Type of test Endoscopy

Normal findings

 Normal ligaments, menisci, and articular surfaces of the joint

Test explanation and related physiology

 Arthroscopy is an endoscopic procedure that allows direct visual examination of a joint space with a specially designed endoscope (Figure 1). Although this technique can visualize many joints of the body, it is most often used to evaluate the knee for meniscus cartilage or ligament injury. It is also used in the differential diagnosis of acute and chronic disorders of the knee (e.g., arthritic inflammation vs. injury). The shoulder is commonly visualized for injury to the rotator cuff.

 Physicians can perform corrective surgery through the endo scope. Diagnostic arthroscopy is performed less often because of the availability and accuracy of MRI of the joints .

Fig1. Arthroscopy. The arthroscope is placed in the joint space of the knee. Video arthroscopy requires a water source to distend the joint space, a light source to see the contents of the joint, and a television monitor to project the image. Other trocars are used for access of the joint space for other operative instruments.

Visual findings may be recorded by attaching a video camera to the arthroscope. Other joints that can be evaluated by the arthroscope include the tarsal, ankle, knee, hip, carpal, wrist, and temporomandibular joints. Synovial fluid can be obtained for fluid analysis through arthroscopy. See arthrocentesis.

Contraindications

 • Patients with ankylosis

 • Patients with local skin infections near the joint

• Patients who have recently had an arthrogram

Potential complications

 • Infection

• Hemarthrosis

 • Swelling

 • Thrombophlebitis

 • Joint injury

• Synovial rupture

 Procedure and patient care

* Before

Explain the procedure to the patient.

 • Ensure that the physician has obtained written consent for this procedure.

• Follow the routine preoperative procedure of the institution.

 • Keep the patient NPO after midnight on the day of the test.

- Instruct the patient who will use crutches after the procedure regarding the appropriate crutch gait. The patient should use crutches after arthroscopy until able to walk without limping.

 • Shave the hair in the area 6 inches above and below the joint before the test (if ordered).

* During

• The patient is placed supine on an operating room table.

 • Note the following procedural steps:

 1. Local or general anesthesia is used.

 2. The leg may be scrubbed and wrapped with an elastic bandage from the toes to the lower thigh to drain as much blood from the leg as possible.

 3. A tourniquet is placed on the patient’s leg. If the tourniquet is not used, a fluid solution may be instilled into the patient’s knee immediately before insertion of the arthroscope to distend the knee and help reduce bleeding.

 4. The arthroscope (a lighted instrument) is inserted into the joint space through a small incision to visualize the inside of the knee joint. Although the entire joint can be viewed from one puncture site, additional punctures may be required for any reparative work.

5. Before removal of the arthroscope, the joint is irrigated. After a few sutures are placed into the skin, a wrapped dressing is applied to the incision site.

 • Note that this procedure is performed in the operating room by an orthopedic surgeon in approximately 60 minutes.

* After

- Instruct the patient to elevate the knee when sitting and to avoid overbending the knee, so that swelling is minimized.

- Inform the patient that he or she can usually walk with the assistance of crutches; however, this depends on the extent of the procedure and the physician’s protocol.

- Tell the patient to minimize use of the joint for several days.

 • Examine the incision site for bleeding.

- Educate the patient to look for signs of bleeding into the joint (significant swelling, increasing pain, or joint weakness).

 • Apply ice to reduce pain and swelling and instruct the patient to continue this at home.

- Educate the patient to look for signs of phlebitis. This is not uncommon in a person immobilized by joint pain. The involved leg may become swollen, painful, and edematous.

- Instruct the patient not to drive until it is approved by the physician.

- Inform the patient that the sutures will be removed in approximately 7 to 10 days.

Abnormal findings

- Torn cartilage

-Torn ligament

-Patellar disease

- Patellar fracture

- Chondromalacia

- Osteochondritis dissecans Cyst (e.g., Baker)

- Synovitis

- Rheumatoid  arthritis

- Degenerative arthritis

- Meniscal disease

- Osteochondromatosis

-Trapped synovium