Historically, second-look arthroscopy has been used to assess healing in
the knee joint postoperatively for research and non-research purposes.
However, due to some of its risks and complications, as well as recent
advances that have yielded better imaging of tissue and structures, orthopedic
surgeons have looked for good alternatives to follow-up knee arthroscopy.
On the other hand, sources for this
Cover Story discussed new in-office arthroscopy technology to get a less-invasive second-look
at a cartilage or meniscal repair, for example. These techniques may mitigate
undergoing a subsequent OR visit and some of the associated risks.
“Second-look arthroscopy, or diagnostic arthroscopy, if you will,
which is a [broader] term, was historically performed in a setting where
we did not know or needed to confirm a diagnosis in the absence of high-quality
MRI to otherwise guide our decision-making,”
Brian J. Cole, MD, MBA, associate chairman of the department of orthopedics at Midwest Orthopaedics
at Rush, told
Orthopedics Today. “But frankly, taking a history, performing a physical and maybe
obtaining an X-ray or MRI may obviate the need for second-look arthroscopy
in many instances simply for the purposes of obtaining a diagnosis.”
Sources said second-look arthroscopy is not standardized in the United
States but is performed on a case-by-case or one-off basis.
Robert G. Marx, MD, professor of orthopedic surgery at Hospital for Special Surgery and Weill
Cornell Medical College, noted patients who are symptom-free after surgery
should not be subjected to second-look arthroscopy as it may cause complications
that may not have occurred otherwise.
Cole does not perform diagnostic second-look arthroscopy, but only uses
second-look arthroscopy when the patient is symptomatic. During medically
indicated second-look, patients may realize a therapeutic benefit. He told
Orthopedics Today this tends to occur in patients who underwent cartilage repair in conjunction
with meniscal transplants or osteochondral allografting.“If I do
an operation on someone and they are symptom-free, I may be interested
to see what is going on, but I will not subject that patient to another
operation, the risks of surgery and the recovery, because I do not feel
it is in their best interest unless they have been enrolled and consented
to a research protocol where it would have stated ahead of time that was
part of the deal,” Marx said.
Click here to read the full article!