”Minimally invasive” is a term that has become popular in the medical field since the 21st century. Broadly speaking, “minimally invasive” refers to the medical concept of using the least invasive operation to achieve the greatest treatment effect. Specifically in orthopedics, we usually categorize minimally invasive surgery as closed nailing, external fixation frames, LESS plates, arthroscopy, laminaroscopy (MED), percutaneous puncture nucleus pulposus ablation, and so on. One of these methods, arthroscopy, is described below.
First: What is arthroscopy?
Why do I talk about this issue? Because I have heard many people ask me skeptically, “What kind of mirror is this that can cure diseases just by looking at it? It is obvious that people have misunderstanding about it. In fact, arthroscopy is the abbreviation of joint endoscopy, not a “demon mirror”, and we are familiar with the gastroscope, cystoscope, rectoscope, etc., is a collection of modern laser, imaging, computer conversion technology, such as high-tech and human histology, clinical diagnosis, surgery and other organic combination of products. The application of arthroscopy in orthopedics is one of the most important achievements of joint surgery in the 20th century.
Arthroscopic technology was introduced into China in the late 1970s and early 1980s, and then carried out successively in Beijing, Shanghai, Guangzhou and Shenyang. When arthroscopic diagnosis and surgery started in Japan more than 30 years ago and gradually spread around the world, there were still many people who gave it a skeptical look, and some thought it was a medical gadget.
However, through decades of practice, it has proven to be a very scientific, advanced, and humane discipline, and has now become an indispensable assistant for joint surgeons and has developed into an independent branch of orthopedics. At present, arthroscopic technology is a necessary item for “Triple A” hospitals and has become one of the criteria for measuring the overall strength of a hospital.
Second, what are the advantages of arthroscopic examination/surgery?
Compared with traditional incision surgery, arthroscopic surgery is becoming more and more popular among orthopedic surgeons and patients because of the unique advantages of clearer vision, no incision, less trauma, faster recovery, safety, and shorter hospital stay. The advantages are as follows.
Less trauma: Arthroscopic surgery requires no major incision, only two or three small holes of 3-5 mm for the placement of lenses and instruments, and generally no postoperative sutures.
High clarity: The light source, camera system and display system magnify the tissues in the joint 10-30 times, which can be clearly seen on the monitor, and the subtle lesions can also be reflected, so the field of view is clearer;
Safety: The operation is carried out completely within the visual range, and what is seen and what is treated, with a very low rate of accidental injury;
Fast tissue repair: small trauma, fine operation, selective treatment of only the damaged tissue, so that the tissue repair is naturally fast;
Reliable efficacy: After thorough treatment of diseased tissues in the joints and selection of indications, the efficacy is reliable;
Short hospitalization time: generally only 3-5 days;
Relatively low cost: Due to the short hospitalization time and no special medication, the cost is relatively low compared to the year-round medication and injection;
Third, which patients need arthroscopy or surgery?
Generally speaking, patients with “negative” arthralgia are suitable. “Negative” arthralgia means that the patient has obvious painful sensations such as swelling, pain, swelling, water retention, and popping of the joints, but no positive findings on X-Ray film. Patients in this category are either told that they are not sick or that they should have an MRI. However, MRI is expensive, has a certain degree of error, and can only examine but not treat. Arthroscopy in this group of patients allows for a clear diagnosis and simultaneous surgery, which can reduce both pain and medical costs.
Minimally invasive treatment of clearly diagnosed joint injuries, such as microscopic suturing and repair of meniscal injuries, tightening and reconstruction of anterior and posterior cruciate ligaments, cleanup of osteoarthritis, release of joint ankylosis periarthritis, and tightening of joint capsule for habitual shoulder dislocation. These surgeries do not require an incision and can be performed on the next day after surgery and can be discharged from the hospital in 3-5 days, with a short course of treatment, fast results and low cost.
The procedure is short, effective, and cost effective.
Biopsy of difficult diseases in the joints.
Fourth: Arthroscopic surgery and rehabilitation for several common diseases
Reconstruction of cruciate ligament injuries
Arthroscopic reconstruction of the cruciate ligament is one of the most successful arthroscopic procedures that can be performed to restore stability of the knee joint by reconstructing and repairing the ligament using autologous patellar tendon, semitendinosus muscle, or allograft ligaments using 2-3 small incisions.
Suturing and revision of meniscal injuries.
Meniscal injury is the most common injury in the knee joint, especially in children and adolescents who love sports. The traditional method is to remove the meniscus openly, which can bring about premature degeneration of the joint. The advent of arthroscopy, however, has solved this problem. The torn meniscus can be sutured or the ruptured edges can be repaired neatly under the microscope, thus solving the pain and preserving the function at the same time. However, I have found in my practice that patients who come to the clinic with a lack of awareness of the dangers of meniscal injury, coupled with our lack of timely diagnosis of meniscal injury, have thus often lost the opportunity to have their sutures closed.
Treatment of chondromalacia patellae
Chondromalacia patellae, a manifestation of articular cartilage degeneration, sometimes accompanied by patellar subluxation, was not well treated in the past. With arthroscopy, it can be effectively treated by decompressing the cartilage and releasing the corresponding contracted ligaments under the microscope.
Synovectomy for rheumatoid and rheumatoid arthritis
In rheumatoid and rheumatoid arthritis, the synovial membrane is hypertrophic, congested, and exudates more, causing pain, swelling, and fluid accumulation in the patient’s joints. With traditional synovectomy, the incision is large, recovery is slow, and joint extension and flexion are often limited. In contrast, arthroscopic resection with selective subtotal excision, without incision, allows for functional exercise after surgery, with good results.
Synovial debridement with irrigation for septic arthritis
Microscopic debridement for osteoarthritis (osteophytes)
Osteoarthritis, commonly known as osteophytes, is clinically classified into four stages, and arthroscopic debridement can be performed for all stages 1-3. Those with stage IV should undergo joint replacement.
Arthroscopically guided internal fixation, etc.