Arthroscopy

Arthroscopy is a minimally invasive surgical technique used to evaluate joints. This is the gold standard for joint exploration in humans. In veterinary medicine, we consider arthroscopy to also be the gold standard for for evaluation of joints as a less invasive, less painful, and more thorough technique. Prior to it’s development, arthrotomy was performed which is cutting open the entire joint surgically to look within the joint itself. This carried a much higher tissue morbidity. Similar to laparoscopy (which is minimally invasive surgery of the abdomen), arthroscopy is a much less painful technique which leads to a faster recovery.

Arthroscopy involves placing a very small arthroscope into a joint which is attached to a camera. This is only a few millimeters in size for the skin incision. Arthroscopy allows for greater magnification and therefore more thorough evaluation of the joint. Adjacent to the portal for the arthroscope, another tiny skin incision is made through which very small instruments/probes are passed for treatment of any joint pathology.

In veterinary medicine, we use arthroscopy for evaluation of all joints including stifle, elbows, shoulders as well as carpus, tarsus and hip. It is most commonly used for canine patients. It is more limited use for felines due to their size restrictions. Arthroscopy involves placing a very small camera into the joint to assess the cartilage/joint surface, and intra-articular structures. The most common uses for arthroscopy in canines include cranial cruciate and meniscal injuries, elbow dysplasia, shoulder OCD (osteochondrosis dissecans), biceps tendon disease, tarsal OCD, evaluation of hip dysplasia, etc.

Cranial cruciate ligament (CCl) disease (stifle) is similar to ACL disease in humans. Arthroscopy can be used to diagnose and treat cruciate and meniscal disease. A camera is inserted into the stifle joint and the cartilage is assessed for any arthritis or cartilage defects. The cruciate ligaments are evaluated for any tears/fraying which is the definitive diagnosis for cruciate rupture. The menisci are probed and evaluated for any tears/fraying. If there are any tears of the cruciate or meniscus, they are removed arthroscopically via a tiny shaver/instruments. Additional surgical stabilization is then performed to help with any instability.

Elbow dysplasia is another common disease in dogs for which the gold standard of treatment is arthroscopy. There are several forms of elbow dysplasia including fragmented medial coronoid process (FMCP), ununited anconeal process (UAP), incongruity and osteochondrosis (OCD). Arthroscopy is used to completely evaluate the joint for any of these conditions as well as to treat the patient. The most common disease is FMCP in which a fragment of bone is removed arthroscopically (minimally invasively).

The shoulder is a common joint to be treated with arthroscopy. Osteochondrosis Dissecans (OCD) is a disease of younger dogs in which there can be a large flap which is unattached to underlying bone on the humerus. Arthroscopy is used to thoroughly evaluate the joint, find and remove the entire fragment, and treat the underlying bone to help with healing. Another frequent use for arthroscopy is evaluation of tendons especially the biceps tendon, and release of the tendon for chronic lameness/shoulder pain.

Decades ago when arthroscopy was not available in the veterinary field, arthrotomy was the only option for evaluating joints.  This involved cutting through the entire joint which carries a vast amount of nerve fibers and therefore was more painful. With arthroscopy, two tiny (few mm) incisions are made into the joint which results in a faster recovery time, less swelling, less pain, and therefore less hospitalization. There is also less risk of tissue damage or surgical/skin infections. This allows for better functionality and improved comfort. The recovery process is faster with arthroscopy and allows for quicker postoperative rehabilitation.