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arthroscopy evolves Over Time to Provide better Patient Outcomes by patrick t. hergenroeder, mD A RTHROSCOPIC SURGERY BEGAN in the late 1970s as a diagnostic tool. MRIs and other diagnostic equipment used today did not yet exist to help plan patient care. Incorrect diagnosis frequently resulted when based solely on the physical examination patient's signs and symptoms. Today, the correlation of arthroscopy procedures and MRIs has enhanced our physical examinations, resulting in better diagnosis and patient care. Diagnostic arthroscopy evolved into arthroscopic surgery and the treatment of the damaged joint. The knee is a large joint, susceptible to injury. But since it is relatively flat, it is accessible and ideal for an arthroscopic surgical approach. This combination of diagnosis and surgical modality is used to treat torn cartilage by meniscectomy and meniscus repair. Through the treatment of ligament injuries, such as anterior and posterior cruciate ligaments and arthritis in the knee, surgeons are able to correct misalignment of the patella and eventually even treat fractures and areas of dead bone. Arthroscopy then shifted to the shoulder, but treatment was initially only for removal of torn tissue at the shoulder, called the labrum. Arthritis is relatively uncommon in this non-weight-bearing joint, but with diagnostic arthroscopy, greater insight was gained into the damage that occurs to the shoulder in throwing activities. Severity of damage is intensified with more force (throwing, weightlifting, overhead activities), and the challenge with competitive sports has been to prolong productive and lucrative careers despite the forces required of these activities. This has been accomplished by visualization of tissue injuries and treating these on a microscopic level before terminal, irreversible damage has occurred, thereby slowing the degenerative process. The relationship between bone spurs, which cause pressure on the rotator cuff, was discovered, which led to their removal and alteration of an entire disease process. Rotator cuff tearing is preventable. This information, when applied to the average patient, has led to reduction of pain and increased productivity throughout a longer lifespan. What a huge addition to medical knowledge. Now, we have developed the ability to repair torn rotator cuff tendons arthroscopically as an outpatient procedure with less pain, scarring, and expense and faster recovery. The one area that has seen a tremendous application of arthroscopic surgery has been treatment for torn rotator cuff. There are actually two processes that go hand in hand: impingement or pressure on the rotator cuff from external forces such as bone spurs or new bone formation and the subsequent tearing of the rotator cuff. Today, improved methods of fixation achieved through suture techniques and implants has led to reliability of cuff repair in excess of 90% when combined with the study and perfection of healing of t end on s , a nd t he ne c e s s a r y physician therapy critical to return of function. Certain limitations, however, still exist. The revascularization of the rotator cuff is a prolonged process, but with good fixation and strong suture techniques, we are able to move the shoulder earlier and achieve improved healing. Arthroscopy of the shoulder has a bright future that lies in earlier diagnosis and treatment of the degenerative process and tearing of the rotator cuff, or when there is minimal tearing, resulting in the best results for patients. Dr. Patrick Hergenroeder is board certified in orthopaedic surgery. He reportedly was the first orthopaedic surgeon in the United States to perform arthroscopic rotator cuff repair. This was in August 1983 at St. Vincent Charity Medical Center in Cleveland, OH, where he continues to practice today. ■ JULY-AUGUST 2013 ■ MDNEWS.COM ■ MD News Cleveland/Akron/Canton | 21