Minimally Invasive Surgery: Arthroscopy

Arthroscopy has reduced the morbidity and period of hospitalisation associated with orthopaedic surgery and has increased the range of procedures that may be performed. From early operations on the knee it has expanded to include procedures for the shoulder, elbow, wrist, hip, ankle, and foot. For some joints the indications for surgery are clear, for others the clinical advantages are still being assessed. This expansion has also led to the recognition of complications, though the incidence is low. Specialist instrumentation has allowed a wide variety of operations previously needing open surgery to be carried out arthroscopically. The repertoire of arthroscopic procedures will undoubtedly continue to expand, and controlled studies are required to validate their efficacy, particularly in the management of degenerative joint diseases.

Arthroscopy has revolutionised orthopaedic surgery: combining diagnostic accuracy, low morbidity, and short length of hospitalisation, it is now one of the commonest orthopaedic procedures performed. As with all innovations, however, arthroscopy has had sceptics, and in 1937 Hustinx said of arthroscopy of the knee: “How can anyone venture to introduce a luminous object into the knee-joint in an effort to look between the articular surfaces, which cannot be separated…” This is quite impossible. Moreover, this procedure is more dangerous than exploratory arthrotomy.1

The development of a rod lens system (designed by Professor Hopkins) surrounded by light conducting glass fibrils and enclosed in a rigid metal sheath led to the modern arthroscope. It soon became apparent that this versatile instrument had numerous applications. It was initially used for diagnostic purposes only, but instrumentation was developed to allow treatment of pathology as well. By the late 1970s arthroscopic operations had become established in the developed world. Early operations were mainly performed on the knee. Being mobile and easily accessible, it is particularly suitable for arthroscopy. Much was learnt …