Dr. Raju Vaishya
Arthroscopic surgery of the joints have come a long way in India over the last 25 years. Growing interest in the learning the skills of arthroscopic surgery has attracted many young surgeons in this field. Until, recently there were only countable arthroscopic surgeons in India, but it is expected that in near future, there would be a tremendous increase in the trained manpower in this field.
Arthrosocpic surgery is a key hole surgery of the joint, which is now being done for variety of problems in almost all the major joints of the body, especially the knee, shoulder, hip, elbow & ankle. With this endoscopic procedure, there is minimal trauma to the tissues during surgery & it offers an excellent & full view of joint from inside. Thus, helping in accurate diagnosis of the problem & most of these problems can now be treated through the key holes using sophisticated & delicate arthroscopic instruments.
Arthroscopy has revolutionized the understanding & treatment of various joint injuries & diseases. Now, numerous new injury & disease pattern have been found & understood as the cause of problem to the patients. Until now, these problems were not recognized & hence not treated adequately. Other supportive investigations like MRI, CT scan etc have also helped in the diagnosis of joint disorders.
In knee & shoulder injuries, arthroscopy has become a gold standard in the diagnosis & treatment. The most common knee injuries, involve the meniscus (cartilage) & the ligaments (ACL/PCL etc). Not only one can remove the torn portion of the damaged meniscus with arthroscopy, but
It is now possible to even repair the damaged portion in selected cases. Cruciate ligament injuries (ACL & PCL) are very disabling & usually occur in young person involved in sports, when the knee is twisted abnormally. These injuries have almost limited or no capability of healing on its own & hence thos involved get repeated episodes of recurrent instability of their knee. This can be totally corrected by doing arthroscopic reconstruction of the ligament. In a recent study, at Indraporastha Apollo Hospitals by Dr Raju Vaishya & his team, on 110 Indian patients with ACL injuries, it was found that 9 out of 10 these patients have had associated generalized joint laxity & this predisposed them for ACL tears.
The damaged articular cartilage of the joint surface has no capability of healing & hence if damaged & untreated, lead to permanent damage & early onset of arthritis in that joint. Now, it is possible to grow the cartilage in a tissue culture lab in India also & later applied to the damaged area of the joint (Autologus Chondrocyte Transplantation). This leads to re growth of the normal cartilage & thus prevention of arthritis & need for future joint replacement surgery.
The most common problems related to shoulder joint are instability, rotator cuff tears, impingement & frozen shoulder. All these can now be addressed with day care arthroscopic surgery. Young people are more prone to have instability of the shoulder joint, leading to recurrent dislocations of their joint. Until now, no satisfactory treatment options were available. But arthrscopic stabilization of these shoulders have changed the scenario with outstanding 95% success rates. Elderly people, on the other hand have more rotator cuff tears, leading to persistent pain, weakness & inability to lift their shoulder above their heads. Arthroscopic repair of the rotator cuff can bring significant relief in pain & improvement in their function. Resistant cases of frozen shoulder, which do not respond to conventional treatments like physiotherapy etc can be treated effectively by arthroscopic surgery.
Other joints which are gaining recognition for arthroscopic surgery are hip, ankle & elbow joints.
Is renowned Orthopaedic Surgeon. He is President, Arthritis Care Foundation & Senior Consultant Orthopaedic & Joint Replacement Surgeon, Indraprastha Apollo Hospitals, New Delhi,He is President of Indian Cartilage Society, India.