Will rheumatologists ever pick up the arthroscope again?

Conditions prompting physicians and surgeons first adapting endoscopes to peer into joints were mainly the sort of synovial conditions that would concern today's rheumatologists. Rheumatologists were among the pre-World War II pioneers developing and documenting arthroscopy. The post-War father of modern arthroscopy, Watanabe, found rheumatologists among his early students, who took back the technique to their home countries, teaching orthopedists and rheumatologists alike. Rheumatologists described and analyzed the intra-articular features of their common diseases in the '60s and '70s. A groundswell of interest from academic rheumatologists in adapting arthroscopy grew considerably in the '90s with development of "needle scopes" that could be used in an office setting. Rheumatologists helped conduct the very trials the findings of which reduced demand for their arthroscopic services by questioning the efficacy of arthroscopic debridement in osteoarthritis (OA) and also developing biological compounds that greatly reduced the call for any resective intervention in inflammatory arthropathies. The arthroscope has proven an excellent tool for viewing and sampling synovium and continues to serve this purpose at several international research centers. While cartilage is now imaged mainly by magnetic resonance imaging, some OA features - such as a high prevalence of visible calcinosis - beg further arthroscopy-directed investigation. A new generation of "needle scopes" with far superior optics awaits future investigators, should they develop interest.

Arthroscopic surgery: a historical perspective.

The most commonly performed orthopaedic procedure today, arthroscopy, has its origins in the 19th century. Considered as one of the three greatest improvements in orthopedic care, arthroscopic visualization can be performed in every joint of the human body. Beginning with the use of the cystoscope in cadaver knees through the development of sophisticated arthroscopic equipment, arthroscopy has become an invaluable component of modern orthopedic care. This article will trace the history of arthroscopy, including arthroscopic pioneers who introduced the notion of examining joint pathology through "key hole" incisions, minimizing pain and reducing recovery time for orthopedic patients throughout the world.

How cold light was introduced to arthroscopy.

In 1954, in a landmark publication, H. H. Hopkins reported that images could be transmitted through glass fibers. This stimulated many investigations and, in 1957, B. Hirschowitz at the University of Michigan, succeeded in constructing a much-needed flexible gastroscope using optic glass fibers. Coating of the fibers by glass of lower refractive index was the next major step forward. Optical fibers were thus insulated and the accuracy of the transmitted image and the light transmission capacity of the fibers were enhanced. Working with American Cystoscope Makers Inc, L. Curtiss and H. Hett were the first to use glass fibers for illumination in an endoscope, producing a flexible ureteroscope in 1960. The light transmitted by the fibers was named "cold light" because it produced little heat, but the term had been used before for other types of illumination. The first arthroscope equipped with cold light was Watanabe's arthroscope No. 22 built by Tsunekichi Fukuyo in 1967. However, Watanabe was not satisfied with the new instrument and he still preferred the conventionally illuminated No. 21 arthroscope with the offset tungsten bulb at his tip. After R. W. Jackson reintroduced the technique to North America, most American pioneers used this conventionally illuminated arthroscope as well. But the early European arthroscopists had cold light instruments made by the German manufacturers R. Wolf and K. Storz since 1969. These rod-lens cold light instruments expanded in all markets during the following decade.

[Arthroscopy of the knee joint--history and present state]. / Artroskopia stawu kolanowego--historia i terazniejszosc.

This study presents, based on the literature, data and own experience, the history, the development and current trends of the knee joint arthroscopy.

The introduction of arthroscopy to North America.

Arthroscopy developed as an offshoot of cystoscopy. Various milestones in the development of endoscopy, and some of the individuals who made significant contributions to the development of arthroscopy are described. After World War II, technology improved and arthroscopy became a valuable adjunct to the armamentarium of the orthopaedic surgeon. There has been a tremendous surge of interest and development of arthroscopy since its reintroduction to North America in 1965. Arthroscopy ranks as one of the three most important contributions to orthopaedics in this past century.

[Ernst Vaubel M. D. German pioneer in the field of arthroscopy 1902-1989]. / Ernst Vaubel, der deutsche Pionier der Arthroskopie 1902-1989.

In Germany of the pre-war period Ernest Vaubel at Wiesbaden was the most eminent arthroscopist. He collaborated with the manufacturer Georg Wolf at Berlin and developed his own arthroscope, a jacobaeus-type thoracolaparoscope with a 45 degrees -optic and an in- and outflow connecting piece. The optic was definitely longer than the trocard and the electric bulb at the tip was in danger during manipulation in a narrow joint. Vaubel did a rather small series of arthroscopies from 1936 to 1939 at the University hospitals of Leipzig and Frankfurt, using local anaesthesia and air medium. 1938 he held a paper at the International Congress of Rheumatologists at Bath. In the same year he published a monograph titled "Die Arthroskopie", the first book of world literature on this issue. 1939 he left the Frankfurt university hospital and went in his own private practice. 1941-1944 he did military service as medical officer of the air force. After war he had not more facilities to practice arthroscopy. His ideas and his instrument were revived in the german speaking countries in the late fifties by the sports surgeons Gottwald Heiss at Stuttgart and Reinhold Suckert at Linz.