In-Office Needle Arthroscopy: A Systematic Review of Indications and Clinical Utility

Editorial Commentary: What You See Is What You Get—Is In-Office Needle Arthroscopy Ready for Prime Time?

“…In 2 cost analyses, IONA had lower costs when used in place of MRI for treatment algorithms involving medial meniscal tears and rotator cuff tears but not lateral meniscal tears. The more recent cost analysis by Zhang et al 1 concurs with a Markov decision tree model published earlier in 2019, but in that study, IONA was also less costly for lateral meniscal tears. 3 Zhang et al rightly point out that IONA is an intra-articular modality only and cannot diagnose concomitant extra-articular soft-tissue damage or important subchondral bone changes in osteochondral lesions.…”

“…The article draws from a potential field of 932 conference abstracts and 369 studies and distills its analysis to 11 studies, 3 of which are abstracts only and 1 of which is a case report, illustrating the limited evidence there is concerning IONA in the literature. 1 In addition, the studies used to assess the accuracy of IONA compared with diagnostic surgical arthroscopy (SA) and magnetic resonance imaging (MRI) were performed in the more controlled environment of the operating room and not the office setting. Although 1 of the articles cited contends that "the exact location would not affect the images obtained or the actual patient or device assessment of the technology," there is little evidence to date that the accuracy of IONA performed in the office setting is the same when performed in the operating room prior to an SA.…”

“…Finally, the first paragraph of the introduction in the article by Zhang et al 1 contains some very interesting and troubling data concerning waiting times in Ontario, Canada, for knee arthroscopy (155-216 days), shoulder surgery (187-248), and MRI (35-96 days). Those time frames should be kept in mind this election season as the benefits of a single-payer health care system are touted by various politicians!…”

Diagnostic and Therapeutic Shoulder Arthroscopy Using a Small-Bore Needle Arthroscope

“…2,9 However, a recent systematic review that suggested promise for NA also highlighted limitations, including the need for clearer diagnostic protocols to expand applications and widespread clinical use. 10 Because of differences between standard arthroscopy and NA technology, namely a 0 optic and less rigid instrumentation, modified techniques are required to accommodate thorough diagnostic arthroscopy. Thus, this article presents our technique for diagnostic arthroscopy of the glenohumeral joint and subacromial space with NA.…”

“… 2 , 9 However, a recent systematic review that suggested promise for NA also highlighted limitations, including the need for clearer diagnostic protocols to expand applications and widespread clinical use. 10 …”