Arthroscopic Surgery
V. Rojvanit
Professor Kenji Takagi of University of
Tokyo did the first arthroscopy of the knee in 1918. He
employed the cystoscope to look inside of the knee joint
of cadavers and tuberculosis of the knee. Since then this
technique had been investigated further and popularized
around the world.
Professor Masaki Watanabe who was the pupil
of Professor Kenji Takagi did the first arthroscopic partial
meniscectomy of the knee in 1962. Besides the knee joint,
many other joints of human body can be examined through
the arthroscope. Of course many procedures can be done
under arthroscopic control. This new technique use arthroscope
pass through skin portals into the intraarticular space
and the special arthroscopic instrument could also pass
along the portals into the joint. This technique enable
the surgeon to perform appropriate arthroscopic surgery
according to the pathology. Because only several tiny
wounds were necessary during the procedure, this enhances
postoperative recovery of the patient. Many of them walk
on the following day after the day of operation. Usually
only light dressing or knee support is enough for support
postoperatively. Thus shorten hospitalization and postoperative
rehabilitation. Patients can resume sports activity quite
soon some within 1-2 weeks. Morbidity and complications
were rare. Postoperative hemarthrosis sometimes encountered
and causing stiff knee. This sequelae needs extra time
of rehabilition until range of motion return.
Arthroscopic instrumentation composed of
arthroscope itself (diameter 4-5.5 mm) and light source
and small surgical instruments such as biopsy punch forceps,
scissors forceps, basket punch forceps. Probing hook can
be used to palpate soft structures inside the joint. The
integrity of the ligament can be checked. Loose bodies
or other structures in the gutters or intercondylar notch
area can be pushed and moved. Irrigation needle and pump
help keeping the intraarticular environmental clear and
easy visualized. The most often used media is the normal
saline fluid. In the old days some tried using carbondioxide
(CO2) gas for joint distension.
Anesthesia: either local, general or spinal
anesthesia can be selected. Thanks to the new development
and new technology, besides power instruments such as
intraarticular shaver, presently radio frequency (RF)
plays important role on arthrosacopic procedures. This
RF can removal tissue as ablation and control bleeding
like electric cautery. Video camera set help all the participants
of the operating team and other medical personals in the
room to be observing the monitors. This kind of set up
is quite important in term of education.
There are numerous pathologic conditions
inside the knee joints that can be handled by arthroscopic
technique (Table 1).
Table 1. Indications for arthroscopic surgery
of Knee joint
ACL: anterior cruciate ligament
One of the common procedures that usually
performed in case of sports injuries is arthroscopic ACL
reconstruction. It should be noted that total knee arthroplasty
remain to be approached by conventional open arthrotomy.
Arthroscopy is very useful. However meticulous surgeon
should start with a very good history and physical examination.
Referred pain should be kept in mind. With careful handling
of the equipments, instrumental failure or nerve injuries
can be avoided.
In Thailand this technique had been introduced
since the beginning of the 80. Several workshops had
been held with the cooperation of foreign authority arthroscopists,
and a number of well trained local orthopedists. In the
formal orthopedic training course, basic arthroscopic
technique had been implemented in the curriculum. Every
year special instructional course will be held to help
the residents to lea the basics.
August 2006, a cadaveric workshop organized
by the Department of orthopedic surgery Faculty of Medicine
Siriraj Hospital and Zimmer Institute on this 6th Floor
Thai-German Multidisciplinary Training Center (TG-MET
Center). Participants were international colleagues. We
felt thankful to Professor Pongsakdi and teams in helping
and providing all the facilities needed during the workshop.
The TG-MED Center should be regarded as one of the most
unique training center in this region of the world.
The royal College of Orthopedic Surgeon
of Thailand allowed a special group of Thai orthopedists
organized a study group in arthroscopy and arthroscopic
surgery since two years. The aim is to catch-up with the
progress of the world in this field. It should be noted
that in Japan, Japan Arthroscopy Association had been
established since 1973. In the United States of America,
similar body had also been established since 1976 and
called North American Arthroscopy Association. Many young
orthopedic surgeons possess interest in this new field.
Its application in term of sports injuries is increasing.
One of the most often performed arthroscopic surgeries
is arthroscopic ACL reconstruction.
The author believes that this technique
continue to develop and grow. New Approach and new strategy
to cope with joint injuries and diseases will be further
investigated for the benefit of the patient care
Orthopedics Training in
Thai-German Multidisciplinary Endoscopic Training Center
