Arthroscopy

Test Overview

Arthroscopy is a surgical procedure that lets a doctor look inside your joints. The doctor uses a thin viewing tool called an arthroscope, or scope. It allows the doctor to see the joint surfaces and the tough tissue that covers and cushions the ends of the bones (cartilage). The doctor can also see the surrounding soft tissues, such as tissue that connects bone to bone (ligaments).

This procedure can be used to see if you have a joint problem or to do surgery that repairs a joint problem. It can also be done to remove a loose or foreign object in a joint. Doctors can also do it to keep track of a disease or to see how well a treatment is working. Arthroscopy is most often done on the knee, shoulder, and ankle. It also can be done on the hip, elbow, and wrist.

During arthroscopy, the arthroscope is put into your joint through a small cut (incision) in the skin. The scope has a light source and a video camera attached to it. Images from the camera can be seen on a video screen. These magnified images provide a clear picture of your joint. During the procedure, a sample of joint tissue can be collected to be tested. This is called a biopsy. If needed, more tools will be put into your joint through other small incisions.

Like open surgery (which is done using a larger incision), arthroscopy allows your doctor to see what is wrong with your joint. But compared to open surgery, arthroscopy usually:

• Is less painful.
• Costs less.
• Lets you recover sooner, depending on what is done.
• Can be done on an outpatient basis without the need for an overnight stay in a hospital. An inpatient stay is often needed with open surgery.

Why It Is Done

Arthroscopy is used to:

• Evaluate and diagnose a joint problem when a physical exam and other tests don't give a clear result. These tests may include X-rays, ultrasound, CT scan, MRI, or blood tests.
• Do surgery to repair a joint problem.

It may be used during surgery to:

• Shave bone tissue to remove calcium deposits or bone spurs.
• Repair or trim soft tissues, such as ligaments, tendons, or cartilage.
• Cut ligaments to help relieve tightness in a stiff joint. They can also be repaired or rebuilt.
• Collect a sample of joint tissue or joint fluid (synovial fluid) for testing (biopsy).
• Remove scar tissue or an area of joint lining (synovium) that is swollen.

Some joint problems may be repaired using arthroscopy with open surgery.

How To Prepare

Arthroscopic surgery is often done on an outpatient basis without the need for an overnight stay in a hospital.

You may have more tests, such as blood tests or urine tests, before your procedure.

Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.

If you have arthroscopy of your ankle, knee, or hip, your doctor will talk to you about using crutches after the procedure. If you have arthroscopy of a joint in your arm, you will likely wear a sling or splint afterward.

You may need to shower or bathe with a special soap the night before and the morning of your procedure. This may help prevent an infection.

How It Is Done

You will be asked to remove any jewelry and to wear a hospital gown. You may be given a sedative shortly before the procedure to help you relax. The skin around your joint may be shaved.

During the procedure

If general or regional anesthesia is used, an anesthesia specialist will give the medicine. A general anesthetic will make you sleep during the procedure. Your heart rate and rhythm, blood pressure, and breathing will be watched closely during the procedure. If a local anesthetic is used, it will be injected into the skin and joint space. If a local or regional anesthetic is used, your limb will be numb. You will be relaxed and drowsy but will be awake.

You probably will lie on your back. Depending on which joint is being looked at, an inflatable band (tourniquet) may be used to briefly restrict blood flow to your joint. This allows your doctor to see all the parts inside your joint. Your joint is scrubbed with an antiseptic solution and draped with sterile towels. Before the tourniquet is inflated, the joint will be raised. It may also be wrapped with an elastic bandage to reduce blood flow to the joint.

A small incision about 0.25 in. (0.6 cm) will be made near your joint. Before the doctor inserts the arthroscope, an irrigation fluid (usually saline) will be used to flush the joint space. This gives the doctor a better view of the entire joint. A steady low flow of fluid is usually used during the procedure. This clears out any debris or blood in the joint so your doctor can evaluate your joint.

After the scope is put in, your doctor will be able to see inside the joint by viewing a video screen attached to the scope. Your doctor or the surgical assistants may bend, extend, and change the position of the joint to see it from different angles. Videotapes or photos of the joint may also be taken.

If more surgery is needed to repair your joint problem, more small incisions will be made. Other thin tools will be put into your joint. When the arthroscope and any other tools are taken out, any blood and debris will be flushed with saline and drained. To reduce swelling or pain, local anesthetics or corticosteroids may be injected into your joint.

The small incision is closed with stitches, skin glue, or tape strips. Depending on which joint was looked at, you may need to use splints, slings, or crutches while you recover from surgery.

How long the test takes

How long the procedure takes depends on what is done. It may take an hour or longer.

How It Feels

If you get a local anesthetic and are awake during the procedure, you will feel a brief burning or stinging in your skin. As the arthroscope is put into the joint, you will notice a thumping feeling. You may feel slight pulling in the joint area as your doctor moves joint structures around.

If you get a general anesthetic or deep sedation, you will be asleep. You won't feel anything. If you get a regional anesthetic, your arm or leg will be numb for several hours.

Risks

Problems during arthroscopy aren't common. Sometimes there is joint stiffness or long-lasting joint pain. Bleeding inside the joint can occur. This is more likely if surgery is done during the procedure.

There is a small chance of infection, getting a blood clot in the affected limb, or having nerve or joint damage. Also, there is a small risk of damage to the structures within the joint.

In rare cases, a serious condition called compartment syndrome can occur. This happens if pressure builds inside a muscle compartment (most commonly in the front of the calf or forearm). When this occurs, medical treatment is needed right away to release the pressure.

In very rare cases, death can occur from problems with anesthesia.

Results

In most cases, your doctor will be able to discuss the results with you right after the test.

Arthroscopy

Normal:

In a normal, healthy joint, the ligaments look like white cables. The cartilage is smooth and white. The joint fluid is clear, and there are no loose pieces of tissue in the joint. If there is no damage or disease seen in the joint, your doctor may conclude that your joint is normal and isn't the cause of your symptoms.

Abnormal:

In a damaged or diseased joint, the ligaments and cartilage are abnormal in color and shape. If there is damage or disease in the joint, your doctor may identify the condition. Your doctor may even do surgery during the arthroscopy to repair the joint problem. Examples of damage or disease in the joint include: Torn, displaced, or loose fragments of soft tissues (such as ligaments or cartilage). Abnormal growths, cysts, or ganglions. Signs of joint or cartilage damage caused by injury or diseases such as arthritis. Infection.

After your doctor has evaluated your joint, you may need more treatment. This could be medicine, physical therapy, or surgery.