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  • Review Article
  • Published:

Advances in arthroscopy—indications and therapeutic applications

Nature Reviews Rheumatology volume 11, pages 77–85 (2015)Cite this article

Subjects

Key Points

  • Arthroscopic procedures for removal, repair and replacement of tissues are increasingly performed instead of traditional open surgeries

  • Although the use of diagnostic arthroscopy has declined with the increasing accuracy of noninvasive imaging, optical technology, instrumentation and implants used in arthroscopic surgery have all improved dramatically

  • Considerable regional variation exists in the use of arthroscopic surgery, reflecting both differences in beliefs over indications for surgery and the slow dissemination of skills and technology

  • The evidence base for the efficacy and cost-effectiveness of arthroscopic surgery is weak, highlighting the need for additional well-designed randomized trials in this area

  • New surgical skills are needed for arthroscopic techniques, requiring modification of training programmes and surgical practice

Abstract

Advances in optical technology, instrumentation and implants now enable arthroscopic surgery to be performed on all large joints and most small joints of the limbs. Arthroscopic techniques are usually a development of surgical procedures previously performed through a large open incision, although the critical element of each procedure (for example removal of a torn meniscus) usually remains unchanged. The smaller size of incisions and reduction in tissue damage associated with arthroscopic surgery can reduce morbidity and complications. Therapeutic arthroscopy now encompasses excision, reconstruction and replacement of damaged or abnormal tissue. Improvements in the accuracy of MRI, CT and high-definition ultrasonography have limited the use of diagnostic arthroscopy to rare indications, but in the past 10 years the rates of some arthroscopic surgeries have increased by over 7-fold. Considerable variation in the type and utilization of arthroscopic procedures exists in practice, partly explained by the slow diffusion of new techniques and technology, but also by differences in clinician and patient beliefs and expectations. This Review reflects on both the success of arthroscopy and the general lack of evidence-based assessment of the efficacy and cost–effectiveness of arthroscopic procedures—a clear sign that more clinical trials in this field are required.

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Figure 1: A simulator used to train and evaluate arthroscopic skills.
Figure 2: Variation in rates of arthroscopic decompression surgery (standardized for age and sex), by English primary care trusts during 2002–2003 and 2009–2010.
Figure 3: Arthroscopic knee surgery.
Figure 4: Arthroscopic hip surgery.

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Acknowledgements

The authors acknowledge funding support from the National Institute for Health Research Oxford musculoskeletal biomedical research unit, and from Arthritis Research UK.

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  1. Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, National Institute for Health Research, Musculoskeletal Biomedical Research Unit, University of Oxford, Windmill Road, OX3 7LD, Oxford, UK

    Andrew J. Carr, Andrew J. Price, Sion Glyn-Jones & Jonathan L. Rees

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Carr, A., Price, A., Glyn-Jones, S. et al. Advances in arthroscopy—indications and therapeutic applications. Nat Rev Rheumatol 11, 77–85 (2015). https://doi.org/10.1038/nrrheum.2014.174

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