Arthroscopy is one of the most transformative techniques in orthopedic surgery. From managing sports injuries to treating complex joint pathologies, its minimally invasive approach offers faster recovery, improved patient satisfaction, and better visualization of intra-articular structures. However, the art of arthroscopy is not mastered overnight.
For orthopedic fellows, the ability to confidently perform a core set of arthroscopic procedures is non-negotiable. These surgeries form the foundation of modern-day sports medicine and joint preservation.
In this article, we break down the key arthroscopic procedures that every orthopedic fellow should aim to master during their training—along with why they matter, how they’re done, and the skills needed to execute them with precision.
What Makes a Procedure “Common” in Arthroscopy?
In fellowship-level training, “common” procedures aren’t just about frequency—they’re about clinical impact. These procedures are:
- Performed routinely across hospitals and private clinics.
- Relevant for treating high-demand patients, such as athletes.
- High yield for diagnostic and therapeutic purposes.
- Foundational for learning more complex techniques.
Understanding these procedures enables fellows to build technical confidence and clinical judgment, both of which are essential for independent practice.
Core Arthroscopic Procedures by Joint
Arthroscopic Knee Procedures
1. Meniscectomy and Meniscus Repair
These are arguably the most frequently performed knee arthroscopies.
Why it’s essential: Meniscus injuries are common in both young athletes and older adults.
What to master:
- Diagnosing tear types (horizontal, vertical, radial, bucket-handle).
- Selecting repair vs. partial meniscectomy.
- Suturing techniques (inside-out, outside-in, all-inside).
Fellowship tip: Prioritize learning when to preserve tissue. Meniscus preservation reduces long-term osteoarthritis risk.
2. ACL Reconstruction
This is a defining procedure in any arthroscopic training program.
Why it’s essential: ACL injuries are prevalent, and poor surgical technique can compromise knee stability.
What to master:
- Tunnel positioning (anatomic footprint).
- Graft selection (hamstring, BTB, quadriceps).
- Fixation options (interference screws, suspensory fixation).
Fellowship tip: Focus on understanding rotational control. Poor tunnel positioning is the number one cause of failure.
3. Cartilage Microfracture or Chondroplasty
Why it matters: Focal cartilage defects are common and can progress to early arthritis.
What to master:
- Differentiating full-thickness from partial defects.
- Performing controlled microfracture with awl or pick.
- Debriding unstable flaps while preserving healthy cartilage.
Arthroscopic Shoulder Procedures
1. Rotator Cuff Repair
Why it matters: Rotator cuff tears affect overhead athletes and elderly patients alike.
What to master:
- Identifying tear patterns (U-shaped, L-shaped, massive).
- Single-row vs. double-row repair techniques.
- Mobilization and footprint restoration.
Fellowship tip: Learn how to deal with retracted tears and poor tendon quality—common in chronic cases.
2. Labral Repair (Bankart and SLAP)
Why it matters: Shoulder dislocations in young, active individuals require stabilization procedures.
What to master:
- Portal positioning and labrum preparation.
- Suture anchor placement (3-6 o’clock positions).
- Capsular plication techniques for instability.
Fellowship tip: Practice instrument handling in tight working spaces of the anterior glenohumeral joint.
3. Subacromial Decompression & Bursectomy
Why it matters: A routine procedure for impingement syndrome.
What to master:
- Proper scope navigation in the subacromial space.
- Acromioplasty for flat vs. hooked acromion.
- Cautery vs. shaver technique for bursa removal.
Arthroscopic Hip Procedures
1. Femoroacetabular Impingement (FAI) Correction
Why it matters: FAI is increasingly diagnosed in young athletes and dancers.
What to master:
- Performing CAM and pincer resections.
- Dynamic assessment of hip ROM after osteoplasty.
- Labral preservation strategies.
Fellowship tip: Use fluoroscopic guidance and be cautious of over-resection.
2. Hip Labral Repair
What to master:
- Small joint access (especially challenging in deep hips).
- Suture anchor deployment in confined spaces.
- Capsulotomy and closure techniques.
Ankle Arthroscopy Procedures
1. Anterior Impingement Release
Why it matters: Anterior ankle pain from scar tissue or bony impingement limits performance in runners and soccer players.
What to master:
- Portal placement and orientation (anteromedial/anterolateral).
- Resection of osteophytes.
- Debridement of hypertrophic synovium.
2. Debridement for Osteochondral Defects
What to master:
- Identifying lesion extent using probing and imaging.
- Microfracture or fragment fixation techniques.
Elbow Arthroscopy (Advanced)
While less common, elbow arthroscopy is valuable for:
- Loose body removal.
- Synovectomy for rheumatoid arthritis.
- Debridement in lateral epicondylitis.
Due to proximity to neurovascular structures, it’s best performed under close supervision until the fellow gains confidence.
Technical and Cognitive Skills Fellows Build
Mastering these procedures helps fellows develop:
- Intra-articular orientation skills (crucial for depth perception and spatial judgment).
- Decision-making on repair vs. reconstruction.
- Comfort with advanced instruments (radiofrequency, shavers, suture passers).
- Patient communication regarding recovery timelines and rehab protocols.
Fellowship Training Makes the Difference
While theoretical knowledge is helpful, actual mastery comes only with:
- Repetition under supervision.
- High case volumes.
- Exposure to different patient demographics and pathologies.
- Regular feedback from experienced mentors.
Programs like Arthroscopy College by Dr. Manu Bora stand out because they emphasize high-volume surgical experience, structured teaching modules, and hands-on learning—making sure fellows don’t just observe but actually operate.
Conclusion
A good arthroscopy fellow is not measured by how many procedures they’ve seen—but by how many they’ve truly mastered. The core arthroscopic procedures outlined above are more than just checkboxes. They’re your gateway to becoming a confident, competent orthopedic surgeon who can make a real difference in patients’ lives.
If you’re committed to building a strong foundation in arthroscopy, seek a fellowship that prioritizes mentorship, hands-on training, and real-world surgical exposure. Explore the Arthroscopy Fellowship Program at Arthroscopy College to take your surgical skills to the next level.
