From the Division of Rheumatology, Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI (ORCiD ID https://orcid.org/0000-0003-4715-4384 ).
Division of Rheumatology, Allergy and Immunology, Department of Medicine, University of California at San Diego, San Diego, CA (ORCiD ID: Orcid.com/0000-0003-0261-3102 ).
J Clin Rheumatol. 2022 Apr 1;28(3):177-181. doi: 10.1097/RHU.0000000000001802.
BACKGROUND/OBJECTIVE: Rheumatologists' interest in arthroscopy began before the 1980s, when many era practitioners began to take up the procedure in earnest. Some of the important players in pre-World War II explorations of arthroscopy were rheumatologists, and the father of modern arthroscopy Makei Watanabe counted many rheumatologists among his postwar students, who were publishing about arthroscopic insights into rheumatic conditions in the 1960s and 1970s. We chose to review this evolution to demonstrate the diverging interests of rheumatologists and orthopedists in arthroscopy and emphasize the chances for reconciliation and cooperation. Methods involve our personal recollection and review of the literature.
Guidelines for the practice of arthroscopy were published by the American Rheumatism Association (now the American College of Rheumatology) 7 years before similar guidelines appeared from the Arthroscopy Association of North America. American rheumatologists ceased arthroscopy when controlled trials showed no effect in osteoarthritis beyond placebo and biologics for synovitis virtually eliminated situations in which synovectomy might be considered. The research potential of arthroscopy has been realized mainly by European rheumatologists, although the ultrasound-guided biopsy is supplanting arthroscopy as means to secure synovium for investigation, despite the advantages of the latter, such as the ability to obtain larger amounts of tissue, select tissue based on macroscopic appearance, sample multiple area in the same joint, and deliver the potentially therapeutic effect of washout. New miniscopes suitable for office use could restore some of the lagging interest in arthroscopy for investigation. Orthopedists have generally been resistant to rheumatologists doing arthroscopy but would not be sharing any turf with rheumatologists using the miniscope.
We hope that we orthopedists and rheumatologists could be friends as we enter this new phase of arthroscopy as we use the technique for different purposes.
背景/目的：早在 20 世纪 80 年代之前，当许多时代的从业者开始认真研究关节镜技术时，风湿病学家就对关节镜产生了兴趣。在二战前探索关节镜的重要人物中，有一些是风湿病学家，现代关节镜之父渡边正（Makei Watanabe）在战后的学生中也有许多风湿病学家，他们在 20 世纪 60 年代和 70 年代发表了有关关节镜对风湿疾病的见解。我们选择回顾这一演变过程，以展示风湿病学家和骨科医生在关节镜技术方面的不同兴趣，并强调和解与合作的机会。方法包括我们的个人回忆和文献回顾。
美国风湿病学会（现为美国风湿病学院）在北美关节镜协会发布类似指南的 7 年前就发布了关节镜实践指南。当对照试验显示关节炎除了安慰剂之外，关节镜没有效果，生物制剂几乎消除了滑膜切除术可以考虑的情况时，美国风湿病学家停止了关节镜手术。尽管后者具有获取更大组织量、根据宏观外观选择组织、在同一关节的多个部位取样以及冲洗的潜在治疗效果等优势，但关节镜的研究潜力主要是由欧洲风湿病学家实现的，尽管超声引导活检正在取代关节镜作为获取滑膜进行研究的手段。适合在办公室使用的新型微型镜可以恢复一些对关节镜检查的滞后兴趣。骨科医生普遍对风湿病学家进行关节镜手术持抵制态度，但不会与使用微型镜的风湿病学家分享任何领域。
我们希望在进入关节镜技术的新阶段时，我们骨科医生和风湿病学家能够像朋友一样，因为我们使用该技术有不同的目的。
