Arthroscopy (also called arthroscopic surgery) is a minimally invasive surgical procedure in which an examination and sometimes treatment of the interior of a joint or other body cavity is performed using an arthroscope, a type of endoscope that is inserted near or into the joint or other cavity through a small incision. Arthroscopic procedures can be performed either to evaluate or to treat many conditions such as orthopedic conditions, including torn floating cartilage, torn surface cartilage, ACL reconstruction, and trimming damaged cartilage. The surgical instruments used are smaller than traditional instruments. Surgeons view the joint or tissues on a video monitor, and can diagnose and repair or treat the joint or tissue, such as ligaments, menisci or cartilage. It is technically possible to do an arthroscopic examination of almost every joint or other cavity in the human body. The joints that are most commonly examined and treated by arthroscopy are the knee, shoulder, elbow, wrist, ankle, foot, and hip.
Treatments of a joint during arthroscopy include application of a local anesthetic to relieve pain or growth factors or certain blood products to aid in healing. Examples of other surgeries in which treatments of other cavities could be made include laparoscopy and endoscopic sinus surgery. However, the proper placement of these treatments is essential to their safe and effective use. Recently it has been learned that the application of even one effective dose of an anesthetic can damage cartilage cells (chondrocytes), possibly leading to chondrolysis (Chu C R et al: “The in vitro effects of bupivicaine on articular chondrocytes”, The Journal of Bone and Joint Surgery (Br), 2008; 90-B:814-20). The FDA has warned physicians that post-surgical intra-articular infusion through the use of pain pump may cause chondrolysis and is not approved. Therefore, it is desirable to limit or avoid the exposure of chondrocytes to local anesthetics, but instead to inject the anesthetic into the soft tissue surrounding the joint such as the capsule or other adjacent soft tissues that are extra-articular.
Treatments to promote healing of tissue damage discovered during arthroscopy include the application of growth factors or blood products (Randelli P S, Arrigoni P, Cabitza P, Vollpi P, Maffulli N: Autologous platelet rich plasma for arthroscopic rotator cuff repair: A pilot study. Disabil Rehabil 2008; 30:1584-1589, Orrego M, Larrain C, Rosales J, et al: Effects of platelet concentration and a bone plug on the healing of hamstring tendons in a bone tunnel. Arthroscopy 2008; 24:1373-1380, Sanchez M, Azofra J, Annitua E, et al: Plasma rich in growth factors to treat an articular cartilage avulsion: A case report. Med Sci Sports Exerc 2003; 35:1648-1652). It would be desirable to be able to place these treatments in the place or places in the joint or tissues where they would be the most effective in promoting healing.
The application of other treatments used in laparoscopy, endoscopic sinus surgery, or other endoscopic surgical techniques would benefit from a device that allows precise and safe application of medication or other medical treatments to remote parts of a body cavity.
The use of intra-articular or extra-articular treatments could be more effectively done during arthroscopy when the tissues are visualized and the application can be directed to the proper place in or around the joint. Likewise, treatments introduced in other cavities during endoscopy may be more effective when precisely applied to the best location for the treatment. The present invention meets the need for a means to apply treatments during endoscopy in such a manner as to reduce the risk of damage from some treatments or to increase the rate or level of healing from other treatments.