Needle Arthroscopy

What is Needle Arthroscopy?

Needle arthroscopy is a newer, minimally invasive procedure for diagnosing and treating orthopedic and joint conditions. It is a diagnostic tool used as an alternative to magnetic resonance imaging (MRI) and traditional arthroscopy. The needle arthroscope is a tiny device consisting of a special needle, a tiny camera fitted inside the needle, a light source, and is connected to an external monitor such as a tablet. This hand-held arthroscope, also known as a nanoscope, enables your surgeon to perform several common orthopedic procedures without the need for general anesthesia or even a scalpel.

Similar to an arthroscope that is employed during arthroscopic surgeries, needle arthroscopy is used to access a joint area in the body for evaluation and the tiny camera attached to the needle conveys real-time images of the area under evaluation to a digital monitor, but without an incision. The needle scope can be inserted into the joint while the patient is aware and awake, creating live images of the joint area on a digital monitor within minutes. Needle arthroscopy can be used in a variety of joints, including the hip, shoulder, knee, elbow, and ankle.

Over the past several decades, MRI has been the gold standard for detecting intra-articular soft tissue pathology of the joint. However, advanced imaging, such as MRI, can sometimes provide inconclusive results, leaving both providers and patients with a diagnostic challenge. In-office needle arthroscopy is a novel, low-risk, diagnostic procedure that enables your doctor to utilize a small-bore needle arthroscope to see the intra-articular joint anatomy. The provider and patient are provided with immediate results of the joint pathology that is of similar or greater diagnostic accuracy compared to MRI and also rules out the need to wait for MRI results, which is normally the case with an MRI.

Indications for Needle Arthroscopy

Needle arthroscopy is indicated to diagnose and treat various intra-articular joint pathologies, such as:

• Meniscal tears
• Labral tears
• Loose bodies
• Tendonitis
• Bursitis
• Anterior cruciate ligament (ACL) tears
• Rotator cuff tears
• Femoral acetabular impingement (FAI)
• Degenerative joint disease
• Cartilage problems in the joints

Needle arthroscopy is also indicated as an alternative to MRI for patients who:

• Are claustrophobic
• Are morbidly obese
• Have implanted medical devices
• Have had a previous operation on the affected joint
• Are renally impaired
• Have metal in their bodies

Preparation for Needle Arthroscopy

Needle arthroscopy only requires a small nick on the skin for needle insertion, hence it does not involve any extensive pre-procedure preparations. In general, the procedure may involve:

• A review of your medical history and a physical examination
• Informing your doctor about medications or supplements you are taking
• Informing your doctor about allergies to any medications, anesthesia, or latex
• Refraining from taking blood-thinners, anti-inflammatories, aspirin, or other supplements for a week or two
• Arranging for someone to drive you home after the procedure

Procedure for Needle Arthroscopy

Needle arthroscopy is most commonly utilized to evaluate the knee joint. This minimally invasive procedure is performed under local anesthesia in an in-office setting. The procedure usually takes about 20 minutes to perform and involves the following steps:

• The area around the knee is thoroughly cleaned with an antiseptic solution.
• Once the area has been sterilized, local anesthesia is administered.
• Your surgeon will then insert the needle arthroscope into the knee with extreme care. The scope can be inserted into many different locations in the knee joint depending upon the region of suspected damage. The most common site in which the needle is inserted is just outside or inside the patellar tendon, below the level of the patella (kneecap).
• While the scope is being inserted, you may feel slight pressure, but it should not cause any pain.
• The needle arthroscope, which is equipped with a light source and tiny camera enables your surgeon to view the inside of the joint through a tablet that is connected to the device.
• The joint is intermittently irrigated with sterile saline solution for better visualization of the inside of the joint. This fluid is suctioned out once the procedure is completed.
• The needle arthroscope is then withdrawn and a small bandage is placed on the joint.

Postoperative Care and Recovery

Following the procedure, you will be kept under observation for a few hours before being discharged home. Your surgeon may apply a larger compressive bandage over the treatment area to help avert swelling into the joint. You should be able to fully weight-bear after a couple of hours of resting. However, if not, crutches may be recommended for a short duration to enable settling down of the joint and facilitate walking. You may notice pain, swelling or discomfort in the treatment area following the procedure. Over-the-counter medications are provided to manage these symptoms. You should be able to return to your normal activities and resume work either the same day or the following day of the procedure.

Benefits of Needle Arthroscopy

Some of the benefits of needle arthroscopy include:

• Minimal pain
• Quicker recovery
• No incisions or suture
• No need for general anesthesia
• More cost-effective than an MRI or traditional arthroscopy
• Quicker results in an office setting
• More accurate than other procedures
• A useful device to assess degenerative arthritis and cartilage damage
• Effective for image-guided injections
• Can be used on patients contraindicated with MRI
• Better images of the joint area than an MRI can provide
• Enables participation of the patient in decision making

Risks and Complications

Needle arthroscopy is a simple in-office procedure with minimal risks and complications. These may include:

• Infection
• Bleeding
• Pain
• Damage to nerves or tissue
• Septic arthritis