damaged structures (meniscus, ligaments, tendons, etc.) to be sutured or replaced, and the cartilage and bone to be treated, for example, in the knee or hip.
The number of portals (incisions) required depends on the specific condition, so that all the necessary surgical activities can be carried out. This is always done in a precise manner and while being viewed directly through the small camera that is inserted at the beginning of the arthroscopy.
As no large incisions are made to access the affected joint, the recovery period is shorter, the postoperative pain is less, and possible complications are reduced compared to conventional surgery.
Finally, the portals are stitched up and the limb is immobilised for some time. This can range from a few days to up to 6 weeks, depending on the procedure performed.
Where is it done?
Arthroscopies are surgical procedures and, as such, are performed in operating theatres. Most arthroscopies are performed on an outpatient basis, in other words, the patient is admitted and returns home on the same day (or at most, in more complex surgeries, they may spend one night in hospital).
These procedures are therefore usually performed in outpatient surgical blocks, where patients, once operated on, are transferred to recovery areas for a few hours, after which they go home.
Who performs the operation?
Arthroscopies are performed by doctors specialising in orthopaedic surgery and traumatology. In many hospitals, within the orthopaedic surgical team, there is a team of arthroscopy experts who specialise in either several joints or one particular joint. Some arthroscopies are also performed by rheumatology doctors. In this case, they usually have a diagnostic function, for the assessment and subsequent treatment of certain rheumatological diseases.
How long does it take?
The time an arthroscopy takes varies according to the complexity of the condition to be treated. The simplest surgeries only last 20-30 minutes, while some more complex operations, involving several procedures, can take more than 90 minutes.
What will I feel during the test?
Arthroscopy is usually performed under local-regional anaesthesia with sedation. This means that the limb where the arthroscopy is performed (arm or leg) is anaesthetised and the patient is given medication to keep them calm and relaxed.
To access the inside of the joint and be able to examine it from the inside, small cuts must be made in the skin (portals) and movements must be made to introduce the camera and the specific equipment that will be used. The patient may therefore feel sensations of traction, distension and movement of the limb, but under no circumstances will they feel pain.
What are the possible complications?
Arthroscopy is a minimally invasive and very safe surgical technique, but this does not mean that it is complication-free.
Major complications (anaesthetic, infectious or thromboembolic) are very rare.
There is a series of minor complications that are more common, suffered by between 2-8% of patients, according to the studies carried out. These local complications include superficial bruising, phlebitis, joint effusion or nerve damage caused by injury to peripheral nerves near the incisions required for the arthroscopy.