In-office Arthroscopy

What is In-Office Arthroscopy?

Arthroscopy, the benchmark for diagnosis of intra-articular joint pathology, is usually performed in an operating room setting with the patient requiring regional or general anesthetics, incision and incision closure, and 4 mm instruments for most joints.

In-office arthroscopy, also referred to as needle arthroscopy, is a new technology that allows your orthopedist to view and diagnose intra-articular joint problems utilizing a small needle with a camera inside under local anesthesia and without making an incision. In-office arthroscopy is most commonly utilized to evaluate shoulder and knee joints.

Working Mechanism of In-Office Arthroscopy

Usefulness of in office/needle arthroscopy.

• In office arthroscopy is minimally invasive with almost no pain.
• It is very cost effective because hospital and anaesthesia fees are avoided.
• Conditions that were traditionally treated in a hospital can be treated now in the office.
• Very good results are now obtainable with office arthroscopy because of small new instruments.
• Many ACL tears can now be treated in the office avoiding painful surgery and longer rehabilitation.
• Many shoulder rotator cuff tears and labral tears can also be treated successfully in the office.
• In office arthroscopy can also be combined with orthobiologics such as PRP and adipose.

Indications for In-Office Arthroscopy

In-office arthroscopy is indicated to diagnose and treat various intra-articular joint pathologies, such as:

• Meniscal tears
• Labral tears
• Loose bodies
• Tendonitis
• Bursitis
• Anterior cruciate ligament (ACL) tears
• Rotator cuff tears
• Femoral acetabular impingement (FAI)
• Degenerative joint disease
• Cartilage problems in the joints

In-office arthroscopy is also indicated as an alternative to MRI for patients who:

• Are claustrophobic
• Are morbidly obese
• Have implanted medical devices
• Have had a previous operation on the affected joint
• Are renally impaired
• Have metal in their bodies

Preparation for In-Office Arthroscopy

In-office arthroscopy only requires a small nick on the skin for needle insertion, hence it does not involve any extensive pre-procedure preparations. In general, the procedure may involve:

• A review of your medical history and a physical examination
• Informing your doctor about medications or supplements you are taking
• Informing your doctor about allergies to any medications, anesthesia, or latex
• Refraining from taking blood-thinners, anti-inflammatories, aspirin, or other supplements for a week or two
• Arranging for someone to drive you home after the procedure

Procedure for In-Office Arthroscopy

In-office arthroscopy procedure is performed under local anesthesia in an office setting. It can be used in a variety of joints, including the hip, shoulder, knee, elbow, and ankle. The procedure usually takes about 20 minutes to perform and involves the following steps:

• The area around the joint is thoroughly cleaned with an antiseptic solution.
• Once the area has been sterilized, local anesthesia is administered.
• Your surgeon will then insert the needle arthroscope into the joint with extreme care. The scope can be inserted into many different locations in the joint depending upon the region of suspected damage.
• While the scope is being inserted, you may feel slight pressure, but it should not cause any pain.
• The needle arthroscope which is equipped with a light source and tiny camera enable your surgeon to view the inside of the joint through a tablet that is connected to the device.
• The joint is intermittently irrigated with sterile saline solution for better visualization of the inside of the joint. This fluid is suctioned out once the procedure is completed.
• The needle arthroscope is then withdrawn and a small bandage is placed on the insertion site.

Postoperative Care and Recovery

• Following the procedure, you will be kept in observation for 30 to 60 minutes.
• Do not remove the dressings until 24 hours has passed. You may then shower. Keep the area covered, with Band-Aids or gauze bandages, if there is drainage from the incisions.
• If you are having a knee in office arthroscopy, we recommend you either borrow or purchase a pair of crutches. Although you may weight bear fully after most procedures it is safer to walk with crutches for a few days to avoid falls and injury.
• Pain medication will be prescribed and can be used as needed if over-the-counter medication is not sufficient.
• Your postoperative activity level will be discussed with you before you leave the office. In most cases you may return to normal activities within a few days. In some cases however such as ACL repair and rotator cuff repair your activities will be modified to allow for these tissues to heal properly.

Benefits of In-Office Arthroscopy

Some of the benefits of in-office arthroscopy include:

• Minimal pain
• Quicker recovery
• No incisions or suture
• No need for general or regional anesthesia
• More cost-effective than an MRI or traditional arthroscopy
• Quicker results in an office setting
• More accurate than other procedures
• A useful device to assess degenerative arthritis and cartilage damage
• Effective for image-guided injections
• Can be used on patients contraindicated with MRI
• Better images of the joint area than an MRI can provide
• Enables participation of the patient in decision making

Risks and Complications

In-office arthroscopy is a simple in-office procedure with minimal risks and complications. These may include:

• Pain
• Bleeding
• Damage to the articular cartilage, nerves, and blood vessels.
• Infection at the skin
• Deep infection and septic arthritis