Arthroscopy or arthroscopic surgery is an advanced surgical technique that is commonly used to correct meniscus injuries and anterior cruciate ligaments of the knee, two problems that frequently occur in the world of sports, and especially among elite athletes. However, this surgery includes treatments for other large joints such as the shoulder and hip, as well as for smaller joints such as the wrist, elbow and ankle.
It is a minimally invasive technique, which allows for significant reduction of damgaing and scarring produced by the operation, all of which translates into better recovery times. The surgery consists of making several incisions, trying to make each one as small as possible, and then proceeding to introduce in the joint in question the surgical instruments that will repair the lesion.
That is when the arthroscope comes into action. This consists of a thin tube equipped with a camera and a light at its end, which allows the surgeon to clearly see the inside of the joint and to position the sutures more precisely. Thus, by being able to determine precisely where and how to do the interventions, recovery times are favorably enhanced.
Although the history of arthroscopic surgery goes back decades, it is now a technique that has greatly benefited from advances in visual technology, which have allowed for the creation of increasingly smaller devices capable of providing High definition images. To this is added optical fiber, a material that allows for the effective connection between the camera inside the joint and a monitor in the operating room.
Thus, technological advances and the use of these materials have made it possible to significantly improve the surgical technique, allowing for a remarkable improvement in efficiency and precision.
Surgery in large joints
Arthroscopy on knees is among the most widespread arthroscopy treatments. When practicing knee surgery that does not require prosthesis placement, in most cases it is completely or at least partially approached with arthroscopic surgery. For example, when it comes to the knee, meniscal injuries are among the most common pathologies and constitutes one of the injuries for which there are more techniques and experienced teams, always with the objective of preserving the meniscus and protecting the cartilage.
For example, knee arthroscopy allows the replacement of the resected meniscus with a meniscal transplant. The treatment is also applied in cases of rupture of the anterior cruciate ligament, an injury usually linked to sports that produces an instability in the knee that can end in lesions of cartilage and meniscus. Thus, reconstruction of the anterior cruciate ligament and other lesions such as chondropathies, osteochondritis or osteoarthritis are successfully treated with the arthroscopic technique.
Additionally, in the context of the application of this advanced technique it is worth mentioning the use of regenerative biological treatments with stem cells, mesenchymal cells and Plasma Rich in Platelets PRP. These serve to promote the regeneration of cartilage, accelerate healing and improve the quality of tissues. To achieve the objectives and depending on the case, these substances can be used during surgeries and also in an outpatient environment.
High demand sports such as dance, various martial arts or soccer are examples of artistic and sports activities that require intense movements of the hip joints, and which can eventually produce FAI deformities and the consequent symptoms of pain. To treat these conditions there is hip arthroscopy, which allows access to the area to obtain an accurate diagnosis of the pathologies that may be affecting the acetabulum of the pelvis or the head of the femur.
Thus, hip arthroscopy is the ideal treatment for pathologies such as femoroacetabular impingement, known as FAI (Femoro Acetabular Impingement), which produces rigidity, pain and limitations in the mobility of the hip. This pathology can progressively destroy the acetabular labrum and cartilage, and thus become an osteoarthritis of the hip. It is at this point that arthroscopy can be used to perform sutures on the labrum injuries, thus preventing the progression of the pathology to osteoarthritis.
On the other hand, pathologies that can occur in the shoulder joint, such as glenohumeral instability, rotator cuff pathology and synovial pathology can be successfully treated with shoulder arthroscopy. Using advanced instruments and tiny optical devices, the application of this technique allows for precise surgical procedures through small incisions in the joint. In general, this treatment has brought with it significant advances in the diagnosis and treatment of these pathologies.
In the case of glenohumeral instability, the joint loses joint congruency and evolves from recurrent dislocation to micro-instability. With shoulder arthroscopy and using anchors with threads, a reconstruction of the stabilizing factors and the effective reduction of the capsular volume is achieved. In the case of rotator cuff pathology, this can range from tendinopathy to rupture of one or more tendons. It usually occurs in patients above 40 yrs old, and through acromioplasty debridement of tendinopathy is performed.
Regarding synovial pathology, arthroscopy allows synovial samples to be taken to perform biopsies for the proper diagnosis of the pathology. An example of the above is synovectomy, a procedure that eliminates the synovium with the use of advanced motorized instruments or radiofrequency.
Surgery in small joints
One of the most common injuries in the field of sports traumatology is the ankle. And as in the case of arthroscopic surgeries in large joints, ankle arthroscopy allows for a better visualization of the structures of this joint and, consequently, effective intervention of the area. This means that patients can avoid more complex and aggressive approaches, as well as performing osteotomies with the consequent need to use osteosynthesis screws. The technique allows access to the talar dome and other injured areas, allowing synthesis of fragments, debridements and accelerate the regenerative process with biological treatments with stem cells.
Sports such as athletics, football or professional dance, generate a repeated impact in this area that produces the response of tissue growth, limiting the mobility of the ankle. When a fracture occurs, the reaction produces joint fibrosis and the common approaches are usually complicated, but with the arthroscopic technique, debridement and arthrolysis can be successfully performed, which translates into the recovery of the mobility of the affected ankles. Another problem that can be effectively treated with this technique is the pathology of the back area of the ankle, where the tip of the talus is located.
This produces impingement in tendons attached to the toes, and as in the case of the other lesions, arthroscopic surgery means less pain and allows a quick recovery and reincorporation of the patient to their activities.
Regarding wrist arthroscopy, it is worth noting that it is the result of important advances in instruments and materials, considering that it requires instruments of even smaller dimensions than those used for larger joints such as the shoulder or the knee. Advances in both the description and treatment of various pathologies have allowed us to evolve from a merely diagnostic technique to various intra-articular treatments -both for the wrist and the hand-, without the need for open surgeries. In this way, we are in the presence of an advanced technique, non-invasive and capable of treating various injuries.
For example, the lesion of the triangular fibrocartilage is one that is frequently treated with the arthroscopic technique. This has a structure similar to the meniscus, is located in the ulnar zone of the wrist and can cause pain and functional limitations in the joint. Also, pathologies such as joint stiffness, chondral-articular injuries and sivectomies due to inflammatory pathology are treated -associated partially or completely with open surgery- with arthroscopic surgery. Other ailments treated effectively with the technique are osteochondral lesions. Other ailments treated effectively with the technique are osteochondral lesions, synovial pathology and the treatment of synovial cysts.
Currently, advances in the instruments used in arthroscopic surgeries have allowed the successful reduction of radius and ulna fractures, including scaphoids.
As with the other small joints, elbow arthroscopy has been an important advance in the description and treatment of pathologies that this joint can suffer. These include osteochondral lesions, injury to articular cartilage that causes pain, joint blockage and limitation of mobility, which can damage the joint to osteoarthritis. Arthroscopic surgery allows both an effective diagnosis and the execution of a treatment that allows the extraction of loose bodies.
Also, diseases of the elbow such as synovial pathology and the treatment of joint stiffness can be treated with great success with this technique. In the first case, it enables both the performance of diagnostic biopsies and the elimination of the synovium with the performance of a synovectomy; in the second, rigidity can significantly affect the daily development of the joint. However, through the technique of arthroscopic joint arthrolysis a remarkable improvement in mobility is achieved.
In short, arthroscopic surgery is an advanced technique to treat joint injuries, both small and large, and when combined with biological treatments such as stem cells, not only guarantees the improvement of tissue quality, but accelerated Recovery.