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Arthroscopy

Hand & wrist arthroscopy: indications for diagnosis/treatment of TFCC tears, ligament injuries, synovitis, and dorsal wrist pain.

106 citationsUpdated Oct 2026

Overview

Arthroscopy provides adequate joint visualization with minimal damage to skin and surrounding soft tissues, thereby minimizing morbidity [2]. The procedure offers benefits including diagnostic accuracy, definitive operative treatment with minimal tissue damage, shorter rehabilitation times, fewer complications, and greater economy [16]. While needle arthroscopy is considered low-risk with an extremely low complication rate when performed with appropriate technique and indications [1], it offers potential for improved patient satisfaction, expedited care, and cost-effectiveness [33]. However, further research is necessary to quantify risks, determine cost implications, and identify best-suited patients and indications for needle arthroscopy [33].

The expansion of arthroscopy has led to abuses driven by financial motives and a lack of ethical standards [35]. There is a general lack of evidence-based assessment of the efficacy and cost-effectiveness of arthroscopic procedures [5]. Shoulder arthroscopy literature remains controversial, with conclusions often unsupported due to bias and limitations [4], and no clinical guidelines for shoulder arthroscopy are definitive pending higher levels of evidence [4]. Indications for small joint arthroscopy in the hand remain poorly understood due to a paucity of papers and inadequate hands-on training [3].

Despite these challenges, specific applications show promise. Basal joint arthroscopy appears to be the seat of advances in arthroscopic procedures with clinical results at least as effective as classical open surgery, though it still requires long-term evaluation [15]. DRUJ arthroscopy should be used selectively and need not be a part of every arthroscopic wrist evaluation [19]. Subtalar arthroscopy yields effective outcomes at long-term follow-up concerning patient-reported outcome measures in athletic populations, with favorable return to sport level, return to sport time, clinical outcomes, and safety outcome measures [17]. Arthroscopic treatment of talus bipartitus can be a safe and effective option with excellent short- and long-term outcomes [37]. Arthroscopic and open approaches for dorsal ganglion cysts have comparable outcome profiles regarding recurrence and complications [38]. Arthroscopic excision is the treatment of choice for localized pigmented villonodular synovitis arising from the quadriceps tendon sheath and is currently thought to be curative [139]. The arthroscopic procedure gives better results than arthrotomy in cases of septic appearance arthritis of the wrist [140]. Elbow arthroscopy is not without complications and morbidity despite being a minimally invasive procedure and advances made in surgical technique [24]. In national arthroscopy registries, compliance with 2-year PROMs does not meet traditional follow-up thresholds of 60% or 80% [22], and reporting of missing-data methodologies in national arthroscopy registries is inconsistent [22]. Suggested guidelines for the practice of arthroscopic surgery emphasize the need for appropriate training, privileges, and performance review by the Arthroscopy Association of North America [7]. These guidelines cover privileges, training, practice standards, continuing education, and performance review to ensure patient safety and surgeon competence [12]. The purpose of fluid management in arthroscopy is to review fundamental concepts and techniques to safely improve arthroscopic visualization [6].

Anatomy & Pathophysiology

Bony Anatomy

The skeleton of the hand and wrist comprises 27 bones, 19 of which are long bones [47]. This skeletal structure is organized into five rays, each forming a polyarticulated chain of metacarpals and phalanges [47]. The base of each metacarpal articulates with the distal row of the carpus [47]. The radioulnocarpal articulation possesses two axes of movement, to which a third axis—pronation and supination from the forearm—is added [47]. These three axes permit the hand to assume any spatial configuration, facilitating placement for grasping [47]. The radial ray, or first ray, is the shortest and consists of only three bones: a metacarpal and two phalanges [47]. It continues the external column of the carpus formed by the scaphoid and trapezium [47]. The trapezium is angled outward in front of the carpal plane, creating an angle of approximately 45 degrees between the first and second metacarpals in the sagittal plane [47].

Regarding relative lengths, the thumb metacarpal is the shortest, while the index metacarpal is by far the longest [47]. The proximal and middle phalanges of the long and ring fingers are longer than those of the index finger [47]. Epiphyseal plate location varies by bone: they are situated at the proximal ends of the phalanges and the first metacarpal, but at the distal ends of the other metacarpals [47]. The hand contains 19 bones, 17 articulations, and 19 muscles situated entirely within the hand, along with approximately the same number of tendons activated by forearm muscles [84].

Soft Tissue Anatomy

Extrinsic muscles originate outside the hand and insert on the hand or carpus, whereas intrinsic muscles have both origin and insertion within the hand [46]. The extrinsic extensors traverse six distinct fibroosseous retinacular compartments at the wrist level [46]. * First compartment: Contains the abductor pollicis longus and extensor pollicis brevis [46]. * Second compartment: Contains the extensor carpi radialis longus and extensor carpi radialis brevis [46]. * Third compartment: Contains the extensor pollicis longus, which runs longitudinally down the forearm and turns abruptly radialward about Lister tubercle [46]. * Fourth compartment: Contains the extensor indicis proprius, lying deep to the four tendons of the extensor digitorum communis [46]. * Fifth compartment: Contains the extensor digiti quinti [46]. * Sixth compartment: Contains the extensor carpi ulnaris tendon, which inserts at the base of the little finger metacarpal [46].

Digital extensor tendons are stabilized over the midline of the metacarpophalangeal joint by attachment to sagittal band fibers [46]. These fibers insert onto the volar proximal phalanx and the lateral borders of the volar plate [46]. They form a sling that transmits proximal extrinsic extensor tension to the proximal phalanx, allowing metacarpophalangeal joint extension without a direct tendinous insertion onto the proximal phalanx [46]. Rupture or attenuation of these fibers permits the extrinsic extensor tendon to sublux to the ulnar side of the metacarpal head, causing ulnar deviation of the finger [46].

The extrinsic finger flexors are the flexor digitorum profundus and flexor digitorum superficialis [46]. The flexor digitorum profundus inserts on the proximal volar aspect of the distal phalanx, flexing the distal interphalangeal joint as well as the proximal interphalangeal and metacarpophalangeal joints [46]. There are seven interosseous muscles: four dorsal and three volar [86]. The dorsal interossei act as abductors, while the volar interossei act as adductors [86]. The middle finger possesses two dorsal interossei (abductors) and no volar interossei (adductors) because the central axis of the hand lies within it [86]. Each dorsal interosseous muscle, with the exception of the third, has two muscle heads [86].

The superficial head of each dorsal interosseous muscle arises dorsally from the shaft of contiguous metacarpals and inserts deeply via a medial tendon onto the lateral tubercle of the base of the proximal phalanx [86]. The deep head forms a lateral tendon, or lateral band, at the level of the metacarpophalangeal joint [86]. This deep head flexes and weakly abducts the proximal phalanx while extending the middle and distal phalanges [86]. At the mid-proximal phalanx level, transverse fibers arch dorsally from each lateral band to join over the dorsum of the finger, flexing the proximal phalanx [86]. More distally, oblique (spiral) fibers from the lateral bands sweep over the distal third of the proximal phalanx to insert onto the lateral tubercles at the base of the middle phalanx, extending the middle phalanx at the proximal interphalangeal joint [86]. Further distally, the lateral bands are joined by lateral slips of the extensor tendon to form the conjoined lateral band [86]. The two conjoined lateral bands for each finger unite at the distal third of the middle phalanx to form the terminal tendon, which inserts at the base of the distal phalanx to extend it [86]. The flexor digiti quinti brevis is structurally and functionally similar to the deep head of the dorsal interossei, forming the ulnar lateral band of the little finger [86].

The three volar interossei arise from adjacent surfaces of contiguous metacarpal shafts [86]. Each volar interosseous muscle has a single head and none insert onto the proximal phalanx [86]. They form the ulnar lateral band of the index finger and the radial lateral band of the ring and little fingers [86]. The abductor digiti quinti and flexor digiti quinti brevis are similar in structure and function to the superficial and deep heads of the dorsal interossei, respectively, and arise from the fifth metacarpal [86]. The opponens digiti quinti lies deepest, arising from the pisohamate ligament and hook of the hamate, and inserts onto the ulnar side of the diaphysis of the fifth metacarpal, flexing and supinating it [86].

The flexor digitorum profundus originates from the proximal ulna and interosseous membrane [93]. In the forearm, it divides into a radial component supplying the index finger and an ulnar component supplying the middle, ring, and little fingers [93]. The flexor digitorum profundus and flexor pollicis longus form the deep compartment of the volar forearm [93]. As these tendons travel through the carpal tunnel, they occupy the floor of the tunnel [93]. The tenosynovial sheath of the flexor pollicis longus is continuous with the radial bursa, while the sheath for the little finger is continuous with the ulnar digital bursa [93]. In some patients, these bursae communicate, allowing a "horseshoe abscess" to spread between the thumb and little finger if infection occurs in the flexor tendon sheath of either digit [93]. The lumbricals originate from the radial side of the index, middle, ring, and little fingers in the palm [93]. The profundus tendon passes through the bifurcation of the flexor digitorum superficialis before inserting into the proximal palmar base of the distal phalanx [93]. Innervation of the flexor digitorum profundus for the index and middle fingers is via the anterior interosseous branch of the median nerve, while that for the ring and little fingers is via the ulnar nerve [93].

The flexor digitorum superficialis has two heads: a radial head from the proximal radius shaft and a humeral ulnar head from the medial humeral epicondyle and coronoid process of the ulna [93]. As the superficialis tendons pass through the carpal tunnel, those of the middle and ring fingers are more superficial and central than those of the index and little fingers [93]. In the proximal finger, the superficialis tendon bifurcates around the profundus at the beginning of the A2 pulley [93]. The tendon slips reunite distally at the Camper chiasm, with approximately half of the fibers staying ipsilateral and half crossing to the contralateral side [93]. The tendon then inserts via radial and ulnar slips into the proximal metaphysis of the middle phalanx [93]. The entire flexor digitorum superficialis muscle receives innervation from the median nerve [93]. Its primary function is digital flexion at the proximal interphalangeal joint [93].

The flexor pollicis longus originates from two heads: a radial head from the proximal radius and interosseous membrane, and an accessory head from the coronoid process of the ulna and medial epicondyle of the humerus [93]. In the palm, the tendon traverses between the abductor pollicis brevis and flexor pollicis brevis [93]. It inserts into the proximal base of the thumb distal phalanx and is innervated by the anterior interosseous branch of the median nerve [93]. The flexor pollicis longus flexes both the interphalangeal and metacarpophalangeal joints of the thumb [93].

Distal to the metacarpal neck, flexor tendons enter the fibroosseous tunnel, or digital flexor sheath, which extends to the proximal aspect of the distal phalanx [93]. The tendinous sheath consists of annular pulleys providing mechanical stability and cruciate pulleys providing flexibility [93]. * A1, A3, and A5 pulleys: Located over the metacarpophalangeal, proximal interphalangeal, and distal interphalangeal joints, respectively [93]. * A2 and A4 pulleys: Situated over the middle portion of the proximal and middle phalanges [93].

The A2 and A4 pulleys are the most essential for maintaining the mechanical advantage of the flexor tendons [93]. The tenosynovium lining the fibroosseous tunnel supplies nutrition and lubrication to the poorly vascularized flexor tendons [93]. Proximal to the sheath, tendons are well vascularized by the peritenon [93]. Within the sheath, vascularity is supplied via the vincula system: the vinculum longus and brevis [93].

The superficial palmar fascia lies in a coronal plane beneath the palmar subcutaneous tissue [96]. It covers a triangular area of the central palm, with the proximal corner facing directly proximal [96]. The palmaris longus tendon, when present, terminates in continuity with the fibers of this proximal corner [96]. From this common point, four central bands of fascia extend distally toward each finger; there is no central band for the thumb [96]. Confluent proximally, these bands separate and diverge just distal to the transverse retinacular ligament, each following the underlying ray [96]. At the distal palmar crease level, the central bands are bridged transversely by the superficial transverse palmar ligament [96]. Although this ligament appears deep to the central bands, fibers from the central bands pass above, below, and through it [96]. At this level, each central band branches in three directions: * Superficial fibers: Stay superficial and merge with vertical retinacular fibers at the dermis’s undersurface in areas between skin flexion creases [96]. * Intermediate fibers: Split transversely into two sections extending toward the lateral border of the digit base; these form the spiral band that tracks around the neurovascular bundle [96]. Proximally, the spiral band is central and superficial to the bundle; distally, it is lateral and deep beneath it [96]. Spiral neurovascular bundles develop when spiral bands shorten [96]. * Deep fibers: Continue dorsally to merge with sagittal interosseous fascia fibers and pierce the transverse deep intermetacarpal ligament to merge with fibers of the sagittal bands of the extensor mechanism [96].

Digital neurovascular structures are surrounded by a diffuse network of thin transverse oblique fibers [96]. Fibers dorsal to the neurovascular bundle are collectively called Cleland ligament, and those palmar to the bundle are called Grayson ligament [96]. Undisturbed, these "ligaments" are a mesh of nonparallel individual fibers; the appearance of a distinct ligament is a dissection artifact from releasing skin attachments [96]. These fibers have a common origin in continuity with the fingers’ retinacular ligaments, the floor of the flexor tendon sheath, and retinacular fibers attaching the palmar digital skin to deeper structures [96]. On the small finger’s ulnar border, lateral fascial attachments are in continuity with the abductor digiti minimi fascia and tendon [96]. A subdermal fascial layer borders the periphery of the web spaces from roughly the radial thumb sesamoid to the ulnar side of the small finger’s proximal flexion crease [96]. These border fibers form the distal first web space ligament between thumb and index in continuity with the natatory ligament spanning the remaining web spaces [96]. Fibers from the natatory ligament extend distally at each finger’s lateral base in continuity with Grayson ligament fibers and the lateral digit dermis [96].

Vascular Anatomy

The arteries of the thumb vary in size and number, making surgical reconstruction delicate [90]. Common variations of palmar arteries are schematized by dividing the thumb into three segments defined by the metacarpophalangeal and interphalangeal flexion creases [90]. In the classical layout, the "princeps pollicis" artery, a terminal branch of the radial artery, crosses the first intermetacarpal space and runs along the ulnar side of the first metacarpal bone and the volar surface of the adductor muscle [90]. It emerges onto the subcutaneous palmar tissue at the level of the cutaneous flexion crease of the metacarpophalangeal joint [90]. Here, it divides into two terminal rami, the collateral palmar arteries of the thumb, which run symmetrically along the digital tunnel with equal caliber [90]. These arteries head distally to unite in the pulp arcade [90]. During transit in the digital tunnel, they branch into numerous cutaneous, articular, or osseous collaterals [90]. An arcade located deep in the flexor tendon joins the two arteries at the level of the distal metaphysis of the first phalanx [90]. From this arcade and a similar, narrower, and inconstant arcade at the distal tendon insertion, vessels originate to enter the "vincula" and irrigate the flexor tendon [90]. Anatomical studies indicate that only 15% of dissections fall into the classical category of palmar artery layout [90].

In the first segment (between the opposition crease and the metacarpophalangeal flexion crease), arteries of surgical interest are rarely found on the volar surface of the thumb [90]. The artery of this segment is located deeply and is more easily accessible from the dorsal surface [90]. In the second segment, the two arteries run alongside the flexor tendon and behind the collateral nerves [90]. The main artery in this segment is the ulnar collateral artery [90].

Classification

Copeland-Levy: This classification is suggested to standardize terminology for subacromial impingement lesions [120].

Gächter: The Gächter classification is the most frequently used system with clinical relevance for evaluating joint infection. It assesses infection according to pathological, anatomical, clinical, or arthroscopic aspects [150].

Palmar: Palmar classified triangular fibrocartilage complex (TFCC) tears into two classes: Type I denotes traumatic tears, while Type II lesions are degenerative in origin [52]. Type I injuries are further subdivided into four types [52]. Except for the type 1A tear, which implies a central articular disk perforation with a stable margin, the other three types of Type I TFCC tears are considered peripheral tears [52]. The Estrella and Ho dorsal type of TFCC tear is located at the junction of the dorsal radioulnar ligament and the joint capsule just radial to the extensor carpi ulnaris (ECU) tendon subsheath [52]. Type 1B TFCC tear broadly includes all injuries of the TFCC at the ulnar attachment, with or without an accompanied ulnar styloid fracture [52].

Other Considerations: Arthroscopy allows for a true assessment of the joint status in thumb carpometacarpal arthritis, which is not accurately represented by simple radiographic means [80]. The arthroscope also allows appropriate staging of the extent of cartilage degeneration to determine therapeutic options in trapeziometacarpal arthroscopy [21]. The International Cartilage Repair Society (ICRS) and Oswestry macroscopic cartilage evaluation scores are validated for use in Autologous Chondrocyte Implantation (ACI) and microfracture [160]. The classification and treatment of acute articular cartilage lesions was described by Dzioba in 1988 [160]. Evaluation of cartilage injuries and repair was described by Brittberg and Winalski in 2003 [160]. Arthroscopic assessment of cartilage repair using 2 scoring systems was validated by Smith et al. in 2005 [160].

Clinical Presentation

The diagnosis of shoulder pain in patients presenting to the clinic often relies on magnetic resonance imaging (MRI) in addition to the surgeon’s physical examination findings [48]. However, MRI is not consistently accurate in diagnosing articular side rotator cuff pathology, cartilage lesions and integrity, and lesions of the labrum [48]. There are a paucity of alternatives that can be performed in-office with a similar accuracy and specificity as MRI, particularly in the case of cartilage, labral, and partial rotator cuff tear pathology [48]. Consequently, shoulder arthroscopy represents the gold standard to evaluate and ultimately treat a patient’s shoulder pathology after nonresponse to nonoperative management strategies [48].

Needle Arthroscopy

Needle arthroscopy involves a device with a 14-gauge needle attached to a high-definition camera with a direct (zero degrees) line of sight [48]. This instrument allows macroscopic examination of the joints and performing biopsy under visual control [27]. It can help in comparing the results of the physical examination and intra-articular changes [27], and aids in the differential diagnosis of acute arthritis [27]. The needle arthroscope can monitor the early signs of rheumatoid arthritis, predict the seriousness of the course, and monitor the disease itself [27]. It provides micro- and macroscopic information for diagnosis [27]. While the condition of joint structures can be established, the severity of the changes in the cartilage and the synovium is underestimated compared to a standard arthroscope [27].

In the knee, needle arthroscopy has been shown to be more accurate for the diagnosis of cartilage and meniscal pathology [48]. Needle-based diagnostic imaging that can be used in the office setting is statistically equivalent to surgical diagnostic arthroscopy with regard to the diagnosis of intra-articular, nonligamentous knee joint pathology [56]. In 48 of 60 knees subsequently operated on, arthroscopic findings were confirmed at operation, with six false negative and six false positive findings in the remaining cases [32].

Diagnostic Utility in Other Joints

Diagnostic arthroscopy is a useful diagnostic tool in patients with suspicion but no clear evidence of periprosthetic shoulder infection [10]. In patients with suspected scapholunate tears, midcarpal arthroscopy often leads to a change in diagnosis and procedure performed [55]. The arthroscope allows appropriate staging of the extent of cartilage degeneration to determine therapeutic options in trapeziometacarpal joints [21]. Arthroscopy provides direct visualization and accurate restoration of articular congruity in the treatment of trapezium fractures [18]. Arthroscopy of small joints is a precious tool for the diagnosis and treatment of osteochondral lesions [54]. MCP joint arthroscopy allows clear visualization of intraarticular disorders with minimal soft tissue trauma [60]. Wrist arthroscopy serves as a crucial tool for diagnosing intra-articular pathology [107], although it is not the universal solution in the diagnosis or treatment of any wrist problem [68].

Investigations

MRI: Magnetic resonance imaging (MRI) serves as a primary diagnostic modality, though its accuracy varies by joint and pathology. In the shoulder, needle arthroscopy and MRI demonstrate comparable accuracy to surgical arthroscopy for diagnosing intra-articular pathologies [48]. However, the presence and severity of glenohumeral cartilage lesions may be underestimated on noncontrast MRI in patients with rotator cuff tendinopathy [142]. For shoulder pathology, the combination of high-field-strength MRI plus operative arthroscopy offers the most accurate diagnostic workup [63]. In the knee, a VisionScope Imaging System (VSI) exam provides a more detailed and accurate diagnostic assessment of intra-articular pathology compared to MRI [133].

Arthroscopy: Diagnostic arthroscopy remains a critical tool for direct visualization and diagnosis. In-office needle-based diagnostic imaging is statistically equivalent to surgical diagnostic arthroscopy for the diagnosis of intra-articular, nonligamentous knee joint pathology [56]. Practitioners should be very selective in using in-office arthroscopy [63]. In the shoulder, diagnostic arthroscopy is a useful tool in patients with suspicion but no clear evidence of periprosthetic shoulder infection [10]. For the wrist, midcarpal arthroscopy in patients with suspected scapholunate tears often leads to a change in diagnosis and the procedure performed [55]. Distal radioulnar joint (DRUJ) arthroscopy should be used selectively and need not be a part of every arthroscopic wrist evaluation [19]. In the hand, arthroscopy of finger joints provides more precise information regarding the status of intra-articular structures than alternative imaging modalities [39].

Other Considerations: Arthroscopy provides direct visualization and accurate restoration of articular congruity, yielding excellent results in the treatment of trapezium fractures [18]. Metacarpophalangeal joint (MCPJ) arthroscopy allows clear visualization of intraarticular disorders with minimal soft tissue trauma, providing satisfactory pain relief and good long-term functional outcomes [60]. Arthroscopy of small joints is a tool for the diagnosis and treatment of osteochondral lesions [54]. MP joint arthroscopy in certain cases is an alternative to open surgery and gives excellent results [28]. Synovial chondromatosis can be invasive, and even the best preoperative imaging may not demonstrate the degree of local tissue involvement [144].

Technical Considerations: Arthroscopic image quality is subject to specific technical variables. Seven disturbances were identified that serve as measures for arthroscopic image quality [71]. Arthroscopic images are subject to distortion that increases with greater lens reflecting angles and oblique viewing angles [176]. The 70° arthroscope demonstrates technical advantages over the 30° arthroscope, including a wider field of view and less image distortion at the periphery [155].

Evidence Quality: The shoulder arthroscopy literature remains controversial, with conclusions often unsupported due to bias and limitations, and no clinical guidelines are definitive pending higher levels of evidence [4]. The number of meta-analyses appearing in the journal Arthroscopy has increased over the past 2 decades [20]. Clinical advances in arthroscopy provide the impetus for in-depth anatomic studies, and the study of anatomy results in very rapid clinical translation compared to other research areas like biomaterials [173].

Treatment

Non-Operative

The provided evidence does not detail specific conservative management protocols such as weight loss, physical therapy, or NSAID regimens. However, arthroscopy is not the universal solution for the diagnosis or treatment of any wrist problem [68], and the majority of sports medicine and arthroscopy-related randomized controlled trials reporting nonsignificant results are statistically fragile [67].

Operative

Indications: Arthroscopy provides direct visualization and accurate restoration of articular congruity for trapezium fractures, yielding excellent results [18]. It allows for a true assessment of joint status in thumb carpometacarpal arthritis, which is more accurate than simple radiographic staging [80]. Osteoarthritis is likely to remain the most common indication for basal joint arthroscopy, while chronic pain and inflammation are useful indications for metacarpophalangeal arthroscopy [113]. Distal radioulnar joint arthroscopy should be used selectively and need not be a part of every arthroscopic wrist evaluation [19]. Patients treated with additional arthroscopy to remove hematoma and debris for intra-articular distal radius fractures do not have better functional outcomes compared with the nonarthroscopically treated group [130]. Debridement of complete tears in scapholunate instability is less beneficial, with complete resolution or mild symptoms in 67% of patients followed for short-term [73].

Surgical Approach / Technique: Basal joint arthroscopy appears to be the seat of advances in arthroscopic procedures with clinical results at least as effective as classical open surgery, but this technique still requires long-term evaluation [15]. Metacarpophalangeal joint arthroscopy in certain cases is an alternative to open surgery and gives excellent results [28]. Arthroscopic abrasion arthroplasty is not superior to ligament reconstruction and tendon interposition for thumb carpometacarpal arthritis, with poor results in the arthroscopy group potentially secondary to inherent joint instability and lack of interposition material [40]. Arthroscopic interposition of material for thumb basal joint arthritis contributes to health care costs without clear benefit to the patient, suggesting routine use of expensive interposition products should be abandoned or carefully evaluated with a prospective randomized controlled trial [167]. The arthroscopic approach for capitellum osteochondritis dissecans is a valuable tool if the surgeon aims to reduce the invasiveness of the procedure, despite being more demanding [99]. Elbow arthroscopy has become a safe and effective treatment for elbow pathology due to improved instrumentation, advanced surgical technique, and better understanding of anatomy [101]. Elbow arthroscopy is a reliable procedure that requires a clear understanding of the anatomy to be able to safely access the joint [103]. Arthroscopic Hill-Sachs filling technique using an absorbable interference screw is safe, easily reproducible, does not require a long learning curve, and allows restoration of joint stability [44]. Arthroscopic treatment of pigmented villonodular synovitis of the proximal tibiofibular joint forms the basis of further development of arthroscopic procedures and reconstruction of adjacent capsulo-ligamentous structure [72]. Arthroscopic antero-superior ancillary portals for talar dome repair help avoid bony osteotomy and limit further articular problems [180]. Percutaneous lateral ulnar collateral ligament reconstruction provides isometry over the range of motion and sufficiently restores posterolateral rotatory stability comparable to the intact situation and open reconstruction in an in vitro setup [181]. Arthroscopy of the proximal interphalangeal joints of the finger suggests horizontal placement of the hand instead of using a traction tower to allow free flexion of the joint [53]. Recommended arthroscopic portals for the proximal interphalangeal joint are either between the central slip and the lateral bands of the extensor mechanism or between the lateral band and the collateral ligament [53]. A blunt technique of introduction is used for proximal interphalangeal joint arthroscopy to avoid iatrogenic cartilage damage and possible digital nerve injury [53]. Arthroscopy of the first carpometacarpal joint uses a 1.9-mm short barrel arthroscope with standard supportive electronic equipment [156]. Arthroscopic portals for the first carpometacarpal joint are located on the radial side of the abductor pollicis longus tendon (1-R portal) and the ulnar side of the extensor pollicis brevis tendon (1-U portal) [156]. Care must be exercised in establishing first carpometacarpal joint portals so that injury to the radial artery and branches of the superficial radial nerve can be avoided [156]. Arthroscopy of the first carpometacarpal joint has been developed as a reliable surgical procedure offering an opportunity for direct evaluation of the joint's intra-articular status with minimal morbidity to the joint capsule [156]. There was no increase in complications when total knee arthroplasty was performed more than six months after knee arthroscopy [81].

Needle Arthroscopy: The needle arthroscope entails less trauma for the patient, can be carried out under local anesthesia as a 1-day procedure, and complications are rare [27]. Needle arthroscopy offers potential for improved patient satisfaction, expedited care, and cost-effectiveness, but further research is necessary to quantify risks, determine cost implications, and identify best-suited patients and indications [33]. In-office needle arthroscopy uses a 0 scope, requiring the surgeon to become familiar with this technical difference compared with a standard scope [174]. Previous surgery may increase the difficulty of using small instruments through previous scars in in-office needle arthroscopy [174]. In-office needle arthroscopy may identify pathologies requiring the operating room setting, potentially leading to a second intervention for the patient [174]. The needle arthroscope allows macroscopic examination of joints and performing biopsy under visual control [27]. Comparing osteoarthritis patients with standard and needle arthroscopes, the needle arthroscope can establish the condition of joint structures but underestimates the severity of changes in cartilage and synovium [27].

Pain Management: Enhanced Recovery After Surgery pathways resulted in a notable reduction in prescribing of opioids postoperatively after both arthroplasty and arthroscopic surgeries [66]. A range of nonopioid strategies exist that can reduce postarthroscopic procedural opioid consumption with equivalent pain outcomes [138]. A comprehensive solution for opioid use after arthroscopy requires identifying the problem, considering multimodal anesthesia, avoiding overprescribing, acknowledging that minimizing opioid use is not equivalent to undertreating pain, minimizing preoperative opioid use, managing patient expectations, and continuing to investigate outcomes while limiting or forgoing opioids [177]. Perioperative intravenous dexamethasone may be a valuable adjuvant to a multimodal systemic pain regimen after hip arthroscopy [182]. Magnesium sulphate added to bupivacaine may significantly improve the analgesic efficacy for arthroscopy [185].

Other Considerations: The arthroscopist should perform an adequate history and physical examination as well as laboratory workup of the patient or determine that these have already been performed [49]. The arthroscopist should explain the procedure to the patient, including its benefits, possible risks and complications [49]. The arthroscopist should exercise due consideration in selecting the correct arthroscopic procedure for a particular condition and be prepared for additional or alternative procedures [49]. The arthroscopist should prepare an operative report of the procedure that includes the indications for the operation, a description of the operation itself and a systematic reporting of findings in each anatomic area [49]. The Foundations of Arthroscopy Techniques Collection was introduced to fill the gap for trainees and practitioners seeking essential fundamentals across multiple joints [14]. Arthroscopy and Arthroscopy Techniques are complementary journals, with the former publishing clinically relevant research and the latter focusing on surgical techniques [11]. The Arthroscopy Association of North America advocates for patient access and balanced interpretation of evidence-based medicine [79]. Shoulder arthroscopy literature remains controversial, with conclusions often unsupported due to bias and limitations, and no definitive clinical guidelines pending higher levels of evidence [4].

Complications

General and Diagnostic

In a series of 211 wrist arthroscopies, the overall complication rate was 5.2% [175]. Two major complications included permanent stiffness following arthroscopic synovectomy and the development of a symptomatic dorsal wrist ganglion over the 3-4 portal site requiring surgery [175]. Nine minor complications comprised transient superficial dorsal ulnar sensory neurapraxia, transient wrist and finger joint stiffness, ulnar neurapraxia, superficial portal site infection, first-degree burns to the forearm from contact with a hot arthroscopic tower, and extensor carpi ulnaris tendinitis [175]. All minor complications resolved at the latest follow-up evaluation with conservative care [175]. Conversely, a 29% complication rate was reported in patients undergoing arthroscopic TFCC repair, necessitating secondary procedures to address extensor digiti minimi tendon capture by the suture and sensory disturbances [175].

In other joint applications, no intraoperative or postoperative complications were encountered in a study of arthroscopic synovectomy of the metacarpophalangeal and proximal interphalangeal joints [159]. Similarly, endoscopic curettage for enchondromas in the hand without bone grafting resulted in no postoperative fractures, infections, recurrences, or other complications [230]. Authors of a study on all-inside suture anchor repair for meniscal root tears noted good results without complication [217]. The arthroscopic Hill-Sachs filling technique using an absorbable interference screw is considered safe, easily reproducible, free of a long learning curve, and effective for restoring joint stability [44]. Arthroscopic treatment for talus bipartitus offers safe and effective options with excellent short- and long-term outcomes [37], while hip arthroscopy for Legg-Calve-Perthes disease often yields successful outcomes with minimal morbidity [218].

Infection and Sepsis

Avoidance of magnetic resonance arthrogram (MRA) within 2 weeks of shoulder arthroscopy may mitigate postoperative infection risk [223]. Arthroscopy is as effective as arthrotomy in treating septic arthritis of the knee in adults, but demonstrates a lower reinfection rate and less frequent clinical signs of initial inflammatory reaction [225]. In a systematic review of acute septic arthritis of the native knee, no significant differences in relevant reported laboratory results (white blood cells, erythrocyte sedimentation rate, C-reactive protein) were observed between arthroscopic and open treatment groups [65]. The minimal soft tissue disruption inherent in endoscopic surgery theoretically decreases the risk of infection and wound complications [82]. One study suggests that patients with rheumatic diseases undergoing arthroscopy may remain on immunosuppression perioperatively without significant risk for infection [226].

Specific Joint and Procedure Complications

In a systematic review of revision rotator cuff repair, the overall complication rate was 12%, with the most frequent complications being repair failure (88%), shoulder stiffness (5%), and infection (4%) [193]. Poor results in the arthroscopy group for thumb carpometacarpal arthritis may be secondary to the inherent instability of the CMC joint and the lack of use of any biological or artificial interposition material [40]. Despite major primary complications and a high incidence of radiographic signs of degenerative changes after 8.8 years, mainly good clinical results were achieved with Judet's bipolar prosthesis for radial head arthroplasty [221]. The revision rate for the LPM ceramic coated proximal interphalangeal joint arthroplasty was higher than in published series for other PIP joint implants, recommending close surveillance of all patients with this prosthesis currently in situ [231].

Complications after open surgery for trigger finger are more severe, a factor that must be taken into account when advising patients regarding treatment [214]. Surgeons should inform patients of the likelihood of having minor complications following open trigger finger release [198]. Arthroscopic and open approaches have comparable outcome profiles regarding recurrence and complications for dorsal ganglion cysts [38]. Osteoarthritis was the most common indication for arthrodesis of distal interphalangeal and thumb interphalangeal joints, with postoperative complications occurring at a rate similar to that reported in existing literature [36]. In patients not requiring revision surgery following pyrocarbon proximal interphalangeal arthroplasty, pain relief was improved and motion maintained [42]. The procedure for osteochondral grafting of the metacarpophalangeal joint in rheumatoid arthritis resulted in stable, painless joints with acceptable outcomes despite some loss of motion [43].

Other Considerations

The editorial states that shoulder arthroscopy literature remains controversial, conclusions are often unsupported due to bias and limitations, and no clinical guidelines are definitive pending higher levels of evidence [4]. This Review reflects on both the success of arthroscopy and the general lack of evidence-based assessment of the efficacy and cost-effectiveness of arthroscopic procedures [5]. In national arthroscopy registries, compliance with 2-year PROMs does not meet traditional follow-up thresholds of 60% or 80%, and reporting of missing-data methodologies is inconsistent [22]. Systematic reviews and meta-analyses in orthopaedic sports medicine literature relied on evidence levels 4 and 5 in 53% of studies over the 5-year study period [201]. Only 70% of orthopedic systematic reviews and meta-analyses published in 6 high-quality orthopedic journals over a 10-year eligibility period had conclusive conclusions [202]. This large gap between published recommendations and current practices means that we should reconsider the relevance of current recommendations and re-evaluate the cost-benefit ratio of prescribing a drug-based thromboprophylaxis after arthroscopy surgery [106]. ERAS pathways resulted in a notable reduction in prescribing of opioids postoperatively after both arthroplasty and arthroscopic surgeries [66].

Recovery

Rehabilitation protocol: Arthroscopic surgery generally offers benefits including shorter rehabilitation times [16]. In the hand, success in zone II combined flexor digitorum superficialis and flexor digitorum profundus repair relies on controlled early rehabilitation to minimize rupture and stiffness [134]. For hip arthroscopy, changes to the rehabilitation protocol including hip circumduction have been shown to reduce adhesions [128].

Other Considerations: The endoscopic carpal tunnel release procedure provides the benefit of faster rehabilitation and return to work compared to open techniques [162]. Wrist arthroscopy is a reasonable early treatment option for athletes, offering the opportunity to return to their pre-injury level of participation and function sooner and more often than was possible in the past or after a period of immobilization [132]. Subtalar arthroscopy yields favorable return to sport time in athletic populations [17].

Key Evidence

• [L5] Needle arthroscopy is considered low-risk, with an extremely low complication rate when performed with appropriate technique and indications. [1] (10.1016/j.eats.2022.07.006)
• [L5] Arthroscopy allows adequate visualization of joints with the smallest amount of damage to the skin and surrounding soft tissues, minimizing morbidity. [2] (10.1016/0020-1383(90)90041-r)
• [L5] Indications for small joint arthroscopy in the hand remain poorly understood due to a paucity of papers and inadequate hands-on training. [3] (10.1016/j.main.2006.07.026)
• [L5] The editorial states that shoulder arthroscopy literature remains controversial, conclusions are often unsupported due to bias and limitations, and no clinical guidelines are definitive pending higher levels of evidence. [4] (10.1016/j.arthro.2012.07.001)
• [L4] This Review reflects on both the success of arthroscopy and the general lack of evidence-based assessment of the efficacy and cost-effectiveness of arthroscopic procedures. [5] (10.1038/nrrheum.2014.174)
• [L5] The purpose of this article is to review the fundamental concepts of fluid management in arthroscopy and the techniques to safely improve arthroscopic visualization. [6] (10.5435/jaaos-d-20-01057)
• [L5] This statement outlines suggested guidelines for the practice of arthroscopic surgery, emphasizing the need for appropriate training, privileges, and performance review by the Arthroscopy Association of North America. [7] (10.1016/s0749-8063(14)00453-8)
• [L3] Diagnostic arthroscopy is a useful diagnostic tool in patients with suspicion but no clear evidence of PPSI. [10] (10.1016/j.arthro.2019.03.058)
• [L5] The editors state that Arthroscopy and Arthroscopy Techniques are complementary, with the former publishing clinically relevant research and the latter focusing on surgical techniques. [11] (10.1016/j.arthro.2015.05.001)
• [L5] This statement outlines suggested guidelines for the practice of arthroscopic surgery, covering privileges, training, practice standards, continuing education, and performance review to ensure patient safety and surgeon competence. [12] (10.1016/s0749-8063(14)00850-0)
• [L5] The authors introduce the Foundations of Arthroscopy Techniques Collection to fill the gap for trainees and practitioners seeking essential fundamentals across multiple joints. [14] (10.1016/j.arthro.2024.09.002)
• [Paper] Basal joint arthroscopy appears to be the seat of advances in arthroscopic procedures with clinical results at least as effective as classical open surgery, but this technique still requires long-term evaluation. [15] (10.1016/j.hansur.2020.05.014)
• [L5] Arthroscopic surgery has had a significant impact on the whole spectrum of surgical treatment, offering benefits such as accuracy of diagnosis, definitive operative treatment with minimal tissue damage, shorter rehabilitation times, fewer complications, and greater economy. [16] (10.1016/j.arthro.2009.10.005)
• [L4] Subtalar arthroscopy yields effective outcomes at long-term follow-up concerning patient-reported outcome measures in athletic population, with favorable return to sport level, return to sport time, clinical outcomes and safety outcome measures. [17] (10.1007/s00167-020-06385-8)
• [L4] Arthroscopy provides direct visualization and accurate restoration of articular congruity, yielding excellent results. [18] (10.1016/j.arthro.2006.07.051)
• [L5] DRUJ arthroscopy should be used selectively and need not be a part of every arthroscopic wrist evaluation. [19] (10.1016/s0749-0712(21)00182-7)
• [L4] The number of meta-analyses appearing in Arthroscopy has increased over the past 2 decades. [20] (10.1016/j.arthro.2015.08.002)
• [L5] The arthroscope allows appropriate staging of the extent of cartilage degeneration to determine therapeutic options. [21] (10.1016/j.hcl.2006.02.006)
• [L4] In national arthroscopy registries, compliance with 2-year PROMs does not meet traditional follow-up thresholds of 60% or 80% and reporting of missing-data methodologies is inconsistent. [22] (10.1016/j.arthro.2020.08.007)
• [L3] Elbow arthroscopy is not without complications and morbidity despite being a minimally invasive procedure and advances made in surgical technique. [24] (10.1177/17585732241249393)
• [L4] [27] (10.1007/s00167-002-0329-4)
• [L5] MP joint arthroscopy in certain cases is an alternative to open surgery and gives excellent results. [28] (10.1016/0266-7681(94)90169-4)
• [L4] In 48 of 60 knees subsequently operated on, arthroscopic findings were confirmed at operation, with six false negative and six false positive findings in the remaining cases. [32] (10.2106/jbjs.l.00072)
• [Paper] Needle arthroscopy offers potential for improved patient satisfaction, expedited care, and cost-effectiveness, but further research is necessary to quantify risks, determine cost implications, and identify best-suited patients and indications. [33] (10.1097/corr.0000000000003105)
• [L5] The paper argues that while arthroscopy has grown rapidly and offers significant benefits through minimally invasive techniques, its expansion has led to abuses driven by financial motives and lack of ethical standards. [35] (10.2106/00004623-199274100-00019)
• [L3] Osteoarthritis was the most common indication for arthrodesis and postoperative complications occurred at a rate similar to that reported in the existing literature. [36] (10.1186/s12891-024-07361-w)
• [L4] Arthroscopic treatment can be a safe and effective option with excellent short- and long-term outcomes. [37] (10.1007/s00167-017-4613-8)
• [L2] Arthroscopic and open approaches have comparable outcome profiles regarding recurrence and complications. [38] (10.1177/1753193417734428)
• [L5] Arthroscopy of finger joints provides more precise information regarding the status of intra-articular structures than alternative imaging modalities. [39] (10.1016/j.hcl.2017.07.018)
• [L3] The poor results in the arthroscopy group may be secondary to the inherent instability of the CMC joint and lack of use of any biological or artificial interposition material. [40] (10.1177/1558944718778405)
• [L4] Overall, in patients that do not require revision surgery, pain relief was improved and motion maintained. [42] (10.1016/j.jhsa.2018.06.020)
• [L4] The procedure resulted in stable, painless joints with acceptable outcomes despite some loss of motion. [43] (10.1054/jhsb.2002.0839)
• [L5] The authors believe the described arthroscopic procedure is safe, is easily reproducible, does not require a long learning curve, and allows restoration of joint stability. [44] (10.1016/j.eats.2022.08.046)
• [L2] [48] (10.1016/j.arthro.2021.03.006)
• [L5] [49] (10.1016/s0749-8063(11)00686-4)
• [L4] [53] (10.1054/jhsb.2001.0725)
• [L4] These two cases also highlight the interest of arthroscopy of small joints as a precious tool for the diagnosis and treatment of such lesions. [54] (10.1016/j.main.2012.10.126)
• [L3] In patients with suspected scapholunate tears, midcarpal arthroscopy often leads to a change in diagnosis and procedure performed. [55] (10.1016/j.jhsa.2013.08.040)
• [L2] Needle-based diagnostic imaging that can be used in the office setting is statistically equivalent to surgical diagnostic arthroscopy with regard to the diagnosis of intra-articular, nonligamentous knee joint pathology. [56] (10.1016/j.arthro.2018.03.010)
• [L4] MCPJ arthroscopy is a simple, safe, and effective procedure that allows clear visualization of intraarticular disorders with minimal soft tissue trauma, providing satisfactory pain relief and good long-term functional outcomes. [60] (10.1016/j.hcl.2011.05.007)
• [L5] The author concludes that practitioners should be very selective in using in-office arthroscopy and that the combination of high-field-strength MRI plus operative arthroscopy offers the most accurate diagnostic workup. [63] (10.1016/j.arthro.2018.06.002)
• [L1] [65] (10.1016/j.arthro.2023.05.038)
• [L4] ERAS pathways resulted in a notable reduction in prescribing of opioids postoperatively after both arthroplasty and arthroscopic surgeries. [66] (10.5435/jaaos-d-24-01232)
• [L2] Using this methodology, we found that the majority of sports medicine and arthroscopy-related RCTs reporting nonsignificant results are fragile. [67] (10.1016/j.arthro.2023.02.022)
• [L4] Arthroscopy is a valuable tool, but still it is not the universal solution in the diagnosis or treatment of any wrist problem. [68] (10.1016/s0266-7681(96)80100-8)
• [L4] Seven disturbances were identified that serve as measures for arthroscopic image quality. [71] (10.1007/s00167-007-0299-7)
• [L5] This forms the basis of further development of arthroscopic procedures of the joint and reconstruction of adjacent capsulo-ligamentous structure. [72] (10.1007/s00167-014-3031-4)
• [L4] Debridement of complete tears is less beneficial, with complete resolution or mild symptoms in 67% of patients followed for short-term. [73] (10.1016/s0749-0712(21)00178-5)
• [Paper] It highlights the Arthroscopy Association of North America's (AANA) advocacy for patient access and balanced interpretation of evidence-based medicine. [79] (10.1016/j.arthro.2014.06.019)
• [L4] [80] (10.1016/j.hcl.2011.06.004)
• [L3] There was no increase in complications when total knee arthroplasty was performed more than six months after knee arthroscopy. [81] (10.1016/j.arth.2015.02.023)
• [Paper] [82] (10.1016/j.eats.2019.11.022)
• [L4] Despite being more demanding, the arthroscopic approach is a valuable tool if the surgeon aims to reduce the invasiveness of the procedure. [99] (10.1007/s00167-019-05568-2)
• [L5] Elbow arthroscopy is a reliable procedure that requires a clear understanding of the anatomy to be able to safely access the joint. [103] (10.1016/j.arthro.2019.05.014)
• [L4] This large gap between published recommendations and current practices means that we should reconsider the relevance of current recommendations and re-evaluate the cost-benefit ratio of prescribing a drug-based thromboprophylaxis after arthroscopy surgery. [106] (10.1016/j.otsr.2020.08.004)
• [L5] Osteoarthritis will likely remain the most common indication for basal joint arthroscopy while chronic pain and inflammation are useful indications for metacarpophalangeal arthroscopy. [113] (10.1016/j.jhsa.2007.02.020)
• [L4] Hence, we suggest the Copeland-Levy classification be used to standardize terminology of the subacromial impingement lesion. [120] (10.1016/j.jse.2017.07.018)
• [L3] Adhesions following hip arthroscopy were reduced with changes to the rehabilitation protocol including hip circumduction. [128] (10.1016/j.arthro.2011.03.043)
• [L3] Patients treated with additional arthroscopy to remove hematoma and debris do not have better functional outcomes compared with the nonarthroscopically treated group. [130] (10.1016/j.jhsa.2018.06.079)
• [L5] Wrist arthroscopy is a reasonable early treatment option for athletes to give them the opportunity to return to their pre-injury level of participation and function sooner and more often than was possible in the past or after a period of immobilization. [132] (10.1016/s0749-0712(21)00587-4)
• [L2] When compared to MRI, a VSI exam can provide a more detailed and accurate diagnostic assessment of intra-articular knee pathology. [133] (10.1177/2325967114s00100)
• [L5] Success relies on atraumatic technique, preservation of pulleys, multistrand repair, and controlled early rehabilitation to minimize rupture and stiffness. [134] (10.1016/j.jhsa.2010.06.024)
• [L1] A range of nonopioid strategies exist that can reduce postarthroscopic procedural opioid consumption with equivalent pain outcomes. [138] (10.1177/23259671231214700)
• [L4] Arthroscopic excision is the treatment of choice and is currently thought to be curative. [139] (10.1016/j.arthro.2005.12.035)
• [L4] The arthroscopic procedure gives better results than arthrotomy. [140] (10.1016/j.main.2013.05.002)
• [L1] Patients with rotator cuff tendinopathy undergoing arthroscopy should be informed that the presence and severity of cartilage lesions may be underestimated on MRI. [142] (10.1016/j.jse.2014.01.048)
• [L4] Synovial chondromatosis can be invasive, and even the best preoperative imaging may not demonstrate the degree of local tissue involvement. [144] (10.1054/jhsb.2001.0677)
• [L4] [150] (10.1007/s00167-021-06525-8)
• [L5] The 70° arthroscope demonstrates technical advantages over the 30° arthroscope, including a wider field of view and less image distortion at the periphery. [155] (10.1007/s00167-014-3452-0)
• [L4] [156] (10.1016/s0363-5023(97)80052-4)
• [L4] No intraoperative or postoperative complications were encountered. [159] (10.1097/bth.0b013e31818ee8d4)
• [L3] [160] (10.1002/jor.24490)
• [L1] The endoscopic procedure is safe and has the benefit of faster rehabilitation and return to work compared to open techniques. [162] (10.1177/1753193412475247)
• [L4] Because arthroscopic interposition of material contributes to health care costs without clear benefit to the patient, routine use of expensive interposition products should be abandoned or carefully evaluated with a prospective randomized controlled trial. [167] (10.1016/j.jhsa.2015.05.010)
• [L5] Clinical advances in arthroscopy provide the impetus for in-depth anatomic studies, and the study of anatomy results in very rapid clinical translation compared to other research areas like biomaterials. [173] (10.1016/j.arthro.2007.01.002)
• [L5] [174] (10.5435/jaaosglobal-d-23-00124)
• [L5] [175] (10.5435/jaaos-20-11-725)
• [L5] Arthroscopic images are subject to distortion that increases with greater lens reflecting angles and oblique viewing angles. [176] (10.1007/s00167-014-3336-3)
• [L5] A comprehensive solution requires identifying the problem, considering multimodal anesthesia, avoiding overprescribing, acknowledging that minimizing opioid use is not equivalent to undertreating pain, minimizing preoperative opioid use, managing patient expectations, and continuing to investigate the outcomes of pain management while limiting opioid prescriptions or forgoing opioids altogether. [177] (10.1016/j.arthro.2019.04.001)
• [L4] They help avoiding bony osteotomy and limiting articular further problems. [180] (10.1016/j.arthro.2016.03.079)
• [L5] In an in vitro setup, the new percutaneous procedure provides isometry over the range of motion and sufficiently restores posterolateral rotatory stability comparable to the intact situation and open reconstruction. [181] (10.1007/s00167-012-2019-1)
• [L1] Dexamethasone may be a valuable adjuvant to a multimodal systemic pain regimen after hip arthroscopy. [182] (10.1177/03635465241232157)
• [L1] Magnesium sulphate added to bupivacaine may significantly improve the analgesic efficacy for arthroscopy. [185] (10.1186/s13018-021-02609-w)
• [L5] [193] (10.2106/jbjs.20.00014)
• [L4] Surgeons should inform patients of the likelihood of having these minor complications. [198] (10.1016/j.jhsa.2009.12.040)
• [L1] Systematic reviews and meta-analyses in orthopaedic sports medicine literature relied on evidence levels 4 and 5 in 53% of studies over the 5-year study period. [201] (10.1177/0363546515580290)
• [L4] This systematic review observed that only 70% of orthopedic systematic reviews and meta-analyses published in 6 high-quality orthopedic journals over a 10-year eligibility period had conclusive conclusions. [202] (10.1016/j.arthro.2021.03.073)
• [L1] Complications after open surgery are more severe; this must be taken into account when advising patients with regard to treatment. [214] (10.1016/j.jhsa.2017.02.011)
• [L4] The authors encourage surgeons to consider this technique, noting their experience has yielded good results without complication. [217] (10.1007/s00167-009-0743-y)
• [L4] Successful outcomes can often be expected with minimal morbidity. [218] (10.1016/j.arthro.2011.03.046)
• [L4] Despite major primary complications and high incidence of radiographic signs of degenerative changes after 8.8 years, mainly good clinical results were achieved with Judet's bipolar prosthesis. [221] (10.1016/j.jse.2010.05.022)
• [L3] Avoidance of MRA within 2 weeks of shoulder arthroscopy may mitigate postoperative infection risk. [223] (10.1016/j.jse.2022.11.018)
• [L1] Arthroscopy is as effective as arthrotomy in the treatment of septic arthritis of the knee in adults, but arthroscopy has demonstrated a lower reinfection rate and less frequent clinical signs of initial inflammatory reaction. [225] (10.1007/s00167-015-3918-8)
• [L3] This study is the first to suggest that patients with rheumatic diseases undergoing arthroscopy may remain on immunosuppression perioperatively without significant risk for infection. [226] (10.1177/2325967121s00664)
• [L4] There were no postoperative fractures, infections, recurrences or other complications. [230] (10.1016/s0266-7681(97)80070-8)
• [L4] The revision rate for the LPM prosthesis was higher than in published series for other PIP joint implants, with close surveillance of all patients with this prosthesis currently in situ recommended. [231] (10.1177/1753193407087864)

See Also

• Soft Tissue Trauma
• Trigger Finger
• Trigger finger release

References

[1] In‐Office Diagnostic Needle Arthroscopy Using the NanoScope™ Arthroscopy System. Arthroscopy Techniques. 2022. DOI: 10.1016/j.eats.2022.07.006

[2] Arthroscopy. Injury. 1990. DOI: 10.1016/0020-1383(90)90041-r

[3] Arthroscopie des articulations trapézométacarpienne et métacarpophalangienne : installation, voie d'abord et exploration. Chirurgie de la Main. 2006. DOI: 10.1016/j.main.2006.07.026

[4] Shoulder Arthroscopy Literature Remains Controversial. Arthroscopy. 2012. DOI: 10.1016/j.arthro.2012.07.001

[5] Advances in arthroscopy—indications and therapeutic applications. Nature Reviews Rheumatology. 2014. DOI: 10.1038/nrrheum.2014.174

[6] Fundamentals of Arthroscopy Fluid Management and Strategies to Safely Improve Visualization. Journal of the American Academy of Orthopaedic Surgeons. 2021. DOI: 10.5435/jaaos-d-20-01057

[7] Suggested Guidelines for the Practice of Arthroscopic Surgery. Arthroscopy. 2014. DOI: 10.1016/s0749-8063(14)00453-8

[10] Diagnostic Arthroscopy for Detection of Periprosthetic Infection in Painful Shoulder Arthroplasty. Arthroscopy. 2019. DOI: 10.1016/j.arthro.2019.03.058

[11] Our Journals Arthroscopy and Arthroscopy Techniques Are Complementary. Arthroscopy. 2015. DOI: 10.1016/j.arthro.2015.05.001

[12] Suggested Guidelines for the Practice of Arthroscopic Surgery. Arthroscopy. 2014. DOI: 10.1016/s0749-8063(14)00850-0

[14] Introducing Foundations of Arthroscopy Techniques. Arthroscopy. 2024. DOI: 10.1016/j.arthro.2024.09.002

[15] Basal joint arthroscopy indications in first CMC joint arthritis. Hand Surgery and Rehabilitation. 2021. DOI: 10.1016/j.hansur.2020.05.014

[16] A History of Arthroscopy. Arthroscopy. 2010. DOI: 10.1016/j.arthro.2009.10.005

[17] Six out of ten patients with sinus tarsi syndrome returned to pre‐injury type of sport after subtalar arthroscopy. Knee Surgery, Sports Traumatology, Arthroscopy. 2020. DOI: 10.1007/s00167-020-06385-8

[18] Arthroscopy in the Treatment of Fracture of the Trapezium. Arthroscopy. 2007. DOI: 10.1016/j.arthro.2006.07.051

[19] ARTHROSCOPY OF THE DISTAL RADIOULNAR JOINT. Hand Clinics. 1999. DOI: 10.1016/s0749-0712(21)00182-7

[20] A Systematic Review of Meta‐analyses Published in Arthroscopy: The Journal of Arthroscopic and Related Surgery. Arthroscopy. 2015. DOI: 10.1016/j.arthro.2015.08.002

[21] Trapeziometacarpal Arthroscopy: A Classification and Treatment Algorithm. Hand Clinics. 2006. DOI: 10.1016/j.hcl.2006.02.006

[22] Substantial Loss to Follow-Up and Missing Data in National Arthroscopy Registries: A Systematic Review. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2021. DOI: 10.1016/j.arthro.2020.08.007

[24] 30-Day complications, operative time, and overnight admission following elective elbow arthroscopy. Shoulder & Elbow. 2024. DOI: 10.1177/17585732241249393

[27] Technique of synovial biopsy of metacarpophalangeal joints using the needle arthroscope. Knee Surgery, Sports Traumatology, Arthroscopy. 2002. DOI: 10.1007/s00167-002-0329-4

[28] Arthroscopic Treatment of Metacarpophalangeal Arthropathy in Haemochromatosis. Journal of Hand Surgery. 1994. DOI: 10.1016/0266-7681(94)90169-4

[32] Shoulder Arthroscopy Simulator Performance Correlates with Resident and Shoulder Arthroscopy Experience. Journal of Bone and Joint Surgery. 2012. DOI: 10.2106/jbjs.l.00072

[33] From Bench to Bedside: Size Matters—Needle Arthroscopy for Office-based Diagnosis. Clinical Orthopaedics & Related Research. 2024. DOI: 10.1097/corr.0000000000003105

[35] Uses and abuses of arthroscopy. The Journal of Bone & Joint Surgery. 1992. DOI: 10.2106/00004623-199274100-00019

[36] Arthrodesis of distal interphalangeal and thumb interphalangeal joint: a retrospective cohort study of 149 cases. BMC Musculoskeletal Disorders. 2024. DOI: 10.1186/s12891-024-07361-w

[37] Talus bipartitus: a systematic review and report of two cases with arthroscopic treatment. Knee Surgery, Sports Traumatology, Arthroscopy. 2017. DOI: 10.1007/s00167-017-4613-8

[38] Arthroscopic versus open excision of dorsal ganglion cysts: a systematic review. Journal of Hand Surgery (European Volume). 2017. DOI: 10.1177/1753193417734428

[39] Progress and Role of Finger Joint Arthroscopy. Hand Clinics. 2017. DOI: 10.1016/j.hcl.2017.07.018

[40] Arthroscopic Abrasion Arthroplasty Is Not Superior to Ligament Reconstruction and Tendon Interposition for Thumb Carpometacarpal Arthritis. HAND. 2018. DOI: 10.1177/1558944718778405

[42] Medium-Term Outcomes With Pyrocarbon Proximal Interphalangeal Arthroplasty: A Study of 170 Consecutive Arthroplasties. The Journal of Hand Surgery. 2018. DOI: 10.1016/j.jhsa.2018.06.020

[43] Osteochondral Grafting of the Metacarpophalangeal Joint in Rheumatoid Arthritis. Journal of Hand Surgery. 2003. DOI: 10.1054/jhsb.2002.0839

[44] Arthroscopic Hill‐Sachs Filling Technique Using an Absorbable Interference Screw. Arthroscopy Techniques. 2022. DOI: 10.1016/j.eats.2022.08.046

[46] A Lange Medical Book Current Diagnosis Treatment In Orthopedics Fifth Edition. 9Hand Surgery > Image DISORDERS OF THE MUSCULATURE OF THE HAND.

[47] Exam Of The Hand Wrist 2Ed. 1.1 SKELETON OF THE HAND > The osseous skeleton.

[48] Needle Diagnostic Arthroscopy and Magnetic Resonance Imaging of the Shoulder Have Comparable Accuracy With Surgical Arthroscopy: A Prospective Clinical Trial. Arthroscopy. 2021. DOI: 10.1016/j.arthro.2021.03.006

[49] Suggested Guidelines for the Practice of Arthroscopic Surgery. Arthroscopy. 2011. DOI: 10.1016/s0749-8063(11)00686-4

[52] Wrist Arthroscopy. 2021.

[53] Arthroscopy of the Proximal Interphalangeal Joints of the Finger. Journal of Hand Surgery. 2002. DOI: 10.1054/jhsb.2001.0725

[54] Ostéochondrite disséquante, métacarpienne traitée par microperforations sous arthroscopie : À propos de deux cas et revue de la littérature. Chirurgie de la Main. 2012. DOI: 10.1016/j.main.2012.10.126

[55] Does Midcarpal Arthroscopy Alter Diagnosis and Treatment of Scapholunate or Triangular Fibrocartilage Injuries?. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2013.08.040

[56] A Prospective, Blinded, Multicenter Clinical Trial to Compare the Efficacy, Accuracy, and Safety of In‐Office Diagnostic Arthroscopy With Magnetic Resonance Imaging and Surgical Diagnostic Arthroscopy. Arthroscopy. 2018. DOI: 10.1016/j.arthro.2018.03.010

[60] Metacarpophalangeal Joint Arthroscopy: Indications Revisited. Hand Clinics. 2011. DOI: 10.1016/j.hcl.2011.05.007

[63] Editorial Commentary: The Desire to Take a Look: Surgeons and Patients Must Weigh the Benefits and Costs of In‐Office Needle Arthroscopy Versus Magnetic Resonance Imaging. Arthroscopy. 2018. DOI: 10.1016/j.arthro.2018.06.002

[65] Arthroscopic Treatment Is a Safe and Effective Alternative to Open Treatment for Acute Septic Arthritis of the Native Knee: A Systematic Review. Arthroscopy. 2023. DOI: 10.1016/j.arthro.2023.05.038

[66] Application and Analysis of the Enhanced Recovery After Surgery Opioid Prescription Protocol in Arthroscopy and Arthroplasty Patients. Journal of the American Academy of Orthopaedic Surgeons. 2025. DOI: 10.5435/jaaos-d-24-01232

[67] The Majority of Sports Medicine and Arthroscopy‐Related Randomized Controlled Trials Reporting Nonsignificant Results Are Statistically Fragile. Arthroscopy. 2023. DOI: 10.1016/j.arthro.2023.02.022

[68] The Value of Wrist Arthroscopy. Journal of Hand Surgery. 1996. DOI: 10.1016/s0266-7681(96)80100-8

[71] Disturbances in the arthroscopic view defined with video analysis. Knee Surgery, Sports Traumatology, Arthroscopy. 2007. DOI: 10.1007/s00167-007-0299-7

[72] Arthroscopic treatment of pigmented villonodular synovitis of the proximal tibiofibular joint. Knee Surgery, Sports Traumatology, Arthroscopy. 2014. DOI: 10.1007/s00167-014-3031-4

[73] THE ROLE OF ARTHROSCOPY IN SCAPHOLUNATE INSTABILITY. Hand Clinics. 1999. DOI: 10.1016/s0749-0712(21)00178-5

[79] Legacies. Arthroscopy. 2014. DOI: 10.1016/j.arthro.2014.06.019

[80] New Frontiers in Hand Arthroscopy. Hand Clinics. 2011. DOI: 10.1016/j.hcl.2011.06.004

[81] Total_Knee_Arthroplasty_Within_Six_Months_After_Knee_Arthroscopy_Is_Associated_W_S0883540315001345. The Journal of Arthroplasty. 2015. DOI: 10.1016/j.arth.2015.02.023

[82] Endoscopic Proximal Hamstring Tendon Repair for Nonretracted Tears: An Anatomic Approach and Repair Technique. Arthroscopy Techniques. 2020. DOI: 10.1016/j.eats.2019.11.022

[84] Exam Of The Hand Wrist 2Ed. INTRODUCTION.

[86] Green S Operative Hand Surgery. Interosseous and Hypothenar Muscles.

[90] Exam Of The Hand Wrist 2Ed. Techniques of investigation of the arterial supply by J P Melki > Vascularization of the thumb > Palmar aspect.

[93] A Lange Medical Book Current Diagnosis Treatment In Orthopedics Fifth Edition. 9Hand Surgery > FLEXOR TENDON INJURY.

[96] Green S Operative Hand Surgery. PERTINENT ANATOMY.

[99] Encouraging mid‐term outcomes for arthroscopic autologous osteochondral transplant (OAT) in capitellum osteochondritis dissecans (OCD). Knee Surgery, Sports Traumatology, Arthroscopy. 2019. DOI: 10.1007/s00167-019-05568-2

[101] Chapter 6 Elbow Arthroscopy and the Thrower’s Elbow. 2019.

[103] Elbow Arthroscopy Made Simple: Indications and Techniques. Arthroscopy. 2019. DOI: 10.1016/j.arthro.2019.05.014

[106] Thromboprophylaxis in arthroscopy: Survey of current practices in France and comparison with recommendations. Orthopaedics & Traumatology: Surgery & Research. 2020. DOI: 10.1016/j.otsr.2020.08.004

[107] Chapter 39 Wrist Arthroscopy. 2019.

[113] Arthroscopy of the Trapeziometacarpal and Metacarpophalangeal Joints. The Journal of Hand Surgery. 2007. DOI: 10.1016/j.jhsa.2007.02.020

[120] Intraobserver and interobserver reliability of the Copeland-Levy classification for arthroscopic evaluation of subacromial impingement. Journal of Shoulder and Elbow Surgery. 2017. DOI: 10.1016/j.jse.2017.07.018

[128] Risk_Factors_for_Adhesions_Following_Hip_Arthroscopy_(SS-39)_S074980631100260X. Arthroscopy. 2011. DOI: 10.1016/j.arthro.2011.03.043

[130] Operative Treatment of Intra-Articular Distal Radius Fractures With Versus Without Arthroscopy: A Randomized Controlled Trial RADAR-trial. The Journal of Hand Surgery. 2018. DOI: 10.1016/j.jhsa.2018.06.079

[132] THE ROLE OF ARTHROSCOPY IN THE EVALUATION AND TREATMENT OF TRIANGULAR FIBROCARTILAGE COMPLEX INJURIES IN ATHLETES. Hand Clinics. 2000. DOI: 10.1016/s0749-0712(21)00587-4

[133] A Prospective Multi-Center Clinical Trial to Compare Efficiency, Accuracy and Safety Of the VisionScope Imaging System Compared to MRI and Diagnostic Arthroscopy. Orthopaedic Journal of Sports Medicine. 2014. DOI: 10.1177/2325967114s00100

[134] Zone II Combined Flexor Digitorum Superficialis and Flexor Digitorum Profundus Repair Distal to the A2 Pulley. The Journal of Hand Surgery. 2010. DOI: 10.1016/j.jhsa.2010.06.024

[138] Arthroscopy Association of Canada Position Statement on Opioid Prescription After Arthroscopic Surgery. Orthopaedic Journal of Sports Medicine. 2023. DOI: 10.1177/23259671231214700

[139] Localized Pigmented Villonodular Synovitis: Arthroscopic Treatment of a Lesion Arising From the Quadriceps Tendon Sheath. Arthroscopy. 2006. DOI: 10.1016/j.arthro.2005.12.035

[140] Contribution of arthroscopy in case of septic appearance arthritis of the wrist: A nine cases series. Chirurgie de la Main. 2013. DOI: 10.1016/j.main.2013.05.002

[142] Diagnostic accuracy of noncontrast MRI for detection of glenohumeral cartilage lesions: a prospective comparison to arthroscopy. Journal of Shoulder and Elbow Surgery. 2014. DOI: 10.1016/j.jse.2014.01.048

[144] Synovial Chondromatosis of the Metacarpophalangeal Joint. Journal of Hand Surgery. 2002. DOI: 10.1054/jhsb.2001.0677

[150] Post‐operative septic arthritis after arthroscopy: modern diagnostic and therapeutic concepts. Knee Surgery, Sports Traumatology, Arthroscopy. 2021. DOI: 10.1007/s00167-021-06525-8

[155] Comparative analysis of visual field and image distortion in 30° and 70° arthroscopes. Knee Surgery, Sports Traumatology, Arthroscopy. 2014. DOI: 10.1007/s00167-014-3452-0

[156] A technique for arthroscopic evaluation of the first carpometacarpal joint. The Journal of Hand Surgery. 1997. DOI: 10.1016/s0363-5023(97)80052-4

[159] Arthroscopic Synovectomy of the Metacarpophalangeal and Proximal Interphalangeal Joints. Techniques in Hand & Upper Extremity Surgery. 2008. DOI: 10.1097/bth.0b013e31818ee8d4

[160] Assessment of Cartilage Repair Quality With the International Cartilage Repair Society Score and the Oswestry Arthroscopy Score. Journal of Orthopaedic Research. 2019. DOI: 10.1002/jor.24490

[162] Carpal tunnel release: a randomized comparison of three surgical methods. Journal of Hand Surgery (European Volume). 2013. DOI: 10.1177/1753193412475247

[167] Long-Term Outcome of Arthroscopic Resection Arthroplasty With or Without Interposition for Thumb Basal Joint Arthritis. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2015.05.010

[173] Arthroscopy, Anatomy, and Translational Research. Arthroscopy. 2007. DOI: 10.1016/j.arthro.2007.01.002

[174] In-Office Needle Arthroscopy: Indications, Surgical Techniques, Tips, and Tricks. JAAOS: Global Research and Reviews. 2024. DOI: 10.5435/jaaosglobal-d-23-00124

[175] Advances in Wrist Arthroscopy. Journal of the American Academy of Orthopaedic Surgeons. 2012. DOI: 10.5435/jaaos-20-11-725

[176] Arthroscopic image distortion—part I: the effect of lens and viewing angles in a 2‐dimensional in vitro model. Knee Surgery, Sports Traumatology, Arthroscopy. 2014. DOI: 10.1007/s00167-014-3336-3

[177] Opioids After Arthroscopy: We're Only Halfway Through the Crisis. Arthroscopy. 2019. DOI: 10.1016/j.arthro.2019.04.001

[180] Arthroscopic Antero‐superior Ancillary Portals for Addressing Surgical Repair perpendicularly on Talar Dome: Sixteen Years’ Experience. Arthroscopy. 2016. DOI: 10.1016/j.arthro.2016.03.079

[181] Percutaneous lateral ulnar collateral ligament reconstruction. Knee Surgery, Sports Traumatology, Arthroscopy. 2012. DOI: 10.1007/s00167-012-2019-1

[182] Perioperative Intravenous Dexamethasone Significantly Reduces Postoperative Opioid Requirement and Nausea After Unilateral Elective Hip Arthroscopy: A Randomized Double-blinded Placebo-controlled Trial. The American Journal of Sports Medicine. 2024. DOI: 10.1177/03635465241232157

[185] The effect of magnesium added to bupivacaine for arthroscopy: a meta-analysis of randomized controlled trials. Journal of Orthopaedic Surgery and Research. 2021. DOI: 10.1186/s13018-021-02609-w

[193] What’s New in Sports Medicine. Journal of Bone and Joint Surgery. 2020. DOI: 10.2106/jbjs.20.00014

[198] Complications of Open Trigger Finger Release. The Journal of Hand Surgery. 2010. DOI: 10.1016/j.jhsa.2009.12.040

[201] Systematic Reviews in Sports Medicine. The American Journal of Sports Medicine. 2015. DOI: 10.1177/0363546515580290

[202] Nearly One‐Third of Published Systematic Reviews and Meta‐analyses Yield Inconclusive Conclusions: A Systematic Review. Arthroscopy. 2021. DOI: 10.1016/j.arthro.2021.03.073

[214] Open Surgery Versus Ultrasound-Guided Corticosteroid Injection for Trigger Finger: A Randomized Controlled Trial With 1-Year Follow-up. The Journal of Hand Surgery. 2017. DOI: 10.1016/j.jhsa.2017.02.011

[217] All‐inside, suture anchor repair for meniscal root tears. Knee Surgery, Sports Traumatology, Arthroscopy. 2009. DOI: 10.1007/s00167-009-0743-y

[218] Hip_Arthroscopy_for_Legg-Calve-Perthes_Disease_Minimum_Two-Year_Follow-up_(SS-42_S0749806311002635. Arthroscopy. 2011. DOI: 10.1016/j.arthro.2011.03.046

[221] Mid- to long-term results after bipolar radial head arthroplasty. Journal of Shoulder and Elbow Surgery. 2010. DOI: 10.1016/j.jse.2010.05.022

[223] Does needle penetration of the shoulder joint prior to arthroscopy increase infection risk? The effect of preoperative magnetic resonance arthrogram or corticosteroid injection. Journal of Shoulder and Elbow Surgery. 2023. DOI: 10.1016/j.jse.2022.11.018

[225] Arthrotomy versus arthroscopy in the treatment of septic arthritis of the knee in adults: a randomized clinical trial. Knee Surgery, Sports Traumatology, Arthroscopy. 2015. DOI: 10.1007/s00167-015-3918-8

[226] Poster 103: Incidence of postoperative infections in rheumatic disease patients undergoing arthroscopy was not affected by use of immunosuppressive medications. Orthopaedic Journal of Sports Medicine. 2022. DOI: 10.1177/2325967121s00664

[230] The Treatment of Enchondromas in the Hand by Endoscopic Curettage without Bone Grafting. Journal of Hand Surgery. 1997. DOI: 10.1016/s0266-7681(97)80070-8

[231] TWO TO FIVE YEAR FOLLOW-UP OF THE LPM CERAMIC COATED PROXIMAL INTERPHALANGEAL JOINT ARTHROPLASTY. Journal of Hand Surgery (European Volume). 2008. DOI: 10.1177/1753193407087864