[Arthroscopy of smaller joints: hand, elbow and ankle arthroscopy].

Ther Umsch

Chirurgische Poliklinik und Handchirurgie, Orthopädische Universitätsklinik, Kantonsspital Basel.

Published: July 1993

These joints are accessible, though technically demanding, by arthroscope. Above all, the evaluation of the lesions is not simple. Arthroscopy always represents the last diagnostical alternative. The extraction of loose fragments, the debridement, the shaving and the treatment of infections are excellent indications. Postoperative rehabilitation is favoured and shortened with the arthroscopic approach. Elbow arthroscopy did not greatly, develop during the last years. Posttraumatic situations, corpora libera and cartilage lesions represent the main indications. The arthroscopies of the ankle and the wrist, however, are increasing. Carpal instability and discus problems of the wrist are quite interesting. Lately, endoscopic carpal-tunnel decompression has been propagated, but is still in its experimental phase. At the ankle, osteochondrosis dissecans, flake fracture and fibrosed plica [discovered through arthroscopy, mostly in athletes] are suitable for arthroscopic removal or reconstruction. Interfering osteophytes at the anterior border of the tibia can also be removed arthroscopically. Percutaneous internal fixation and fusion of the ankle joint need first to be evaluated in a long-term follow-up. Arthroscopic debridement and rinsing against infections are quite successful for all the joints. The arthroscopy of a small joint is technically quite demanding; therefore, it should be practised only by a few specialized centres.

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