Arthroscopy

To understand the theory (and folly) of this seemingly “harmless” procedure, one needs to understand the physiological composition of the joint. Most of the joints in the body are synovial joints, which are flexible and self-lubricating.

The ends of the bones are covered with a protective substance known as articular cartilage. These thin coatings are separated by a layer of synovial fluid, which further cushions and lubricates them where they meet to form the joint.

Ligaments add support and hold the joints together. Tendons secure the muscles, which provide movement to the body. The whole structure is wrapped in a capsule of tissue known as the synovial membrane, which also secretes the lubricating and somewhat revitalizing synovial fluid.

The knee and the wrist joints also contain pads of fibrous cartilage, known as menisci, which help these overworked joints bear the extra stresses to which they are often subjected.

The articular cartilage which protects the inner surfaces of the joints is a homogenous substance devoid of nerves, lymphatic vessels or blood cells, made up primarily of water, collagen and specialized proteins (proteoglycans). Its structure is fairly simple; it contains a small percentage of cells known as chondrocytes, which are solely responsible for the maintenance and repair of the articular cartilage, via their ability to synthesis collagen and proteoglycans.

The high water content of the articular cartilage, coupled with the innate compressibility of the proteoglycans, give it the slick, cushioning properties so essential to maintaining healthy, pain free joints, minimizing friction and stress between the bones.

All the available evidence seems to indicate that chondrocytes are fully capable of regenerating articular cartilage throughout the course of a lifetime, which would account for the healthy cell counts even in very old people. However, since they are not fed by blood vessels, they are wholly dependent on nutrient delivery from the synovial fluid; this lack of blood supply puts a damper on their proliferative capabilities.

It is the movement of the joints that loads nutrients into, and waste out of, the cartilage. Despite their limited metabolic resources, chondrocytes can still churn out large quantities of collagen and proteoglycans.

The invasive tools of arthroscopic surgery are used to excise injured ligaments, cartilage and meniscus (which leads to a further depletion of the articular cartilage because the meniscus supplies nutrients to it)—either through shaving or slicing with a high-powered electrical instrument. The immediate result is a temporary respite from whatever pain existed before the procedure— followed by more or less permanent weakness and instability in the joint.

Unfortunately, such “collateral damage” seems more acceptable to the industrialized medical establishment than less invasive (and less profit-oriented) therapies like trigger point injections and Prolotherapy. It would be somewhat comforting to know that such intensely destructive procedures are falling from favor, if it weren’t for the fact that other, less obvious, but equally damaging techniques are still widespread.

Discussions from our Radio Show:
KNEE REPLACEMENT

 
CALLER: I have a knee that a couple doctors told that I should have a knee replacement surge. IT is pretty swollen and sore, I sure would like to avoid the knee surgery.

Dr. Darrow: With this process of Prolotherapy there is a very good chance of building up enough collagen and cartilage so that you can walk around, hopefully pain free after a few series of injections.

It’s an amazing thing. You know any doctor that you go to will tell you that knee replacement is the way to go, and it seems silly to me to jump into a surgery when there is something else that can be done. Surgery is something, it seems to me, should be the last option, and it is very rare for someone to come to our clinic and then have to go onto surgery.