Arthroscopy and How It Has Changed Orthopaedic Surgery

Apr 30, 2020 | Articles

One of the stumbling blocks encountered by early physicians was the inability to obtain a clear view of the internal anatomy of the human body without resorting to surgery. While the invention of the X-ray machine by William Roentgen in 1896 was a significant aid to diagnosticians, the resulting grey-scale images required skilful interpretation and failed to reveal much of the finer detail. Although it would be a while before the emergence of arthroscopy, experimentation in other disciplines of medicine led to the development of several instruments known generically as endoscopes, due to their ability to provide an “inside view”.

The first of these appeared ninety years earlier in 1806 and was invented by one Philipp Bozzini. It consisted of a narrow tube with an eyepiece that could be inserted into a body cavity where it illuminated the contents with the aid of a candle and mirrors placed at suitable angles. Named the “Lichtleiter” or “light conductor” this early precursor of arthroscopy was first used to examine the larynx but was later adapted for use in urological and gynaecological examinations.

A few pioneers engaged in efforts to improve on Bozzini’s design which, in 1853, led to the development of an instrument for internal examination of the bladder and urinary tract. The inventor, Antoine Jean Desormeaux, was also responsible for coining the term endoscope. At this stage, however, the prospects of developing an instrument suitable for arthroscopy remained slim as most physicians still regarded open surgery as the more informative alternative.

It was, first, the advent of electricity and, later, the means to manufacture a sufficiently small electric light bulb that proved to be the turning point for the endoscope and the many variants that followed. These instruments offered the physician a soot-free and more brightly illuminated view of the interior of various body cavities. It was not long, however, before one doctor saw the potential value of examining the interior of a joint in the same manner. In 1919, a Tokyo professor named Kenji Takagi became the first to perform the procedure now known as arthroscopy.

To examine the internal structure of a knee joint, Takagi modified a pre-existing instrument of the type used to examine the bladder now known as a cystoscope. With it, he was able to evaluate the extent of any damage to cartilage, bone and the surrounding soft tissues. Since his pioneering orthopaedic application, the performance of endoscopes has improved dramatically thanks to developments such as fibre-optics, the LED and miniature video cameras. Today, the minimally invasive technique of arthroscopy is more likely to be the first choice of orthopaedic surgeons rather than resorting to open methods.

Furthermore, the role of this procedure is no longer limited to that of a diagnostic tool or restricted to the knee joint. Not only is it routinely performed on hips, shoulders and other joints but, in many cases, the arthroscope is now being used to perform minimally invasive surgeries. Procedures such as repair to the meniscus and anterior cruciate ligament are regularly undertaken in this fashion while some surgeons are even performing joint replacements with the aid of arthroscopy. The option tends to reduce some of the risks associated with open methods such as excessive bleeding and infection while also reducing recovery time.

If you wish to learn more about this specialised field or wish to make an appointment with Dr Jan de Vos, contact us at 012 807 0335 or send an email to