Arthroscopy is one of the most common orthopedic procedures done in the United States today. While the knee is the most common joint involved, arthroscopy is also performed on shoulders and ankles, and sometimes hips, elbows and wrists.

Joint deterioration and injuries can cause pain, tightness, stiffness, swelling, tenderness or even a collection of fluid (“water on the knee”) around your joints. When such problems occur, you should see your primary care physician and an orthopedic specialist.

Your diagnosis will begin with an exam to try to determine the possible causes of your symptoms. The physician will look at your medical history, perform a physical exam, take X-rays, and possibly conduct an MRI scan. All of these can help diagnose the problem, but an arthroscopy is the most accurate tool in determining exactly what’s going on.

The reason arthroscopy is so accurate is because it’s the only tool that enables physicians to look directly at the joint, while everything else is evaluating the joint indirectly. In some ways it’s comparable to feeling something through a curtain—you have a pretty good idea what you’re touching indirectly. But when the curtain is pushed away and the details are revealed, you get a much more accurate picture.

Looking In the Joint
Arthroscopy will find problems not discovered during the other parts of your exam. It is the only tool that enables the surgeon to look inside.

When you break apart the word arthroscopy it gives you “arthro,” which means joint, and “scopy,” which means to look inside. Arthroscopy is a surgical procedure to look in the joint.

Why Do Arthroscopy?
Arthroscopy serves two purposes—diagnostic and therapeutic. When being done for diagnostic purposes, it is to confirm the physician’s initial diagnosis, provide a more thorough answer or to find additional problems. During arthroscopy, a tiny scope inserted in the joint can diagnose problems such as:

• anterior cruciate ligament (ACL)
• meniscal tears
• damaged joint surfaces
• articular cartilage softening
• synovial membrane inflammation.  

The second reason for arthroscopy is therapeutic. Once a firm diagnosis is established, the problems discovered with the look inside will be corrected as much as they possibly can be. Some joint problems are corrected relatively easily through arthroscopy. Others have a lower success rate in alleviating symptoms. Common problems include:

• Loose body. You may have a “catch” between bones. The surgeon can look for a chip in your knee that may be cartilage, bone or gristle that is easily removed.
• Meniscal tears. The C-shaped rubbery tissue between your leg bones is called a meniscus. The tissue acts as a shock absorber and joint stabilizer. You have one meniscus on the outer side of your knee and one on the inner side. If a meniscus tears or deteriorates, premature arthritis and other problems can develop. Some tears can be repaired. Most are removed to alleviate symptoms.
• Ligamentous tears. Ligaments are the tough bands of connective tissue that connect your bones. Generally, tears are evident on an MRI scan, so your surgeon can explain repair procedures ahead of time.
• Condylar defects. An arthroscopy performed in patients typically as they age often reveals damage from a previous injury or preexisting or arthritic changes to joint linings. These condylar defects can be addressed by smoothing any rough tissue from its “coarse sandpaper” texture to a less coarse texture to decrease friction and pain. However, the procedure does not always help because it cannot return the tissue to its original condition.

If tissue no longer exists, the exposed bone can be scraped to
see if the resulting blood clotting will create a new lining. Adult tissue does not easily rejuvenate, so while the procedure can make an improvement in some cases, the tissue won’t be returned to its original, completely undamaged state.

• Plica (fold tissue). Plica can develop from injury or be developmental. When plica thickens, it rubs against bones on the inside of your knee, causing pain and motion problems. Removing plica brings knee operation back to nearly normal.

About the Procedure
Arthroscopy is typically performed as an outpatient procedure using general anesthesia. The entire procedure typically lasts from 15 minutes to an hour and a half, depending on what needs to be done.

Of course, each person’s recovery is different. Return to work varies by the surgery done to your knee and type of work you perform. Patients with desk jobs can generally go back within a few days. Patients on their feet for long periods of time who do not control job functions may need eight to 12 weeks off work. Two to three months are generally needed to totally heal from an arthroscopic procedure. iBi