A change in scope: redefining minimally invasive

Abstract

The editors of KSSTA recently highlighted the increase in demand for ankle arthroscopy that is expected for the near future [5]. Arthroscopic techniques are increasingly sophisticated and the range of indications for arthroscopy is broadening accordingly. In contrast with these developments, arthroscopic cameras have hardly changed since their first introduction. We still use rod-lens scopes of substantial diameters, making arthroscopy as invasive as it was decades ago: posing risk to neurovascular tissue [3] and cartilage [4] and causing unnecessarily long recovery times. Current innovation in the field of needle arthroscopy might help to better facilitate the pending increase in ankle arthroscopic procedures.In several lab and patient settings, our international collaborative group has been working with a novel needle arthroscopic system (NanoScope™, Arthrex, Naples, FL). With an optic chip at the camera tip and no inner rod-lenses, this semi-rigid scope remains durable at a total diameter of just 1.9-mm, and 2.26 mm including the cannula. Image quality is higher than that of traditional needle arthroscopes, offering a 400 × 400 pixel number with a 120° field of view.In contrast with previous needle arthroscopes, this new system comes with tailored surgical instruments, which introduces the possibility of operative needle arthroscopy. The safety and efficacy of this technology was systematically tested in a cadaveric setting, and this fundamental research was translated into a broad clinical portfolio. The results of first studies are promising [1,2]. Cadaveric experience in the ankle is presented in this issue of KSSTA [1].In general, operative needle arthroscopy offers a minimally invasive technique, with a less than 3-mm skin incision that requires only paper suture closure. This minimal portal footprint reduces local soft-tissue trauma and often obviates the need for any more than a local anaesthetic, both factors expediting patient recovery. Under these circumstances, smaller arthroscopic interventions can become bedside procedures performed in an office setting. Anterior and posterior ankle arthroscopy with debridement of osteophytes and cicatrized tissue is a reproducible technique that lends itself particularly well for operative needle arthroscopy. First metatarsal phalangeal joint limited cheilectomy and evaluation of chondral wear is another facile use. Tendoscopy of the Achilles, peroneal and tibialis posterior tendons is an attractive and simple procedure that can be both diagnostic and therapeutic in nature, allowing easy debridement using 2 and 3-mm shavers and augmenting repairs with biologic delivery systems. Similar ease of access can also be achieved in the knee, shoulder and other joints, where bony and soft-tissue impingement can be identified with clarity and addressed appropriately. Furthermore, clinical experience has confirmed the versatility of this technique as both a bona fide method of performing many therapeutic procedures as well as an augment to diagnostics.The use of operative n...

Improved Clinical Outcomes and Patient Satisfaction of In-Office Needle Arthroscopy for the Treatment of Posterior Ankle Impingement

“…IONA for the diagnosis and intervention of foot and ankle pathology has already been demonstrated to be a safe tool in cadaver models. 17,18 We have confirmed these initial observations by demonstrating that select patients with PAIS can be successfully managed under WALANT conditions with results comparable to endoscopy in a full operating room suite. We stress the importance of having a thorough conversation with the patient and understanding his or her pathology before the procedure to ensure that the indications for IONA are met.…”

Location Distribution of 2,087 Osteochondral Lesions of the Talus

“…62 Novel concepts of imaging strategies in the form of an innovative in-office needle arthroscopy may aid in this process as it could improve the visualization of early cartilage damage whilst simultaneously, as well as instantly, performing a preventative treatment. 67,68 Our research, therefore, functions as a stepping stone to the more accurate estimation of prognosis as well as towards the development of a novel preventive treatment option, hereby clearly demonstrating the clinical relevance of our research outcomes.…”

Needle Arthroscopic All-Inside Repair of Meniscal Tears Under Local Anesthesia

“…5 This innovation has fueled the use of needle arthroscopy, with diagnostic and interventional indications arising in the ankle, knee, and shoulder. [6][7][8] Needle arthroscopy seems to be perfectly suited for repair of isolated meniscal tears. To the patient, a meniscal suture may sound like a relatively simple operation.…”