While knee arthroscopy is commonly used for partial meniscectomy (trimming a torn meniscus) on middle aged to older adults with knee pain, the claimed positive results seem to lack scientific evidence. Many studies have shown the outcomes from knee arthroscopic surgery for osteoarthritis and degenerative meniscal tears are no better than the outcomes from placebo (fake) surgery or other treatments (such as exercise therapy).
The BMJ Rapid Recommendations group makes a strong recommendation against arthroscopy for osteoarthritis on the basis that there is high quality evidence that there is no lasting benefit and less than 15% of people have a small short-term benefit. There are rare but serious adverse effects that can occur, including venous thromboembolism, infections, and nerve damage. The BMJ Rapid Recommendation includes infographics and shared decision-making tools to facilitate a conversation between doctors and patients about the risks and benefits of arthroscopic surgery.
Two major trials of arthroscopic surgery for osteoarthritis of the knee found no benefit for these surgeries. Even though randomized control trials have demonstrated this to be a procedure which involves the risks of surgery with questionable or no demonstrable long-term benefit, insurance companies (government and private) world-wide have generally felt obliged to continue funding it. An exception is Germany, where funding has been removed for the indication of knee osteoarthritis. It is claimed that German surgeons have continued to perform knee arthroscopy and instead claim rebates on the basis of a sub-diagnosis, such as meniscal tear.
A 2017 meta-analysis confirmed that there is only a very small and usually unimportant reduction in pain and improvement in function at 3 months (e.g. an average pain reduction of approximately 5 on a scale from 0 to 100). A separate review found that most people would consider a reduction in pain of approximately 12 on the same 0 to 100 scale important—suggesting that for most people, the pain reduction at 3 months is not important. Arthroscopy did not reduce pain or improve function or quality of life at one year. There are important adverse effects.
One of the primary reasons for performing arthroscopies is to repair or trim a painful and torn or damaged meniscus. The technical terms for the surgery is arthroscopic partial meniscectomy (APM). Arthroscopic surgery, however, does not appear to result in benefits to adults when performed for knee pain in patients with osteoarthritis who have a meniscal tear. This may be due to the fact that a torn meniscus may often not cause pain and symptoms, which may be caused by the osteoarthritis alone. Some groups have made a strong recommendation against arthroscopic partial meniscectomy in nearly all patients, stating that the only group of patients who may—or may not—benefit are those with a true locked knee. Professional knee societies, however, highlight other symptoms and related factors they believe are important, and continue to support limited use of arthroscopic partial meniscectomy in carefully selected patients.
Hip arthroscopy is a widely adopted treatment for a range of conditions, including labral tears, femoroacetabular impingement, osteochondritis dissecans.
Arthroscopy is commonly used for treatment of diseases of the shoulder including subacromial impingement, acromioclavicular osteoarthritis, rotator cuff tears, frozen shoulder (adhesive capsulitis), chronic tendonitis, removal of loose bodies and partial tears of the long biceps tendon, SLAP lesions and shoulder instability. The most common indications include subacromial decompression, bankarts lesion repair and rotator cuff repair. All these procedures were done by opening the joint through big incisions before the advent of arthroscopy.
Arthroscopic shoulder surgeries have gained momentum in the past decade. "Keyhole surgery" of the shoulder as it is popularly known has reduced inpatient time and rehabilitation requirements and is often a daycare procedure.
Many invasive spine procedures involve the removal of bone, muscle, and ligaments to access and treat problematic areas. In some cases, thoracic (mid-spine) conditions require a surgeon to access the problem area through the rib cage, dramatically lengthening recovery time.
While he is often considered the inventor of arthroscopy of the knee, the Japanese surgeon Masaki Watanabe, MD, receives primary credit for using arthroscopy for interventional surgery. Watanabe was inspired by the work and teaching of Dr Richard O'Connor. Later, Dr. Heshmat Shahriaree began experimenting with ways to excise fragments of menisci.
The first operating arthroscope was designed by them, and they worked together to produce the first high-quality color intraarticular photography. The field benefited significantly from technological advances, particularly advances in flexible fiber optics during the 1970s and 1980s.
Canadian doctor Robert Jackson is credited with bringing the procedure to the Western world. In 1964, Jackson was in Tokyo completing a one-year fellowship and serving as a physician for the Canadian Olympic team. While there, he spent time at the clinic of Watanabe learning the thirty year old procedure that had only been used to investigate arthritis in the elderly. Jackson returned to Toronto where he continued to practice the technique, eventually becoming "the world's foremost expert on arthroscopy".
Arthroscopy is considered a low-risk procedure with a very low rates of serious complications. Commonly, irrigation fluid may leak (extravasates) into the surrounding soft tissue, causing edema which is generally a temporary phenomenon, taking anywhere from 7–15 days to completely settle. Rarely, this fluid may be the cause of a serious complication, compartment syndrome. However, postarthroscopic glenohumeral chondrolysis (PAGCL) is a rare complication of arthroscopic surgery and involves chondrolysis wherein the articular cartilage of the shoulder undergoes rapid, degenerative changes shortly after arthroscopic surgery.
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