Following the success of the Watanabe Type 21, various surgeons sought to develop both surgical techniques to take advantage of the new technology, as well as new technologies to facilitate new surgical possibilities. Before the arthroscopic stack arrived at its current state, various early instruments were developed. Some of these still exist in some form.
A few of the developmental instruments from Dr. Robert W. Jackson’s collection are shown here.
The O’Connor Operating Arthroscope, manufactured by Wolf, in use. (O’Connor and Shahriaree 1984, 115)
The O’Connor Operative Arthroscope (c. 1970s)
The O’Connor operative arthroscope was the first of several similar instruments that emerged during the early 1970s only to be mostly abandoned by about a decade later. These were attempts to modify the arthroscope with a port to allow surgical tools to be used within direct view of the operator.
The O’Connor Operative (also called “Operating”) Arthroscope was invented by Dr. Richard L. O’Connor in 1974. His design, developed in collaboration with the Wolf Manufacturing Company of Germany, featured an offset eyepiece and a 3 mm port (later enlarged to 3.4 mm) channel into which specially designed tools could be inserted. The design was in the prototype phase in 1976 and was likely first produced shortly after that. The original instruments had a 3 mm channel.
This arrangement had obvious advantages. A single incision would accommodate both the surgical tools and the arthroscope while the surgeon could easily manage both. The tool tip was always in view. On the other hand, the port reduced the amount of fiber optic illumination on the arthroscope’s tip. The hollow channel resulted in a relatively wide instrument that could use only very narrow tools.
By about a decade later, the trend towards specialized operative instruments was fading as experience with arthroscopic surgery increased and the skill of triangulating the position of lens and tool, applied through the double puncture technique, became standard practice. This was facilitated by the increasing use of video in the operating room.
The Storz Operative Arthroscope (c. 1970s)
This Storz arthroscope is an example of an operative instrument that followed the O’Connor arthroscope. It was likely adapted from an existing ureteroscope. The 45° angle of the eyepiece relative to the operating angle proved disorienting to some. This model was later updated to reposition the eyepiece at the operating angle. This updated version had a horizontal offset like the O’Connor and Eder operating arthroscopes.
Instruments like the Storz and O’Connor/ Wolf arthroscope represent an early point in the entry of the incumbent endoscope manufacturers into the arthroscope market. Such instruments had advantages over the earlier Watanabe Type 21 arthroscopes, including the fact that they were autoclavable and featured fibre optic illumination.
The Dyonics Needlescope (c. 1970s)
Introduced in 1973, the Needlescope from Dyonics, Inc. of Woburn, Mass. had a very narrow lens of either 1.7 mm or 2.2 mm outside diameter. It gained a wide following among North American arthroscopists.
This instrument shared a common origin with the Watanabe Type 21 arthroscope. With the success of that earlier instrument in the 1960s, Watanabe experimented extensively with ways to create a narrower instrument that could be used on joints other than the knee. He experimented with fibre optics but found the image quality unsatisfactory.
In 1968, the Selfoc (“self focussing”) material was developed in Japan. This was a GRIN (gradient-index) lens made for laser applications that allowed for excellent light transmission along a very narrow glass rod. In 1970, Watanabe introduced the Type 24 Selfoc arthroscope.
The Type 24 introduced the same outside diameters as the later Needlescope. Dyonics sourced its Selfoc lenses from the same Japanese supplier. Watanabe applied the Type 24 to joints such as the elbow, wrist, ankle, and hip, releasing his textbook Arthroscopy of Small Joints in 1985. Meanwhile, Dr. Lanny Johnson of Lansing Michigan successfully developed the Needlescope as a less invasive means of inspecting the knee under local anesthesia, leading to its widespread adoption.
Use of the needlescope for diagnostic purposes declined with the increased use of video displays, which required larger arthroscopes that could produce brighter images.
Hall Arthrotomes (c. 1980s)
The first motorized instrument for arthroscopy, the Intra-articular Shaver System, was introduced by Dyonics Inc. in 1976. Other manufacturers followed with their own motorized systems. These, along with a growing number of interchangeable blades, greatly facilitated the development of arthroscopic surgical technique.
This Hall Arthrotome was likely introduced in the mid-1980s. There are several similar Hall motorized instruments in the Jackson Collection, including the examples shown in the OOA exhibit. One was a cutaway instrument, likely created for a commercial display. The other was a standard instrument that has been customized with Jackson’s signature. Both probably indicate that Jackson was a consulting surgeon involved in the development of the system.