There can be little doubt that Röntgen’s discovery of X-rays marked a turning point in medicine. However, the resulting images required careful interpretation and provided only a shadowy outline of a patient’s internal anatomy. These images may have been useful for spotting hairline fractures, but it was arthroscopy that gave orthopaedic surgeons their first live view of the internal structure of a joint.
Even before this technology became available to the orthopaedic specialist, scopes of different designs were already in use, providing doctors with a means to explore the interior of the body’s various cavities. Known generically as endoscopes, these instruments are hollow tubes of varied design and complexity that allow doctors to view the internal details of organs, such as the bladder, stomach, lung, and colon directly.
A primitive endoscope discovered in the ruins of Pompeii predates the modern science of arthroscopy by perhaps as much as two millennia, but only during the early 17th century did doctors and scientists resume this development in earnest. That said, the focus of those early pioneers continued to be directed exclusively at the exploration of anatomical features other than the joints. In practice, the first recorded use of an endoscope for the latter purpose took place only in 1919.
Traditionally the credit for this game-changing achievement is awarded to one Professor Kenji Takagi who, in 1919, adapted a cystoscope, an instrument usually used to look inside the bladder, to examine the interior of a knee joint. His success inspired others to build and improve on his work, and so, arthroscopy was gradually adopted by orthopaedic specialists as a routine diagnostic tool. Having confirmed the nature and extent of any pathology present, open surgery would then be performed if deemed necessary.
It did not take too long for some adventurous surgeon to attempt taking the process a step further. While making one tiny incision to insert the scope, why not create one or two more to insert the necessary instruments and carry out the surgery in a single procedure? Diagnostic arthroscopy evolved into keyhole surgery when a second Japanese surgeon, Masaki Watanabe, performed the first surgical intervention on a knee joint using this technique.
Today, orthopaedic surgeons routinely perform this minimally invasive type of procedure to treat a variety of conditions affecting the knee. These include the resection or repair of a torn meniscus, removal of an inflamed synovial membrane, irrigation to remove loose fragments of bone and cartilage, and the reconstruction of damaged ligaments, such as the anterior cruciate (ACL). Arthroscopy is now often the technique of choice when performing joint replacements.
While the advent of fibre optics and miniature TV cameras have led to ever more sophisticated scopes, their evolution is continuing with efforts to reduce their already relatively narrow bore to that of a syringe needle. More significant, perhaps, are some of the possible future applications of this technology. For example, there is the prospect of slowing or even halting degenerative joint conditions to prolong activity among the elderly. Also, used in conjunction with emerging technologies like autologous chondrocyte implants, arthroscopy could provide surgeons with a minimally invasive technique to restore articular surfaces.