Will rheumatologists ever pick up the arthroscope again?

Abstract

Conditions prompting physicians and surgeons first adapting endoscopes to peer into joints were mainly the sort of synovial conditions that would concern today's rheumatologists. Rheumatologists were among the pre‐World War II pioneers developing and documenting arthroscopy. The post‐War father of modern arthroscopy, Watanabe, found rheumatologists among his early students, who took back the technique to their home countries, teaching orthopedists and rheumatologists alike. Rheumatologists described and analyzed the intra‐articular features of their common diseases in the ’60s and ’70s. A groundswell of interest from academic rheumatologists in adapting arthroscopy grew considerably in the ’90s with development of “needle scopes” that could be used in an office setting. Rheumatologists helped conduct the very trials the findings of which reduced demand for their arthroscopic services by questioning the efficacy of arthroscopic debridement in osteoarthritis (OA) and also developing biological compounds that greatly reduced the call for any resective intervention in inflammatory arthropathies. The arthroscope has proven an excellent tool for viewing and sampling synovium and continues to serve this purpose at several international research centers. While cartilage is now imaged mainly by magnetic resonance imaging, some OA features – such as a high prevalence of visible calcinosis – beg further arthroscopy‐directed investigation. A new generation of “needle scopes” with far superior optics awaits future investigators, should they develop interest.

Clinical Comparative Trial of Arthroscopic Debridement Combined with PRP Therapy versus Pure PRP Therapy for Knee Joint: A Clinical Comparative Trial

“…Knee arthroscopic treatment for osteoarthritis is used to relieve symptoms and delay joint replacement surgery [10]. However, there is controversy regarding the e cacy of arthroscopic debridement surgery in KOA [11][12][13]. Some studies suggest that knee arthroscopic debridement surgery may bene t KOA patients, while others disagree.…”

Washing Out the Septic Knee

“…With decreasing levels of anesthesia and increased performance of arthroscopy in an office or procedure room compared to when it was strictly in an operating room procedure, barriers to employment of arthroscopy have been steadily reduced. Reengineering of small-bore needle arthroscopes to produce instruments which show images equivalent to those from conventional glass lens arthroscopes [14], have made in-office arthroscopy not only feasible but attractive. Recently, Stornebrink and colleagues described a series of patients whose septic knees were managed with a needle arthroscope at the bedside -a procedure in which much less fluid washes through the joint than with O.R.-based arthroscopy -and achieved uniformly satisfactory outcomes [15], extending it to a larger group of patients with other infected joints and finding similar results [16].…”

Regarding Arthroscopy

“…Images of arthroscopes obtained directly from their respective manufacturers, who also granted permission to use the images in this publication. Figure reproduced from Ike and Kalunian, 29 with permission.…”