Development of the arthroscope has revolutionized surgical treatment of the knee. With the help of this high tech device, today’s joint problems may be diagnosed and treated without the discomfort of large incisions or the inconvenience of extended hospital stays. And it was NASA that made it all possible.

An arthroscope is an optical instrument connected to a light source. At the end of the instrument is a long metal tube, which is inserted through a tiny incision into the knee, providing the surgeon with a good view of the knee structures. The optics magnify these structures two to two and a half times, creating an image that is conveyed to a TV screen which displays an even larger picture of the knee for the surgeon to observe.

This procedure usually calls for a general or spinal anesthetic to relax the muscles and ligaments of the knee, allowing the joint surfaces to fall apart and creating space into which the arthroscope and the tiny arthroscopic instruments can be passed.

The exact procedure, of course, depends on what damage has occurred to the structures inside the knee, so diagnosis is important. On the various procedures treatable by arthroscopy, the repair of torn knee cartilage is the most common. But numerous other conditions are easily corrected with this state-of-the-art technology. Knee cap problems, loose pieces of detached joint surface (loose bodies), knee ligament repairs and reconstructions, and even some arthritic conditions can be treated with this remarkable little spin off of our space program.

So easy is the recovery for the patient, surgery is done on an outpatient basis in a hospital operating room. Unlike the old days, when incisions were large and painful, requiring numerous stitches and a lengthy hospital stay, today’s arthroscopy is finished when each tiny incision is closed with a single stitch or small band-aid, and the patient encouraged to walk as soon as he is awake.

It is not at all unusual for patients to return to school or office the day after surgery and full functional recovery, including participation in sports, often possible within six weeks. Of course, rapid recovery depends on the patient’s general health and condition and the extent of diagnostic and surgical treatment. Even after this Band-aid surgery, the avoidance of vigorous physical therapy to rehabilitate the muscle and ligaments about the joint is necessary.

Continuing exercises at home for several months’ after surgery will increase strength and muscle balance. So what’s in store for the future? Today, Scientists are developing robots, which can perform surgery directed by one surgeon from a Command Central outside the operating room.

From this vantage point, the surgeon will be able to control several robots performing different operations in different rooms simultaneously. Such progress sounds cost efficient, but it may take some doing to persuade patients to hold still for RoboDoc!

--- Dr. Edwin J. Taegel. M.D.