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Arthroscopy
is a minimally invasive procedure which has diagnostic as well as therapeutic
merits. It is often useful for patients whose symptoms may be attributed
to a specific mechanical problem, such as torn cartilage or a loose
body in the joint. Arthroscopy can also be used for removal of an inflamed
joint lining (synovectomy). This may be particularly valuable for patients
with rheumatoid arthritis, hemophillic arthropathy, or pigmented villonodular
synovitis. In addition, new techniques now permit repair of various
structures, particularly in the knee and shoulder. In selected patients,
cartilage may even be harvested and grown for re-implantation later.
The
arthroscope is approximately 4 to 5 mm in diameter. It utilizes a fiberoptic
tube and a series of lenses to produce a very high resolution image
of the joint on a television screen. This tube is inserted into the
joint through a small incision. A second incision is made through which
a variety of arthroscopic tools may be inserted. These tools permit
many different tasks to be performed, including grasping and removing
a loose body, sewing a torn structure, or smoothing out an area of roughened
cartilage. A third incision may be required to permit better fluid flow
through the joint.
Arthroscopy
may be performed with general anesthesia (going to sleep), regional
anesthesia (a spinal or epidural block) or, in selected cases, with
local anesthesia. Most arthroscopy is performed as an outpatient. The
incisions are so small that they typically require only one stitch,
if any.