Arthroscopy is a surgical technique developed by a Tokyo doctor, Dr. Masaki Watanabe, in the early 1960s to permit orthopaedic surgery in a relatively non-invasive way. Based on a cystoscope, an instrument used in bladder examinations, the first arthroscope had a tiny camera lens mounted on a flexible tube, which allowed a surgeon to peer into the interior of joints through a small incision.

In 1964, a 32 year old orthopaedic surgeon with the Canadian team at the Tokyo Olympics, Dr. Robert Jackson, now Chief of the Department of Orthopaedic Surgery at Baylor University Medical Center in Dallas learned the technique and brought it to North America. Jackson began using the arthroscope to repair knee injuries in professional athletes, greatly reducing healing times and limiting the amount of permanent damage in his patients’ joints.

In the 30-odd years since, technical refinements have turned Watanbe’s relatively crude device into a sophisticated fibre-optic instrument the diameter of a drinking straw. Fitted with a miniature camera, a light source and precision tools at the end of flexible tubes, the arthroscope can literally peer around corners inside a joint. That allows not only diagnostic procedures but a range of surgical repairs, such as debridement, or cleaning, of a joint, removing bits of torn cartilage and flushing out worn cartilage debris with a saline solution, simple ligament reconstruction, and synovectomies, removal of inflamed joint linings. All is done without a major, invasive operation, and, since arthroscopy requires only tiny incisions, many procedures can be done on an outpatient basis with local anesthetic.

It took time and technological refinements for what people once called ‘the needle with an eye’ to catch on, but procedures are now done regularly in the knees, shoulders and wrists. With further miniaturization, arthroscopy may eventually be used in every joint in the body, including fingers.

Needle arthroscopes, which are even narrower in diameter than ordinary arthroscopes, are already used in diagnosis and some procedures, but their capabilities are limited and surgeons’ enthusiasm muted. New applications are in development, including studies with laser arthroscopes to ‘re-bond’ injured tissues, rather than simply remove them, and even smaller, digital imaging devices to replace and improve on current television-camera imaging.

Dr. Jackson believes that, because of its diagnostic capabilities and the potential for minimally invasive repairs of early arthritic damage, arthroscopy may confer preventative advantages, especially for the knee: ‘Because we see things earlier, before they become irreversibly damaged - if there’s a small tear or chip in joint tissue, we can fix it with minimal intervention, so you don’t run into problems of wound healing and complications of major surgery. So, we may see in the next few years a significant decrease in the amount of degenerative arthritis of the knee.’