Office-based knee arthroscopy using a scope for small joints

Although arthroscopy has a low degree of invasiveness, it still requires considerable time, cost, and effort to be perfomed in the operating room. Surgeons or patients sometimes hesitate due to risks and constrains, especially for a diagnostic second-look arthroscopy. In order to make knee arthroscopy less invasive, we use a 1.9 mm-diameter scope. The purpose of this study is to assess the feasibility and usefulness of this method for diagnostic knee arthroscopy without using the operating room. Local anesthesia is placed at the lateral infrapatellar portal, and the joint is inflated. Skin and capsule are penetrated directly by the apex of the obturator, and the scope is inserted into the joint. Saline irrigation is used during arthroscopic evaluation. The wound is closed by a bandage, without need for suture. Video images obtained during arthroscopy were reviewed by three orthopaedic surgeons. The images were scored based on the classification from three categories: 3 points, useful; 2 points, somewhat useful; 1 point, useless. The average point was used for the final evaluation. The patients assessed pain with a visual analog scale (100 mm long from no pain [0] to unbearable pain [100]). Twenty patients were reviewed on this cliteria. Video images were evaluated as 3 points for fifteen patients, as 2.7 points for three and 2.3 points for two patients. Mean pain score was 13.4 mm. Downsizing the scope allows the procedure to be done simply as insertion and removal without incision or suture, reducing risk of infection. This technique makes diagnostic arthroscopy feasible in the office of clinic without using the operating room and increases the likelihood of direct observation of the joint whenever the surgeon or patient feels it necessary. Thus, this method is especially useful for second-look diagnosis of cartilage in settings such as post-cartilage repair.