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Diagnostic Needle Arthroscopy and Partial Medial Meniscectomy Using Small Bore Needle Arthroscopy.

ABSTRACT: As resolution and image quality improve, several potential advantages make needle arthroscopy (NA) appealing for broader therapeutic applications in the operating room. The smaller camera size and weight allow for a minimally invasive approach with smaller incisions than standard arthroscopy and decreased arthroscopic fluid use. Differences in the technology, such as a 0-degree optic and less rigid instrumentation necessitate a novel technique to accommodate thorough diagnostic arthroscopy as well as new approaches to therapeutic procedures. This manuscript introduces our preferred approach to diagnostic arthroscopy and partial medial meniscectomy with NA and small-bore instruments. The minimally invasive nature of this technology may decrease postoperative pain and improve return of comfort and function.

SUBMITTER: Quinn R

PROVIDER: S-EPMC7253772 | biostudies-literature | 2020 May

REPOSITORIES: biostudies-literature

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Diagnostic Needle Arthroscopy and Partial Medial Meniscectomy Using Small Bore Needle Arthroscopy.

Quinn Ryan R Lang Sarah D SD Gilmer Brian B BB

Arthroscopy techniques 20200425 5

As resolution and image quality improve, several potential advantages make needle arthroscopy (NA) appealing for broader therapeutic applications in the operating room. The smaller camera size and weight allow for a minimally invasive approach with smaller incisions than standard arthroscopy and decreased arthroscopic fluid use. Differences in the technology, such as a 0-degree optic and less rigid instrumentation necessitate a novel technique to accommodate thorough diagnostic arthroscopy as we ...[more]

PMID: 32489839

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Project description:Diagnostic needle arthroscopy performed in office is a safe and cost-effective method for accurate evaluation of intra-articular pathology, improving clinical decision making. This minimally invasive approach is an effective alternative to traditional diagnostic techniques of diagnostic surgical arthroscopy and magnetic resonance imaging (MRI). Needle arthroscopy is considered low-risk, with an extremely low complication rate when performed with appropriate technique and indications. The purpose of this article is to describe an approach to an in-office diagnostic procedure using a needle arthroscopy system. Technique Video Video 1 Standard arthroscopic approach to the left knee via anterolateral and anteromedial portals. Place the patient in a supine or sitting position, with the left knee at ∼90°, and sterilely prep the left knee. Anesthetize the anterolateral and anteromedial standard portal sites with ∼15 cc of local anesthetic (1% lidocaine with epinephrine and 0.5% Marcaine without epinephrine) on a 25-gauge needle, creating a wheel. Next, insufflate the joint via the anterolateral portal using 20 cc of .25% Marcaine without epinephrine on a 20-gauge needle. After an additional re-prep of the knee with chlorohexidine, wait about 5 minutes, and then place sterile blue drapes at the proximal tibia and distal femur to create a sterile field. Introduce the 2.2-mm inflow NanoScope™ (Arthrex) sheath with the sharp trocar into the anterolateral portal, which is the primary viewing portal, and withdraw the trocar, and then attach the one-way stop valve to the sheath. Insert the 1.9-mm NanoScope™ (Arthrex) needle arthroscopy system, which is approximately one-third of the size of a standard arthroscopy camera. Connect a 30-cc syringe of sterile 0.9% normal saline to the NanoScope™ (Arthrex) via the one-way stop valve, open the valve, and use all 30 cc to insufflate the joint. This is followed by connecting another 30 cc of sterile saline to the one-way stop valve to inject as needed, while performing a standard diagnostic left knee arthroscopy to identify and assess any intraarticular pathology. In this particular patient, a medial femoral condyle defect is identified. If needed, a 2.0-mm NanoProbe (Arthrex) or other NanoSope™ (Arthrex) instrumentation can be used for both diagnostic and therapeutic treatment. This is inserted into the anteromedial portal, which is the accessory portal. If possible, have an assistant available to provide valgus stress or assist in patient knee positioning, as the arthroscopy is being performed. At the conclusion of the standard diagnostic needle arthroscopy, aspirate as much fluid off the knee as possible through the NanoSope™ (Arthrex), while it remains inserted in the anterolateral portal. Remove the scope and resolve any bleeding by applying pressure with sterile gauze. Apply Steri-Strips to the percutaneous portal sites, followed by gauze and an ACE wrap. The patient may ambulate immediately afterward. Post-procedure antibiotics may be considered

Project description:BackgroundHundreds of thousands of surgical arthroscopy procedures are performed annually in the United States (US) based on MRI findings. There are situations where these MRI findings are equivocal or indeterminate and because of this clinicians commonly perform the arthroscopy in order not to miss pathology. Recently, a less invasive needle arthroscopy system has been introduced that is commonly performed in the physician office setting and that may help improve the accuracy of diagnostic findings. This in turn may prevent unnecessary follow-on arthroscopy procedures from being performed.ObjectiveThe purpose of this analysis is to determine whether the in-office diagnostic needle arthroscopy system can provide cost savings by reducing unnecessary follow on arthroscopy procedures.MethodsData obtained from a recent trial and from a systematic review were used in comparing the accuracy of MRI and VisionScope needle arthroscopy (VSI) with standard arthroscopy (gold standard). The resultant false positive and false negative findings were then used to evaluate the costs of follow-on procedures. These differences were then modeled for the US patient population diagnosed and treated for meniscal knee pathology (most common disorder) to determine if a technology such as VSI could save the US healthcare system money. Data on surgical arthroscopy procedures in the US for meniscal knee pathology were used (calendar year [CY] 2010). The costs of performing diagnostic and surgical arthroscopy procedures (using CY 2013 Medicare reimbursement amounts), costs associated with false negative findings, and the costs for treating associated complications arising from diagnostic and therapeutic arthroscopy procedures were assessed.ResultsIn patients presenting with medial meniscal pathology (International Classification of Diseases, 9th edition, Clinical Modification [ICD9CM] diagnosis 836.0), VSI in place of MRI (standard of care) resulted in a net cost savings to the US system of US$115-US$177 million (CY 2013) (use of systematic review and study data, respectively). In patients presenting with lateral meniscus pathology (ICD9CM 836.1), VSI in place of MRI cost the healthcare system an additional US$14-US$97 million (CY 2013). Overall aggregate savings for meniscal (lateral plus medial) pathology were identified in representative care models along with more appropriate care as fewer patients were exposed to higher risk surgical procedures.ConclusionsSince in-office arthroscopy is significantly more accurate, patients can be treated more appropriately and the US healthcare system can save money, most especially in medial meniscal pathology.

Dataset Information

Diagnostic Needle Arthroscopy and Partial Medial Meniscectomy Using Small Bore Needle Arthroscopy.

Publications

Diagnostic Needle Arthroscopy and Partial Medial Meniscectomy Using Small Bore Needle Arthroscopy.

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