Awe-Inspiring Arthroscopy Advances

When you ask surgeons about the importance of crystal-clear visualization in arthroscopy, you’ll often hear something about better visualization yielding better results. Dig a little deeper, and you’ll find out just why that is. Augustus “Gus” Mazzocca, MS, MD, FAAOS, FAOA, medical director of Mass. General Brigham Sport Medicine, says better visualization gives surgeons the ability to assess tissue quality and damaged areas on patients when planning their approach for arthroscopic repairs. He uses the example of rotator cuff tears, which come in all different varieties, to illustrate his point. “A 45-year-old construction worker who suffers an acute tear is likely to have good quality tissue compared to a 71-year-old who starts to have a tear tracked to the glenoid,” says Dr. Mazzocca. “These become different procedures.”

The ability to assess tissue quality and easily determine the nature of the problem (acute versus chronic) is a key benefit of cutting-edge visualization. Such visualization is achieved in arthroscopic surgery by a combination of excellent optics on the arthroscopes themselves, improved video technology so that the scope image is transmitted to the flat screen monitor with the highest resolution possible and techniques such as joint distraction in hip, shoulder and ankle arthroscopy, says James Stone, MD, president of the Arthroscopy Association of North America (AANA).

Top-tier visualization for today’s arthroscopy procedures is generally recognized as 4K, a resolution and color reproduction that is four times greater than what you get through standard HD. But is 4K necessary for arthroscopy? Dr. Stone sure thinks so. “Current 4K technology has given us the best resolution for arthroscopic procedures, and superior visualization is critical to the performance of arthroscopic surgical procedures,” he says. Remember, though, if you want true 4K then you must make sure both the monitor screen and camera are 4K-equipped; an HD camera combined with a 4K video monitor will not give you true 4K.

In addition to the visualization, advances in the scopes themselves have made surgeons’ lives easier in the OR — and even in an office-based setting. “We’ve seen recent technological improvements of high resolution, small diameter arthroscopes that are disposable and can be used for in-office arthroscopic examination under local anesthesia,” says Dr. Stone.

When it comes to the cameras delivering the imaging to surgeons, Dr. Mazzocca says facility leaders should expect quality, durability and the ability to withstand the rough intraoperative anatomy in which they are placed, adding that a problem with some older cameras was the heat from the corresponding light source. “The heat could cause the camera to fog up, and if you have a cloudy picture, there’s a chance you won’t do as good a job,” he says.

Current 4K technology has given us the best resolution for arthroscopic procedures.
— James Stone, MD

Another nice-to-have feature of newer systems is arthroscopy towers with wireless controls of automated irrigation pump controls. “The fewer wires the better,” says Shane Nho, MD, an orthopedic surgeon in sports medicine and hip arthroscopy at Midwest Orthopaedics at Rush in Chicago. “Wireless technology is all around us, so we need to adapt to these technologies in the OR, too.” Although wireless arthroscopy equipment is far from the standard today, Dr. Nho believes this technology is right around the corner for outpatient facilities. “Wireless arthroscopy is coming,” he says. “There are newer companies that have developed the ability to perform arthroscopy without a light source or camera cord.”

As exciting as these advances may be, arthroscopy is a skill-based specialty, and the tech will never trump the precision and technique necessary to do these procedures effectively, something that takes a lot of time, effort and repetition. “Surgery is a skill, just like playing a sport. The more procedures you perform, the more facile you become,” says Dr. Nho, adding that what often separates a good surgeon from a superior one is the volume of procedures they handle.

For Dr. Stone, new ideas and innovations that have been generated by individual surgeons are at the core of arthroscopy advances — advances that are ultimately benefitting patients. “These surgeons, working with industry partners, develop new techniques and the instrumentation to perform them so that reparative procedures can be performed arthroscopically,” he says. “When a procedure can be performed arthroscopically rather than through large open incisions, patients often see the benefits of having them performed as outpatient rather than requiring hospitalization, with faster rehabilitation and a decreased incidence of complications.” OSM