Diagnostic Arthroscopy

Joint disorders are among the more common ailments of today. While for many, treatment may comprise a round of anti-inflammatories and physio, others may require ‘arthroscopy’ which has been playing an essential role in the examination and treatment of joint injuries and disorders for decades. Over time, with technological advancements in medical science, it evolved into “needle arthroscopy” which utilises a tiny camera the size of a needle. This has transformed how knee joint problems are being addressed by surgeons today. In end 2021, Malaysia’s first needle arthroscopy using Nanoscope® was performed by Dr Shamsul Iskandar Bin Hussein, Consultant Orthopaedic Surgeon from Ara Damansara Medical Centre in Malaysia for the knee joint, where the patient was fully conscious throughout the half-hour procedure and resumed his usual activities within hours.

For much of its history, arthroscopy was mostly relegated to a more diagnostic role, but it found renewed popularity after being combined with operative or surgical procedures. The data garnered from arthroscopy can determine the diagnosis and consequent treatment in both traumatic as well as non-traumatic joint disorders, especially where the cause is not immediately evident.

In a basic arthroscopic procedure, a narrow tube is attached to a fibre-optic video camera through a small, buttonhole-sized incision. The video and images detected in the site of injury are then transmitted to a high-definition video monitor. Surgery can then be performed during the arthroscopy itself, using thin, high-precision surgical instruments that are inserted via additional incisions.

Standard arthroscopy involves a surgical incision to look inside the joint (for example the knee) for evaluation and treatment of the problem. By contrast, in needle arthroscopy, the minor procedure is performed using smaller instruments and without making a surgical incision. Needle arthroscopy can be performed by using local anaesthesia in a clinical setting, while standard arthroscopy requires putting the patient under general anaesthesia or regional anaesthetic block.

Needle arthroscopy is recommended for patients who are not suited for an MRI procedure due to claustrophobia. It is also considered the most suitable procedure for patients who have a pacemaker, metal implants, and with suspected intraarticular pathologies. The procedure can also benefit those with arthritis who are candidates for joint replacement surgeries and when planning for cartilage repair.

In the first-ever NanoScope procedure for the knee in Malaysia, a patented disposable needle arthroscopic instrument was used. A needle arthroscopy performed using NanoScope has very minimal risk of infection and contamination, while allowing for immediate access to injury assessment. This enables surgeons to plan the patient’s treatment and care management more efficiently. The procedure also limits complications that may arise in a standard arthroscopy, while also permitting better understanding of the healing process through a ‘second-look evaluation’ for patients who have undergone a cartilage procedure.

Needle arthroscopy is considered to be a minor procedure and not a complicated technique. Compared to more conventional techniques, needle arthroscopy has the added benefit of immediate results, minimal to no pain to the patient, and a lower risk of anaesthetic complications. It is also deemed as being more precise than an MRI and more time-efficient, leading to patients spending less time at a medical facility and enjoying cost efficiencies.

Getting back on one’s feet within hours of a knee surgery and with minimal discomfort is the gold standard when it comes to treating joint problems. As technology and medical science evolve further, we expect to see the rise of more minimally invasive, patient-centric joint treatments that will further contribute to wellbeing and quality of life after a knee injury.

This article is contributed by Dr. Shamsul Iskandar bin Hussein, Consultant Orthopaedic Surgeon (Sports & Joints), Ara Damansara Medical Centre, and does not represent the views or opinions of Health Matters Malaysia.