Needle arthroscopy of the knee with synovial biopsy sampling: Technical experience in 150 patients

Needle arthroscopy is an office-based technique allowing direct visualisati on of the knee cavity and selective sampling of the synovial membrane. We p erformed needle arthroscopy in 150 patients with synovitis of the knee (1) to evaluate the diagnostic potential in early arthritis, (2) to perform the rapeutic lavage in persistent: inflammatory synovitis and (3) to assess the balance between technical feasibility, safety and patient comfort on the o ne hand, and the relevance of the obtained macro- and microscopic informati on for diagnosis and research purposes on the other. After disinfection of the leg and local anaesthesia of the skin and joint, a 1.8-2.7 mm needle ar throscope was introduced into the knee. Synovial fluid was aspirated and la vage of the joint cavity was performed to allow macroscopic evaluation of h yperaemia and hypertrophy of the synovial membrane. Biopsies were taken at inflamed sites, followed by another lavage to remove blood and debris. Need le arthroscopy of the knee is a simple and easy to pet-form technique made particularly attractive by the local anaesthesia and the ambulatory setting . It allows good macroscopic evaluation of synovial inflammation and select ive sampling of the synovial membrane. Biopsies are suitable for RNA and DN A extraction, bacterial or lymphocyte culture, and cell isolation. Because samples were sometimes too small for representative histology, we switched from a 1.8 mm to a 2.7 mm biopsy forceps with good results. In nearly all c ases the arthroscopy was well tolerated. Moreover, some patients reported r elief of symptoms and even improvement of mobility after lavage of the infl amed joint. No major complications were noted. It was concluded that needle arthroscopy of the knee is a simple, safe and well-tolerated technique, wi th promising perspectives as a diagnostic, scientific and possibly therapeu tic tool in rheumatic diseases.