5 Key Advances in Arthroscopy

There's no doubt a surgeon's skill and technique play a crucial role in the performance of arthroscopic surgery. But what's also undeniable is the role technology plays in conducting arthroscopic procedures that let physicians examine, treat and even reconstruct joints in a minimally invasive manner. This often leaves patients with rapid recovery times — and outpatient facilities with the ability to do many cases. Perhaps more than any other form of surgery, arthroscopy requires you to stay up-to-date on the latest products and technologies that are shaping an ever-changing field. With that goal, here are 5 advances that have made arthroscopy more safe, effective and efficient in recent years.

1 High-def imaging
By now, surgical facility leaders are starting to see the many benefits of the quality afforded to them through 4K imaging. While standard high-definition no doubt offers quality imaging, there's a major difference when you make the leap to 4K. You can identify pathology, get specific measurements, treat conditions and perform arthroscopic surgery with greater clarity with the aid of 4K. With this technology, it's the subtle differences in neighboring anatomy that can have a major impact on the surgery you're performing. The better the image, the easier it is for me to see and treat a patient. If I don't have to discern where a cartilage defect begins or ends or where the anatomical landmark is for a ligament I'm reconstructing, I can operate much more efficiently — and expediently. The new arthroscopic imaging systems have been a great improvement in surgical visualization.

2 Knotless suture anchors
One of the more exciting things about arthroscopy today is that we're doing large surgeries in a minimally invasive manner. This is possible because of the advances in imaging systems, but also because of technological advances in the implants we're using to perform these surgeries.

One example of these advances is knotless suture anchors. Suture anchors are small, commonly polymer or metallic devices that are attached to sutures and inserted directly into the bone. They are commonly used for fixing tendons and ligaments to bone. When a surgeon has to manually tie knots to secure the anchors, it can slow down the overall surgery process and add operating room time if the knot is tied incorrectly. This can be an issue for busy hospitals or ASCs.

For example, consider a large arthroscopic rotator cuff repair. If you're using 4 suture anchors to create a solid repair, you're talking about several extra minutes per anchor — which can really add up when you're doing multiple cases in a day.

That's why many busy, high-volume facilities can benefit from knotless anchor technology. The latest knotless anchors perform similarly to knotted anchors, but can be placed more quickly and efficiently.

Another promising development is the advancements we've seen in bioabsorbable suture anchor implants. These non-metal materials, which eventually dissolve inside the patient, help surgeons because they don't obscure post-operative imaging in the same way metal implants do. Another benefit: Not having metal in the surgical field makes it easier to perform revision surgeries.

3 Advanced suture options
Suture options for repairing tissues are also improving and offering more choices for surgical scenarios. Some sutures change mechanical properties when exposed to fluid, which allows them to swell causing greater fixation contact and strength. Similarly, some sutures are changing from a simple round piece of material-like thread, to a broader (think broad tape) design, which lends itself to a bigger footprint and better force distribution when repairing tissues.

One of the elements I appreciate the most about these broader suture options is that they do not create the friction burns or skin damage to the surgeons' hands when tying the fine, thin, round suture types. Think about alcohol sterilizing your hands with multiple small paper cuts and you'll appreciate the broader suture design as well!

4 Streamlined scopes
When it comes to the devices that let physicians do these minimally invasive procedures, there's a lot to be excited about at this time.

Angle-guided instruments for arthroscopy, particularly in hip scopes, have made procedures more accessible. With this type of instrument, more (angles) truly is less (incisions). Because the flexible nature of the instruments lets a physician get more angles through a single incision, the total number of incisions on the patient can be reduced. In the example of hip arthroscopies, flexible, angle-guided instruments can turn a 4-to-5-incision surgery into a 2-to-3-incision procedure.

Meniscal repairs have also improved dramatically in recent years because of low-profile, all-inside arthroscopic repair devices. While meniscal repairs used to be performed through inside-out techniques — where large open incisions were made in the back of the knee so the sutures could be passed through the meniscus around a tear — we're now seeing more all-inside procedures because the meniscal tear devices are available in adjustable depths and varying angles to help reach different types of tears. These new devices do not require big open incisions, but still provide excellent reduction and fixation of the meniscus tear.

5 Pump flow systems
While there's nothing wrong with wanting to have the best imaging tools or the newest arthroscopy instruments and devices, it should never be done at the expense of your pump flow system. All too often, this is an area that gets overlooked. Pump flow is the workhorse of arthroscopy.

As opposed to first-generation pumps that relied solely on gravity to pump fluid into the joint, today's "smart" pumps are much more efficient at regulating flow and preventing excess fluid from getting into the surrounding tissues. The latest pumps have the ability to push and pull fluid into and out of the joint and automatically adjust the level to achieve an equilibrium. If you haven't updated your pump system recently, this is something that should be at the top of your priority list for consideration. After all, a proper arthroscopy pump system is a critical part for visualizing and performing arthroscopic procedures.