Arthroscopy Has Become the Ultimate Resource of the Orthopaedic Surgeon

Dec 15, 2019 | Articles

When, in 1895, Professor Wilhelm Conrad Roentgen first observed a form of radiation that was able to penetrate human soft tissues but not bone or metal, he probably had little idea of the far-reaching consequences of his chance discovery. One of his first applications for his newly-discovered X-rays was to produce a film of his wife’s hand which clearly showed the bones of her fingers and palm, as well as her wedding ring. Before the birth of arthroscopy almost 25 years later, the X-ray was the main diagnostic tool of the orthopaedic surgeon.

While these negative images are able to provide visual evidence of damage to the bones of a joint, such as fractures and abrasions, they are no substitute for a live view of the interior of the joint itself. The ability to view the interior of various bodily cavities has long been the desire of doctors and surgeons, and while various scopes were developed in order to examine the bladder, the reproductive system, the gastrointestinal tract, and the respiratory system, orthopaedic specialists were among the last to benefit from such devices. It was Professor Kenji Takagi who became the father of arthroscopy when, in 1919, he used a modified cystoscope to examine the interior of a patient’s knee joint.

The idea was quickly adopted as a diagnostic procedure by many of Takagi’s contemporaries. These included a Swiss named Eugen Bircher who, during the 1920s, published a number of papers describing its use in locating damaged joint tissues which he later repaired with open surgery.

Early instruments used in arthroscopy consisted of little more than an illuminated tube that allowed a surgeon to view a magnified image of the joint directly through an eyepiece. Later, the development of fibre-optics and miniature video recorders would make it possible to display full-colour, real-time images on a high-resolution monitor screen, but not before another enterprising Japanese surgeon named Masaki Watanabe made the quantum leap of using an arthroscope fitted with a special sheath through which he introduced a punch biopsy into the joint cavity.

The act made Watanabe the first to employ arthroscopy as a practical means with which to perform minimally-invasive joint surgery. Since then, major improvements to the performance of these devices have made it possible to extend his technique to perform a variety of procedures on various joints. Modern procedures involve making one or two keyhole incisions which may then be used to insert additional instruments, which the surgeon can manipulate whilst monitoring both his or her actions and the target site on a screen.

However, perhaps the greatest breakthrough that has been made possible by improvements in arthroscopy has been its use to perform partial and total joint replacements. While the technique does demand more skill and experience on the part of the orthopaedic surgeon, it is believed to hold a number of potential benefits for the patient when compared with the conventional approach in which it is necessary to expose the entire joint.

The use of a minimally-invasive procedure is seen as a means to reduce the risk of the complications associated with most surgical procedures, such as excessive blood loss and infections. It can also serve to reduce the time required for post-operative recovery. Together, these potential benefits have led to the increasing use of arthroscopy as a surgical option rather than just as a diagnostic tool.

In addition to their use when performing total and partial joint replacements, these devices are widely employed to carry out a number of other common orthopaedic interventions. These include the irrigation of joints to wash out any fragments of bone and cartilage that may have resulted from injury or erosion due to osteoarthritis. Other procedures may address repairs to the soft tissues of a joint. In the case of the knee, for example, arthroscopy has become the option of choice when it is required to repair a torn meniscus or an anterior cruciate ligament (ACL).

What began as a simple tube that could be inserted into a joint to reveal details not always visible in an X-ray image has, with the enhancements provided by subsequent advances in technology, become an indispensable tool upon which much of the work performed by an orthopaedic specialist now relies. Based on current experience, that there will be a future for arthroscopy and that the performance of these innovative devices will continue to be enhanced would seem to be a given.