Arthroscopy – Its History, How it Works, and Why It Is Important
Successful attempts to mend broken bones date back to prehistoric times and were common practice among those attending to the injuries of Roman and Egyptian soldiers. For the greater part of history, the task was undertaken by bonesetters with no medical training, often as a lucrative family business. In parallel, orthopaedics remained an informal pursuit and was dedicated mainly to correcting skeletal deformities in children. Two events revolutionised the profession – the introduction of compulsory medical training for its practitioners and the invention of arthroscopy.
Formal anatomy and surgical training led to a profession with much broader interests and capabilities. The discovery of X-rays in 1895 provided a welcome diagnostic aid for practitioners in all branches of medicine, including the comparatively new discipline of orthopaedics. However, the ingenuity of a Japanese professor in 1918 proved to be a game changer in the diagnosis and treatment of joint disorders. Professor Kenji Takagi modified an instrument employed to inspect the bladder and used it to examine the internal structure of a knee joint to become the first person to perform an arthroscopy. In place of negative black-and-white X-ray images, Takagi’s modified cystoscope offered a full-colour view of the entire structure, including the soft tissue components, without exposing the whole joint.
Subsequently, a series of improvements to the early design led to the development of a dedicated instrument for orthopaedic use. The modern version consists of a flexible tube containing lenses and a fibre optic cable. When inserted into the joint, the optics focus the light from an LED onto the examination area and relay images back to be captured by a miniature video camera and displayed on a monitor. Initially, arthroscopy was used merely as a diagnostic tool, providing the soft tissue detail less visible in an X-ray image.
However, in 1955, another Japanese physician extended an arthroscopic examination to remove a giant cell tumour. Later, in 1962, Dr Masaki Watanabi also became the first to perform a meniscectomy in this fashion, using miniature instruments he developed for the task. These procedures marked a new era in orthopaedics that would see many open surgical procedures replaced by the minimally invasive techniques made possible by the pioneers of arthroscopy.
Surgeons have had to master the more exacting skill of working in confined spaces viewed on-screen. However, those new-found skills benefit their patients, lowering the risk of infection and excessive bleeding and reducing recovery times. The orthopaedic department of the Life Wilgers Hospital in Pretoria has gained national and international acclaim for the many minimally invasive procedures now routinely performed there by our experienced surgical team specialised in the applications of arthroscopy.