Arthroscopy and arthrography

Summary Arthrography and arthroscopy are invasive diagnostic procedures performed on all main joints of the human body. Both procedures are effective, with differing methods of visualizing intra-articular structures. Whereas the arthrogram reproduces a black-and-white, two-dimensional picture of a spatial structure (an indirect procedure), arthroscopy provides a colored picture facilitating a three-dimensional assessment of the joint cavity, palpation, and the arthroscopic operation. However, both procedures have their weaknesses. False-positive and false-negative results may occur in arthrographic techniques, whereas in arthroscopy, the inability to visualize particular joint regions resulting from the anatomical features of the joints is known. Arthroscopy and arthrography are complementary procedures in joint diagnosis. The present paper is based on experience gathered in 5188 arthroscopies of the six large human joints. Prior to all hand and hip arthroscopies, arthrographic examinations were performed. They provided essential information in 30% of all ankle-joint arthroscopies and in 10% of all knee arthroscopies, but in only a few elbow and shoulder arthroscopies.     

Hip Arthroscopy Update

The management of hip injuries in the athlete has evolved significantly in the past few years with theadvancement of arthroscopic techniques. The application of minimally invasive surgical techniques has facilitated relatively rapid returns to sporting activity in recreational and elite athletes alike. Recent advancements in both hip arthroscopy and magnetic resonance imaging have elucidated several sources of intraarticular pathology that result in chronic and disabling hip symptoms. Many of these conditions were previously unrecognized and thus, left untreated. Current indications for hip arthroscopy include management of labral tears, osteoplasty for femoroacetabular impingement, thermal capsulorrhaphy and capsular plication for subtle rotational instability and capsular laxity, lateral impact injury and chondral lesions, osteochondritis dissecans, ligamentum teres injuries, internal and external snapping hip, removal of loose bodies, synovial biopsy, subtotal synovectomy, synovial chondromatosis, infection, and certain cases of mild to moderate osteoarthritis with associated mechanical symptoms. In addition, patients with long-standing, unresolved hip joint pain and positive physical findings may benefit from arthroscopic evaluation. Patients with reproducible symptoms and physical findings that reveal limited functioning, and who have failed an adequate trial of conservative treatment will have the greatest likelihood of success after surgical intervention. Strict attention to thorough diagnostic examination, detailed imaging, and adherence to safe and reproducible surgical techniques, as described in this review, are essential for the success of this procedure.