Needle Arthroscopy Demonstrates High Sensitivity and Specificity for Diagnosing Intra-Articular Shoulder and Knee Pathology

Abstract

Introduction: Needle arthroscopy has been introduced in recent years as an alternative to magnetic resonance imaging (MRI) for the evaluation of knee and shoulder conditions. It has continued to evolve at a rapid rate with newer generation models making in-office integration simple. As MRI can sometimes prove inconclusive, it is worthwhile to consider these alternative options for evaluating musculoskeletal pathology as a primary diagnostic tool.Purpose: The purpose of this study is to evaluate the specificity and sensitivity of needle arthroscopy in diagnosing intra-articular shoulder and knee pathology in a small case series of patients who ultimately underwent surgical arthroscopy.Methods: A retrospective, single-centre, single-surgeon, cohort study was performed over a three-year period from August 2018 to June 2021. During this time, diagnostic needle arthroscopy was performed on patients with suspected shoulder or knee pathology based on MRI findings and clinical exams. These patients subsequently underwent standard surgical arthroscopy.Results: Thirty-four patients were included in the study. There were 35 joints included, 25 shoulders and 10 knees, with a mean age of 41.88 +/-11.32 years and BMI of 29.33 +/-6.27 in the shoulder group and a mean age of 45.5 +/-14.54 and BMI of 31.5 +/-4.94 in the knee group. When evaluating shoulder pathologies, needle arthroscopy showed a sensitivity of 0.93 for rotator cuff tears, 1.00 for labral tears and 1.00 for loose bodies. Needle arthroscopy for the shoulder was found to be 100% specific for all shoulder pathologies. Needle arthroscopy for the knee was found to have a 1.00 sensitivity for detecting chondral defects and 0.80 sensitivity for meniscal tears. There were once again no false positive needle arthroscopy findings amongst the knee group.Conclusion: Needle arthroscopy is an accurate diagnostic tool for the evaluation of intra-articular knee and shoulder musculoskeletal pathology. It can provide a potential solution for MRI-derived diagnostic inaccuracies that can lead to missed pathologies or unindicated procedures. It is less invasive than surgical arthroscopy and should be considered a useful tool in the armamentarium of orthopedic surgeons.

Improved Network Integrity and Patient Follow-up After In-Office Needle Arthroscopy Compared to Outpatient Advanced Diagnostic Imaging for Intra-articular Pathology

“…The sensitivity and specificity of identifying intra-articular pathology, such as meniscal tears, has been well documented, as has the patient tolerance profile. 6 , 16 Advances in current imaging chip technologies have allowed for clearer visualization compared to earlier generations ( Fig 1 ). Additionally, IONA equipment, such as knee posts, shoulder distractors, and small joint instrumentation, has been developed to allow for procedure optimization.…”

Needle Arthroscopy as a Promising Alternative to MRI for the Diagnosis of Meniscus Injury

“…Recently, in-office needle arthroscopy has received increasing attention for its potential to change the therapeutic strategies for joint diseases and has been described as an alternative procedure to MRI for the diagnosis of intra-articular lesions. This technique has been reported to provide a potential solution to MRI-derived diagnostic inaccuracies, which can lead to missed lesions or incorrect treatment procedures [ 6 ]. Needle arthroscopy of the knee has been shown to have a 1.00 sensitivity for detecting chondral defects and 0.80 sensitivity for meniscal tears.…”

“…As the diagnosis of the meniscal injury using the needle arthroscope in-office is assumed to be performed under local anesthesia, differences in pain control and muscle relaxation between general and local anesthesia may affect the visualization of the menisci. Finally, the three examiners had approximately 10 years of experience each as orthopaedic surgeons, which may have led to lower sensitivity and specificity for MRI and needle scope compared with other reports [ 6 , 13 ]. This limitation could have been improved by the inclusion of experts in knee surgery.…”

“…Moreover, diagnosis using MRI has high false-positive and false-negative rates, which may lead to unnecessary arthroscopic surgeries being performed due to false positives or delays in treatment due to false negatives [ 4 , 5 ]. The diagnostic accuracy of MRI can be affected by various factors, including magnetic strength and the physician’s level of experience [ 6 ]. As such, more accurate tools that are unaffected by such variable factors are required to diagnose meniscal injuries.…”

Arthroscopic Hip Labral Repair Using Needle Arthroscopic Visualization

“…Needle arthroscopy (NA) is a rapidly growing field that provides an alternative solution for the surgeon with options for both diagnosis and treatment. 6 Traditionally used for a diagnostic role in the office setting, advances in visualization optics allows for its use in the operative theater in lieu of a traditional arthroscope during surgical repair. 7 With a 120° field, the disposable 14-gauge arthroscope provides visualization not attainable with a traditional arthroscope.…”