Dr. John Kennedy on the impact of nanoscopes in orthopedics, sports medicine

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John Kennedy, MD, chief of the division of foot and ankle surgery and professor in the department of orthopedic surgery at NYU Langone, performed an ankle debridement with a new visualization device at New York City-based NYU Langone in September. 

Developed by Arthrex, the NanoScope device allowed Dr. Kennedy to evaluate the cartilage repair as well as remove scar tissue and bone spurs from the ankle of a patient. 

NanoScope can also be used for orthopedic or endoscopic procedures in joints such as the knee, elbow, wrist and ankle.

Here, Dr. Kennedy discusses the advantages of nanoscopes or needle scopes, and the impact these devices will have on the field of sports medicine.

Question: NYU Langone Health's debut procedure with the NanoScope was an ankle debridement, which you successfully performed. How do you visualize this device developing in sports medicine?

Dr. John Kennedy: Needle scopes or nanoscopes allow visualization of joints and tendons under local anesthetic in an office or treatment room setting without the need for general anesthesia or large incisions. Until now it was difficult to get adequate visual clarity using needle scopes as the technology simply was not there yet. With the introduction of a 1.9mm miniscope we can now see with excellent clarity into joints and tendon sheaths in a bedside setting.

This will revolutionize how we diagnose and treat sports injuries in the future. While MRI is the gold standard in the diagnosis of soft tissue injury and cartilage injury, it is not always practical or easy for a patient to get an MRI and wait for the results before a diagnosis is made and treatment initiated. With the introduction of NanoScope, we can now make a clinical diagnosis and confirm this at the same setting in the office. Furthermore, we can also treat many of these intraarticular pathologies at the same sitting. In the sports world, ankle injuries are common; 2,700 ankle sprains occur every day and of these up to 14 percent will have a chronic ankle sprain and torn ligament, with a further 30 percent having some form of chondral or cartilage injury. 

While most ankle sprains resolve with physical therapy, many require surgical repair or replacement of the anterior talo-fibular ligament. Recent attention has focused on arthroscopic ligament repairs, but some concerns remain about nerve injury from multiple portals using standard arthroscopes. With a smaller needle scope, we can now perform this through tiny nano portals, avoiding nerves and minimizing soft tissue trauma.

Chondral injuries by their nature do not repair and therefore the ability to diagnose and treat these early on is enormously beneficial. For small chondral injuries in the ankle and knee we can now use biologic adjuncts to help protect remaining cartilage as well as stimulate a physiologic chondral grout hyaline like repair within small defects. All of this can be done using nano technology, in an expeditious fashion not requiring a formal operating room and reducing down time to accelerate recovery. In the sports world, anything that can accelerate time from diagnosis to return to play is crucial. Needle scopes can now see and do what we had to have larger arthroscopes for until now. 

Intraarticular pathology is just one area where Nano technology allows us to make speedier diagnosis and expedite treatment. Because of the small size of the needle we are now able to use this as a diagnostic tool in the office to look at tendon and tendon sheath. In the sports world, perineal tendon pathology is common. Often MRI can be inconclusive due to the magic angle effect. Using the needle or NanoScope we can access the perineal sheath easily and identify tears, inflammation and other pathologies. Dynamic pathologies including tendon subluxation and stenosis are not easily seen on MRI, while using the NanoScope, these are immediately visible and can be treated at the same sitting.

Achilles tendinitis can also be treated in the office or treatment room with the NanoScope where debridement of the paratenon and even resection of the planters is easily performed.

There is no doubt that as this procedure evolves, professional sports teams will have this equipment in their facilities to diagnose and treat where appropriate in an expeditious fashion. Nanoscopes will not take over the role for traditional arthroscopy nor open surgery where the pathology indicates. It will however expand the indications for minimally invasive therapies and as orthobiologics become more mainstream, their delivery can be facilitated by nano technology and needle arthroscopy.

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