Arthroscopy: mirror-imaging the joint
Arthroscopy, also known as the articular or keyhole technique, is a minimally- invasive procedure which has, over the past few years, established itself as the standard procedure for the treatment of diverse joint illnesses and diseases in (among others) the knees, hips, shoulders, and ankles.
The joint experts at ECOM® Excellent Center of Medicine are specialized in diagnostics and therapy using minimally-invasive arthroscopy and are recognized nationally and internationally as consultants of choice.
Which forms of joint damage can be treated using arthroscopy?
As a rule, arthroscopy can be used in all joints such as the knees, hips, shoulders and ankles. Arthroscopy is used to provide a conclusive diagnostic confirmation of the reasons for joint disorders and diseases after an MRT diagnosis, and provides the basis for direct therapy and treatment of such problems. The most common causes of such disorders are:
- Injuries or changes to the joint caused by accidents (traumatic)
- Degenerative changes (joint wear and tear) which may be caused by arthrosis
- Cartilage and bone damage
- Ruptures of ligaments, tendons, and muscles
- Inflammatory processes in the bursa sac and joint mucosa
- Capsule, ligament, or joint instability
What is an arthroscopic procedure?
An arthroscopic procedure is a special form of endoscopy, in which the interior of organs and joints are examined and/or treated. The term „arthroscopy“ is derived from the Greek language and means arthros = joint and scope = to look inside. Today, however, arthroscopy is seen not only as a method of looking into the joint, it provides the opportunity to simultaneously repair joint damage on the knees, hips, shoulders or ankles (as well as other joints) using a minimally-invasive procedure.
Benefits of an arthroscopic procedure
An arthroscopy is a minimally-invasive surgery on the joint. Because arthroscopy is done via a small incision in the skin, there is a significant reduction in the amount of damage done to soft tissue in comparison to standard open joint operations. This results in a reduction of postoperative pain, and regeneration and healing take place more rapidly.
The affected joint regains flexibility rapidly and overall mobility is quickly restored. Whether arthroscopic procedure is appropriate, or an open joint surgery is required, is dependent upon the individual diagnosis; the decision as to which method of treatment is to be used must be made by the attending physician.
Use of arthroscopy
Arthroscopy is a minimally-invasive procedure on the joint, which can be used for diagnostic and therapeutic purposes. However, the demand for arthroscopic procedures for purposes of diagnostics only has declined considerably in recent years.
This is due to the high level of acceptance and the development of nuclear magnetic resonance imaging (MRI). MRI technology can depict joint structures in layers, using only magnetic fields. Information won from MRI technology is additionally enhanced through the use of a contrast agent, which is injected into the joint via a vein within the context of an MRI.
On the other hand, therapeutic arthroscopy can often be implemented in place of a larger operation, for example in cases of arthrosis, cruciate ligament ruptures, and impingement.
Arthroscopy on the knee joint is an essential part of today‘s field of modern surgery. It has revolutionized the treatment of knee damage/disorders and is one of the most frequently performed forms of arthroscopy. Indications for this form of surgery are usually meniscus damage, cartilage damage, and cruciate ligament ruptures.
During an arthroscopic procedure on the knee, normally two incisions of only a few millimeters are required. Via one of these access routes, the arthroscope (comprised of a camera and lighting) is inserted into the knee joint, allowing an exact assessment of the knee joint including all of its important structures such as the meniscus, cartilage, and cruciate ligaments on a high-resonance monitor.
Existing joint damage is repaired with special instruments, which are introduced into the joint cavity via a small second access route. Thus, experienced surgeons are able to treat and/or repair a multitude of injuries to the knee with the highest level of precision.
Timely treatment using arthroscopic procedures can prevent long-term knee disorders and permanent restrictions of mobility. In particular, triggers and causes of knee arthrosis can be treated proactively, before the knee becomes stiff and immobile through wear and tear.
Indications for knee arthroscopy
- Treatment of meniscus ruptures
- Treatment of cruciate ligament ruptures
- Treatment of tears to the patella tendon
- Stabilization of knee disc instability/knee luxation
- Correction of axis misalignments (Knocked knees and bowed legs)
- Treatment of cartilage damage within the knee joint
- Treatment of knee arthrosis
Up until a few years ago, arthroscopic procedures performed on the hip were done for purely diagnostic purposes. Due to its specific form, in which the joint head is encompassed by the hip socket, the hip joint in particular is quite difficult to access. This problem was resolved through the improvement of access techniques to the joint itself. However, hip arthroscopy must still be seen as a specialized surgical procedure on the hip joint, which should only be performed by experienced, specialized surgeons.
During the procedure, the arthroscope (comprised of a camera and a light source) is inserted into the joint via a small skin incision. Thereafter, the interior of the hip joint, including the gap between the femoral neck and the joint socket, the thigh bone, the hip joint lip and the outer region of the hip joint, including the joint capsule enclosure, can be viewed and assessed precisely.
Subsequently, the diseased or damaged areas are treated surgically over a second access route, using the smallest of surgical instruments. During the course of an arthroscopic procedure, highly specialized surgeons are able to control these instruments remotely and perform precise surgery on the hip joint.
Timely, proactive treatment with hip arthroscopy can prevent protracted hip disorders and prevent permanent restrictions to mobility. In particular, triggers and causes of hip arthrosis can be remedied before the hip joint, as a result of wear and tear, finally becomes stiff and immobile.
Indications for hip arthroscopy
- Removal of particles within the hip joint
- Treatment of cartilage damage within the hip joint
- Treatment of hip arthrosis
- Treatment of diseases within the hip bursa sack
- Treatment of impingement within the hip joint
In the past, shoulder operations were often very complex procedures. Today, thanks to modern, minimally invasive surgical procedures with arthroscopy, surgical procedures on the shoulder are very successful and present minimal risk. Using arthroscopic procedures, medical experts can treat damage to the shoulder joints via minimal epidermal incisions, allowing them to help patients, who may have had to deal with constant pain and immobility in the past, effectively and safely.
During shoulder arthroscopy, the experienced surgeon is able to make a comprehensive and precise evaluation of all damage to the shoulder joint with the help of a mini-camera, and if necessary, optimally treat such damage immediately. As a general rule, only two or three incisions of approximately 3 mm are required for such treatment.
A small optic is inserted into the shoulder joint via one of these access points. A mini-camera is connected to this optic, allowing the interior of the shoulder joint, including all of its vital structures (tendons, ligaments, bursa sack, and cartilage) to be assessed accurately on a high-resolution monitor. Via an additional small incision, diseased areas can be removed and damage repaired with the help of specialized instruments.
Through proactive treatment using shoulder arthroscopy, long-term shoulder diseases and/or damage with the resulting permanent loss of mobility may be prevented. In particular, triggers and causes for future shoulder arthrosis can be eliminated in a timely fashion, before the shoulder joint becomes stiff and immobile through wear and tear.
Indications for shoulder arthroscopy
- Treatment of rotator cuff ruptures
- Treatment of bottleneck syndrome/shoulder impingement
- Removal of calcium deposits (calcified shoulder)
- Treatment of shoulder stiffness
- Improvement of stability in cases of shoulder instability/shoulder luxation
- Treatment of cartilage damage to the shoulder joint
- Treatment of shoulder arthrosis
Ankle pain can be the result of a variety of causes. Our experts recommend arthroscopy as the best method of minimally-invasive treatment for pain in the ankle joints. Through treatment using the minimally-invasive keyhole surgery technique on the ankles, the causes for pain/diseases can be remedied, calcified tissue removed, and cartilage damage, protruding bone edges, impingement syndromes, instability, and damage to tendons can be treated.
During ankle arthroscopy, two small incisions are usually made at the ankle joint line. Additionally, anterior or posterior incisions may be required.
Via the first incision, damage to the ankle joint is assessed with the aid of a camera and lighting system. Subsequently, required surgical instruments are introduced into the ankle joint via the second incision. Due to this access method and small incision size, damage to soft tissue is kept to a minimum. This results in a reduction of pain during the healing process after surgery.
Through timely treatment with shoulder arthroscopy, long-term shoulder diseases/disorders can be prevented and permanent restrictions to mobility prevented. In particular, triggers and causes for shoulder arthrosis can be treated proactively, before the shoulder joint becomes stiff and immobile as a result of wear and tear.
Indications for arthroscopy on the ankle joints
- Treatment of ligament ruptures within the ankle joint
- Treatment of ankle impingement
- Correction of axis deviations within the ankle joint
- Treatment of diseases to the bursa sack
- Stabilization in cases of ankle instability
- Treatment of cartilage damage within the ankle joint
- Treatment of ankle arthrosis
The arthroscopic procedure
Arthroscopy is performed with an arthroscope, which is a special endoscope consisting of a highly developed optical system with a camera and light source as well as surgical suction and pump channels. In an arthroscopic procedure, the arthroscope is inserted into the affected joint using the so-called keyhole technique. Via the smallest of cuts, the causes of joint diseases and disorders to the back and within the knee, hip, shoulder, and ankle joints can be treated directly and with a minimum of damage to surrounding soft tissue.
According to the individual indications, the arthroscopic procedure is done either under general anesthesia or via localized anesthesia, which only requires the anesthetics to be applied to the generalized area or to one limb. After application of the anesthetics, the joint in question is opened with an approximately 5 mm long incision, known as a stitch incision.
Subsequently, the articular cavity is filled with a sterile liquid or carbon dioxide gas and the endoscope is inserted. The endoscope contains a miniature camera which transmits images from the inside of the joint to a high-resolution screen in real time. This allows joint structures such as cartilage, the meniscus, and tendons to be evaluated in detail and the initiation of required subsequent steps. For this purpose, further small incisions are made to allow introduction of the required surgical tools into the joint cavity.
Rehabilitation after arthroscopy
The affected joint should be kept immobilized for as long as possible after outpatient and stationary arthroscopy. Pain and anti-inflammatory medication, cooling and measures to prevent swelling, as well as resting the joint in an elevated position, help to guarantee rapid and full recovery.
After the immobilization phase, joint function is supported with the help of targeted rehabilitation measures and restored quickly. Support and strengthening of the surrounding muscle structures is extremely important, in particular after arthroscopic surgery on the knee, hip, and shoulder joints, as these surrounding muscles are vital to stabilizing the joint itself.
Your experts for arthroscopic surgery and other forms of treatment
„Innovative, minimally-invasive methods such as arthroscopic surgery return patients quickly to sporting activities and daily doing“.
Dr. Erich Rembeck
Specialist for orthopedics, sports medicine
„The patient is often traumatized or in a state of shock. Targeted diagnostics and individual therapy are key factors for successful treatment“.
Dr. Alexander Rauch
Specialist for orthopedics, trauma surgery, sports medicine and specialized trauma surgery
„Arthroscopic surgery has revolutionized the field of hip surgery and has paved the way to new, minimally invasive forms of treatment.“
Prof. Dr. Hans Gollwitzer
Specialist for orthopedics and trauma surgery
Specialist for orthopedics, sports medicine, chiropractic therapy
Consultation and contact for questions regarding arthroscopy
Do you have questions regarding therapy with arthroscopy? Our experts, Dr. Erich Rembeck, Dr. Alexander Rauch and Prof. Dr. Hans Gollwitzer will be happy to provide you with more information within the framework of a personal appointment. Please make an appointment here. We are looking forward to hearing from you.