Small joint arthroscopy is a highly specialized surgical technique
utilized by very experienced and patient surgeons. Arthroscopy of a small joint like the 1st MPJ is no different then
scoping a knee or shoulder, just the instruments and joints are smaller. The pathology is the same, combination of synovitis,
scar tissue, cartilage or capsular problems. All can be managed arthroscopically.
Surgeons and patients unfortunately have to decide whether minimal incision
surgery arthroscopically is better than an open procedure. Often, small joint arthroscopy may simply be utilized as
a diagnostic tool since we are unable to assess cartilage in the foot with any traditional imaging modality. Of course
xrays can show gross DJD changes, but so often patients can have small and isolated chondromalacia or cartilage injuries which
can go undetected. No one wants to have surgery not knowing the outcome or expectations. Being able to treat such
injuries through small portals allows patients to walk faster, have less pain and swelling and ultimately return to work faster.
Small joint arthroscopy will always have limitations.
Patients and surgeons need to realize that we have the technology to do traditional surgeries
arthroscopically, but is the extra time and risks of anesthesia worth it? Open procedures pose their own risks but contrast
an open procedure of 30minutes versus an arthroscopic procedure of 2hours. Common sense must prevail, and on numerous
occasions we must abandon a scope because we can't do everything arthroscopically.
Granted 15 years ago, only a handful of orthopedic surgeons were doing
arthroscopic ACL repairs. Today, rarely are these performed open. Like the knee, we will all see small joint arthroscopy
of the foot increasing in popularity. And more and more patients will ask for these procedures in lieu of an open procedure.
