Diagnostic knee arthroscopy
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Arthroscopic visualisation of joints revolutionised orthopaedic surgery. Once good visualisation had been achieved the ability to access the joint through limited incisions and then intervene, repairing structures or removing damaged and mechanically unstable structures paved the way for the huge range of arthroscopic procedures which are now routine. Without the early steps of diagnostic arthroscopy over a century ago, this would not have occurred.
Arthroscopy of the knee was the first joint to be targeted with this new and revolutionary a technology extrapolated from the cystoscope used in endoscopic urology. It was Professor Kenji Takaji of Tokyo who first applied these techniques to the knee in 1918, but it was not until 1920 that the true ‘arthroscope’ was born. In the beginning this was wide bore at 7.3mm, but during the 1920s Takaji using the improving lens technology narrowed the diameter of the arthroscope leading to a 3.5mm arthroscope by 1931which could be used in a variety of joints with saline distension similar to modern arthroscopy. For a full history of arthroscopy it is worth reading the chapter written by Masaki Watanabe (who developed operative arthroscopic technique with Hiroshi Ikeuchi in the 1960s) in O’Connor’s Textbook of Arthroscopic Surgery (available through the ISAKOS website www.isakos.com) , first published in 1971. It was O’Connor that visited Tokyo to learn and transport the techniques back to the USA, where a number of advances then occurred during the 1970s including the shaver (Lanny Johnson with Dyonics Inc) scoping acutely injured knees and meniscal repair (DeHaven) and fixation of osteochondral defects (Guhl)
Initially the visualisation of the joints was critical for diagnosis, but with the paralleled advance of magnetic resonance imaging (MRI) the need for diagnostic arthroscopy has almost completely disappeared. Therefore today there really is no such operation as ‘Arthroscopy’ rather the technique is used as the medium by which to perform therapeutic procedures. A clear understanding of the arthroscopic set up and learning how to safely sweep around a joint without causing damage whilst visualising all the key structures is a vital part of orthopaedic training.
This OrthOracle technique will guide you through that learning for the knee joint. There is considerable natural variation in ability with arthroscopic techniques which does not always mirror open surgical ability, but this is a long road and there is no substitute for experience, but the road starts with a clear understanding of what you are trying to achieve.
I hope you enjoy these techniques and have much success in developing the art of arthroscopic surgery. Good luck!
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Author: James Murray FRCS(Tr & Orth)
Institution: The Avon Orthopaedic Centre, Southmead Hospital, Bristol, UK
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