Arthroscopic surgery
Arthroscopic surgery of the shoulder is still very much in its infancy, but appears to be emerging at a virtually uncontrollable rate. When discussing such a new technique, two basic questions must be asked. The first is 'what can be achieved?' The second, and far more important, is 'what should be achieved?' For the wise surgeon will realize that the mere ability to perform an operation should not be an indication for its use. This chapter aims to answer both of these questions in turn, through a review of current techniques.
At present, arthroscopic surgery of the shoulder can be considered on five planes of increasing complexity, as shown in Table 7.1.
|
First generation |
Diagnostic arthroscopy Targeted biopsy Removal of loose bodies Excision of labral tears |
|
Second generation |
Synovectomy Shoulder debridement Coraco-acromial ligament division Arthroscopic subacromial decompression (ASD) |
|
Third generation |
Anterior rconstruction Staple Cannulated screw Rivet Suture |
|
Fourth generation |
Complex reconstruction SLAP tears Inferior capsular shift Combined intracapsular / extracapsular repair |
|
Fifth generation |
Arthrodesis Rotator cuff repair |
