Ravi Mittal Associate Professor Department of Orthopaedics All India Institute of Medical Sciences Ansari Nagar New Delhi
Jitendar P Vij
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Step by Step Basics of Knee Arthroscopy
© 2006, Ravi Mittal
All rights reserved. No part of this publication and interactive CD ROM should be reproduced, stored in a retrieval system, or transmitted in any form or by any means: electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the author and the publisher.
First Edition: 2006
9788180617164
Typeset at JPBMP typesetting unit
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7Preface
Arthroscopy of knee is probably the commonest orthopedic procedure performed today in the West. However, in India, arthroscopic surgeries are not very common and performed at only few places. This scenario is changing fast and people are realizing the benefits of arthroscopy and adopting this procedure. There are many ways and avenues to learn arthroscopic surgery. One of these is reading the relevant literature. This book is an effort in this direction to help the beginners to know about the basics of arthroscopy. One should be familiar with the instrumentation and set up for the procedure, since it is quite different from the usual open orthopedic operations. It is essential to know the normal arthroscopic anatomy since it would help to identify the pathologies inside the knee joint. After one learns to perform a diagnostic arthroscopy of the knee, the next logical step is to operate and manage the common pathologies of meniscus, articular cartilage, synovium and anterior cruciate ligament using arthroscopic methods. It is my endeavor to present this information in an easy step-by-step format in a simple language with an emphasis on how to avoid problems and complications. The book has many diagrams and operative photographs to supplement the text.8
I thank my teachers: Prof PK Dave, Prof M Farooque, Prof S Bhan, Prof PP Kotwal, Prof S Rastogi and Prof A Jayaswal who have taught me and given various opportunities to learn about arthroscopic surgery. I am grateful to Prof R Malhotra and Dr HL Nag who provided invaluable guidance to me. I also thank my colleagues Dr CS Yadav, Dr Vikas Gupta, Dr S Alam Khan and Dr Vivek Trikha for their constant help in times of need. I owe my gratitude to my wife and family for their support and patience during the preparation of this book. Shree JP Vij Chairman and Managing Director and Mr Tarun Duneja General Manager (Publishing) of Jaypee Brothers Medical Publishers (P) Ltd. New Delhi have been extremely supportive and helpful in preparation of this book. I express my gratitude for their support.
Ravi Mittal
9Introduction
Man has always wanted to see the interior of his body. The use of vaginal speculum and proctoscopes were his earliest documented attempts to see inside the body. His earliest efforts were to use an “endoscopic device” to see inside the urinary bladder using hollow tubes and candle light for illumination. The invention of the incandescent lamp provided a new technology for illumination and cystoscopy became much easier. His urge to see more led him to view the interior of joints, the knee being first joint to be seen through a modified cystoscope called an arthroscope.
The credit for being the first person to perform a knee arthroscopy in 1912 goes to a Danish surgeon, Severin Nordentoft. In 1918, a Japanese surgeon, Professor Kenji Takagi, performed knee arthroscopy in a cadaver and later developed an endoscope specific for the knee—arthroscope. His student, Dr Masaki Watanabe, carried his work further forward. He developed the true arthroscope for the knee, initially using incandescent light and later using fiber light. He recorded his work very diligently and produced the “Atlas of Arthroscopy” in 1957 along with his model 21 arthroscope. In the West, Dr Eugene Bircher and Dr Michael Burman were the early pioneers in this field. Dr Eugene Bircher was a Swiss general surgeon who performed knee arthroscopy in cadavers in 1920. 10Dr Burman from the Hospital for Joint Diseases in New York developed his own “arthroendoscope” in association with Mr Reinhold Wappler and published his results in 1931.
Many people visited Dr Watanabe in Tokyo and learnt the techniques from him. Dr Robert Jackson, an orthopaedic surgeon from Toronto, went to Japan in 1968 to study tissue culture of bone tumors, but instead learnt the technique of arthroscopy. He was responsible for making arthroscopy popular in North America. Some of the surgeons who practiced arthroscopy in the 1960s and 1970s were Dr RW Jackson, Dr JB McGinty, Dr Richard O'Connor, Dr John Joyce III, Dr Harold Eikelaar, Dr Jan Gillquist, Dr Ejnar Eriksson, Dr David Dandy and Dr Dinesh Patel. These people developed the techniques for various arthroscopic procedures and collaborated with the industry to produce new instrumentation for these procedures.
Today, besides the knee joint, arthroscopic procedures are being undertaken for the shoulder, elbow, wrist, hip, ankle and even spine. Initially, arthroscopy was performed for the purpose of diagnosis only. Today, it is a therapeutic tool and magnetic resonance imaging (MRI) being used as a diagnostic tool. Newer procedures are being developed and newer technologies, like laser and electrosurgery are being perfected and adapted for arthroscopic surgeries.
It is hoped that in the future, arthroscopic procedures will replace the open procedures.