Sports medicine and orthopedic surgery have undergone dramatic changes over the last couple of decades. While the most fundamental changes in the surgeries themselves took place with the introduction of the arthroscope, the subsequent tools, devices and implants let us perform procedures through 2 or 3 very small incisions rather than the 6-inch scars we often see on patients with injuries treated in the 1970s and 1980s.

The arthroscope let surgeons see structures within the knee, shoulder, elbow, ankle and other joints that used to require extensive exposure, if they could be visualized at all. For example, surgeries for recurrent shoulder dislocations were previously done almost exclusively through open incisions. While results were often good at repairing the labrum and restoring stability, surgeons had no ability to see tears in the superior or posterior labrum or other structures in the shoulder other than what could be seen anteriorly, despite 4-inch incisions.

In addition, for a number of surgeries, arthroscopic techniques have significantly shortened rehabilitation times, meaning that patients regained range of motion, strength and function of their joints faster than with the standard open techniques. As the appeal of arthroscopic procedures increased, attention to the technical difficulty became essential. The number of orthopedic surgeons specializing in sports medicine and arthroscopic surgery seemed to rise along with this surgical shift. In fact, many of us who trained in the last decade believe that we can perform many of the surgeries through the arthroscope better than we can do them through open incisions. Here's a rundown of 5 devices and techniques that I would argue have changed our approach to surgical problems.

1. High-definition arthroscopy systems
While it's not the game changer that the arthroscope itself was, high-definition systems give surgeons much clearer views of the joints. They often have wider fields of view and other tools to enhance the images that surgeons see. The cost of these systems often hindered their entry into arthroscopic surgery, but they have gradually replaced the older camera systems.

2. Digital image and video capture
While not changing the procedures themselves, equipment to record still images and video segments of the surgeries have made medical records much more complete. Patients can still receive paper copies of the arthroscopy pictures, and surgeons can keep discs of the images to put into electronic medical records permanently or use for talks and other materials.

3. Meniscal repair devices
While "inside-out" meniscal repair is still thought to be the gold standard for meniscal repair in terms of healing rates, it requires incisions outside the knee and involves much longer surgery times. Plus, in-ligament reconstructions and other procedures, adding 45 to 60 minutes for that technique, aren't always feasible. Devices such as the FasT-Fix have revolutionized meniscal repair techniques. Unlike conventional suture-based repair systems, FasT-Fix is an implant system with a pre-tied, self-sliding knot that eliminates the need for intra-articular knot tying. It provides a strong, reproducible and reliable meniscal repair with biomechanical properties equal to that of the open, vertical mattress stitch suture technique.

4. High-strength polyester suture
Arthroscopic device companies have developed sutures made of higher-strength materials that have enhanced the strength of repairs for many procedures. FiberWire from Arthrex, among others, is used in suture anchors and independently to help increase the strength of repair of soft tissue structures.

5. Speed Bridge and other rotator cuff repair systems
There's still a tremendous amount of research trying to improve our results with rotator cuff surgery. New implants and techniques, such as double-row fixation, suture configurations designed to both anchor the tendon to bone and compress the tendon to enhance healing, and anchors to obtain better purchase in older bone, offer promise that better results are attainable.