Case: Arthroscopy to debride cartilage lesions

Arthroscopy involves inserting a lens inside a joint through a small stab incision. This relays images to a video screen. Matteo does our arthroscopy cases. He sees inside plenty of elbows and a good number of shoulders. Arthroscopy allows a systematic exploration of the joint, with the advantages of magnification for diagnostic purposes. Much of the joint can be examined without the need for invasive surgery, and the making of large wounds.

In addition to just looking around, surgical probes, cutting tools and power burs can be inserted into the joint down “working channels” made through separate small stab incisions to allow treatment of much joint disease as well as diagnosis.

The first two videos show the elevation of cartilage flaps in the elbow using the tip of a needle. The small needle tip looks enormous, giving a good idea of how much magnification arthroscopy gives.

The joint is flushed with saline during the process to keep debris and blood out of the field of view, and tiny silver bubble of air can be seen occasionally. The reddish seaweed like fronds that waft around are part of the joint capsule. They have the red colour because they have blood vessels. cartilage in comparison is brilliant white because it has no blood supply; instead it gets all its nutrition from the joint fluid.

The third video is longer. It starts with a look around the joint and you will see the smooth curve of the ulna fitting neatly into the contours of the humerus. 2-3 minutes in, you’ll see a power bur at work, grinding off damaged cartilage and underlying bone, while debris is carried away in the saline that is constantly flowing through the joint during the process.