Diagnosis, Indications, Complications, and Technical Considerations for In-office Needle Arthroscopy: A Scoping Review

Purpose Review the diagnostic and therapeutic indications, complications, and technical considerations for the use of In-office needle arthroscopy (IONA). Methods Authors conducted a scoping review using PubMed, Cochrane, and EMBASE evaluating IONA studies published between June 2013 and October 2024. Inclusion criteria were primary literature written in English assessing diagnostic capability, functional outcomes, or patient-reported outcomes. Qualitative analysis of technical reports assessed the pearls, pitfalls and step-by-step guides to performing IONA. Case reports, reviews, infographics, cost-effectiveness, cadaveric, animal, and operating room use of arthroscopy studies were excluded. Diagnostic capability, procedure length, clinical outcomes and technical considerations were evaluated. Results The search yielded 143 results, 29 of which (8 clinical outcome studies, 21 technical reports) met inclusion criteria, covering the shoulder, knee, foot/ankle joints. Level of evidence ranged from IV-V. IONA was used to diagnose intra-articular pathology pertaining to long head of the biceps tendinopathy, full thickness osteochondral defects of the femoral condyle, meniscus tears, Achilles tendinopathy, and anterior/posterior hindfoot pathologies. IONA procedures included: biceps tenotomy, medial meniscal repair, anterior talofibular ligament repair, ankle impingement debridement, first metatarsophalangeal joint cheilectomy, Achilles and peroneal tendoscopy, and intra-articular lavage. Multiple studies reported post-operative improvements in clinical outcome measures, including the visual analog scale, Foot and Ankle Outcome Score, Tegner Lysholm Knee Scoring Scale, and PROMIS pain and function domains. Several studies reported high patient satisfaction and return to activity following IONA. Conclusion The current literature on IONA consists predominantly of Level IV-V evidence, including small case series and technical reports. While available studies suggest IONA is technically feasible and may be associated with short-term improvements in patient reported pain and functional outcomes in select indications, the absence of comparative trials, standardized outcome reporting, and long term follow up limits definitive conclusions regarding safety, effectiveness, or superiority to conventional arthroscopy or advanced imaging.