73: Arthroscopy - Smith Flashcards
review anterior portal locations
*anterolateral (just lateral to peroneus tertius tendon)
anterocentral
*anteromedial (just medial to tibialis anterior tendon)
* 97% of arthroscopy can be done through these portals
review posterior portal locations
posteromedial
posterolateral
trans-achilles
indications for arthroscopy
- 25% of all diagnostic cases provide benefits
- get better just by looking around the jt - due to insulflation breaking up some ankle adhesions
- When there is absence of a diagnosis in a symptomatic ankle
- To evaluate chronic pain
- Trauma
- Non-traumatic
contraindications for arthroscopy
- local/systemic infection (septic joints are ok)
- ankylosis (no jt space)
- DJD with jt space narrowing
advantages of arthroscopy
- Early ROM
- Less morbidity Vs. Open surgery
- Less post-op recovery Vs. Open surgery
- No ligament damage
- Cost
noninvasive vs invasive ankle distraction
- Non invasive - literal pulling
- “Uncontrolled”
- Gravity
- Force
- “Semi-controlled”
- Guhl
- No more than 30# (135N)
- Relax every 30-40 minutes
- Dowdy et al
- Nerve conduction change with 1 hour
- “Uncontrolled”
- Invasive
- Indications
- Noninvasive Inadequate
- Ex-Fix with controlled distraction
- Contraindications
- RSD
- Open Physis
- Osteopenia
- Infection
- Disadvantages
- Risk of neurovascular damage
- Pin site infection
- Pin Failure
- Stretching of Ligaments
- Ligamentous disruption
- Inability to manipulate ankle positioning
- Indications
what is used to insulflate the joint?
marcaine
- put it in until you meet resistance
what is an open arthrotomy?
be prepared to open the jt if …
instrument breaks
something is too big to get through canula
don’t give arthroscopic privileges without arthrotomy priv
principles of arthroscopy
_****_
- Pistoning-Increases or decreases magnification (in and out)
- Rotation-Allows for an oblique view
- Sweeping - med/lateral motion
- Triangulation - knowing where things are in relation to your hands
synovectomy
chondroplasty
abrasion arthroplasty
- removing scarred, thickened, hypertrophic synovium, chronic or acute synovitis
- removing bits of cartilage
- power removal of soft cartilage spots, may even go subchondral
review the gutter anatomy
complications
- General
- Infection
- anesthesia
- thrombophlebitis
- Specific
- Compartment syndrome
- broken instruments
- nerve entrapment
- capsule tear and cartilage damage
post op management
- Day 1-5
- ROM (active and passive), NWB, RICE and NSAIDS
- Day 5-7
- First Dressing, ROM and WB to tolerance
- Day 10-14
- Suture removal, WB and physical therapy
encourage lots of movement!!
