Endoscopic surgery of the limbs.

Creation of a space to work in is necessary for endoscopic surgery.In orthopedics, the joints have long been the privileged sites of arthroscopictreatment. However, subacromial decompression or theendoscopic treatment of carpal tunnel syndrome have been used formany decades and have shown that it is possible to work outside ofthe articulations. At the end of 2003 we held a symposium with theFrench Society of Arthroscopy to better define the possibility ofendoscopic surgery outside of the joints in orthopaedic practice.These techniques are rarely practised and, in general, fewer than 10surgeons have more than an anecdotal experience. However, webelieve that these techniques, rather than being isolated and withouta future, are the beginning of a new era. Extra-articular endoscopyis only part of the development of mini-invasive surgery. The endoscopeis the technical means to control and/or realize less invasiveprocedures, believed to lessen morbidity.To date, one can split these techniques into two groups. The firstand easiest for the orthopaedist to understand contains the extraarticulardiseases that are treated through an intra-articular approachas, for example, the treatment of synovial cysts or lateralepicondylitis (tennis elbow). The second is a true endoscopic techniquein which the surgeon works either in real anatomical spaces(tendinous sheaths (tendinoscopy of the ankle), bursae (treatment ofhygromas, Haglund’s disease, bursitis, snapping scapula,...) or hasto create de novo, a space to work in, as in the treatment of plantaraponevritis or chronic compartment syndromes.We present the potential use of extra-articular endoscopy in orthopaedicsurgery but, except for plantar aponevritis, the real indicationsfor these techniques, in comparison with classic open surgery,are yet to be defined.