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Musculoskeletal > Arthroscopy > Flashcards

Arthroscopy Flashcards

1
Q

What size of arthroscopes are typically used for small animal arthroscopy?

A

1.9mm, 2.3 or 2.4mm, and 2.7mm.

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2
Q

Label the following diagram.

A
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3
Q

What are the two working lengths of arthroscopes?

A

Short: 8.5 cm
Long: 13 cm

Short arthroscopes are easier to handle, and are appropriate for most small animal applications with the exception of the hip and shoulder joints.

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4
Q

What are the two types of connection styles between the arthroscope and camera?

A
  1. Clip-on.
  2. Direct coupling (threaded connection).
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5
Q

What are the functions of an arthroscopic cannula?

A

Maintenance of an arthroscopic portal, protection of the arthroscope, ingress of fluid.

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6
Q

Label the following instruments.

A
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7
Q

What is shown in the image?

A

Arthroscopic camera.

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8
Q

What are the types of light sources that can be used in small animal arthroscopy?

A

Xenon, halide and halogen.

Xenon is used most frequently as it has the greatest light intensity and higher color temperature. The downside of these lamps is that they may suddenly fail.

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9
Q

Label the following components of a scope tower.

A
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10
Q

What equipment is shown.

A
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11
Q

What are the roles of fluid irrigation during arthroscopy?

A

Provides a clear field of view, flushed the joint of debris and contamination, provides a tamponade effect to minimize bleeding.

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12
Q

What solution is ideal for use in lavage during arthroscopic procedures?

A

Lactated ringers solution may be more physiologic than saline (although both may cause chondrocyte death due to their isotonic osmolarity of 300 mOsm/L). Hypertonic fluids may have a chondroprotective effect but are not routinely used.

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13
Q

What is a reasonable starting pressure of a joint during arthroscopy?

A

60 mmHg.

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14
Q

How can egress be achieved during arthroscopy?

A

Permitting outflow through the instrument and arthroscopic portals or by inserting a specific egress instrument (may be blocked to pressure the joint if required).

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15
Q

Name the following instruments.

A
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16
Q

What instruments are shown?

A
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17
Q

What instruments are shown?

A
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18
Q

What instruments are shown?

A
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19
Q

What instruments are shown?

A

Arthroscopic curettes.

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20
Q

What instruments are shown?

A
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21
Q

What instrument is shown?

A

Arthroscopic micropick for microfracture

22
Q

What instrument is shown?

A

Arthroscopic probe with measuring marks

23
Q

Joint capsule collagen is primarily of what type?

A

Type 1

24
Q

What is the effect of use of radiofrequency probes on a joint capsule?

A

Denaturation of collagen and shrinkage of tissue (normally between 15-25%).

Has been reported for use in medial shoulder instability.

Used infrequently due to severe damage that may be caused to the cartilage, limited studies demonstrating long-term efficacy, challenges in providing protection to the denatured tissue post-operative as it regains strength.

25
Q

What instruments are shown?

A

Arthroscopic shaver tips. A, Radial shaver. B, Burr. C, Aggressive cutter.

26
Q

What instrument is shown?

A

Arthroscopic power shaver handpiece

27
Q

What instruments are shown?

A

Electrosurgery tips. A, Standard; B, arthroscopic.

28
Q

What is the disadvantage of intraarticular joint injections of local anesthesia following arthroscopy?

A

Potential chrondrotoxicity.

29
Q

What are two arthroscopic techniques that can be used to promote healing of full-thickness cartilage lesions?

A
  1. Abrasion arthroplasty: use of a burr to remove subchondral bone.
  2. Micropick: use of a micropick or awl to crack through the subchondral bone plate.

Both techniques encourage the formation of fibrocartilage rather than hyaline cartilage.

30
Q

What is the post-operative infection rate with arthroscopic surgery?

A

<1%.

Other complications are rare but may include; neuropraxia, increased pain, lameness, hematoma.

31
Q

Describe the portal positions for shoulder arthroscopy.

A
32
Q

Describe variations in arthroscopic portal placement dependent on the disease process of the shoulder?

A

Caudal instrument portal: OCD of the humeral head, treatment of soft tissue injury to the medial supporting structures (glenohumeral ligament, subscapularis).

Cranial instrument portal: diseases of the biceps tendon.

Medial camera portal: diseases of the lateral shoulder (glenohumeral ligament, lateral aspect of the joint capsule).

33
Q

Describe the structures of the normal canine shoulder during arthroscopy.

A
34
Q

What structures can be viewed by medial and lateral arthroscopy of the shoulder?

A

Lateral: medial glenohumeral (collateral) ligament, subscapularis muscle tendon, humeral head, glenoid, supraglenoid tubercle, tendon of origin of the biceps brachii muscle, joint capsule, and caudal joint pouch.

Medial: lateral collateral ligament, humeral head, glenoid, supraglenoid tubercle, tendon of origin of the biceps brachii muscle, and joint capsule.

35
Q

What size arthroscopes are typically used for elbow arthroscopy?

A

1.9 or 2.3/2.4 mm.

2.7mm carries a higher risk for iatrogenic damage to the joint.

36
Q

Describe the portal positions for elbow arthroscopy.

A

Arthroscope portal is distal and slightly caudal to the medial epicondyle.

The instrument portal is 1-2 cm cranial to the arthroscope portal, caudal to the medial collateral ligament.

37
Q

What structures can be visualized during elbow arthroscopy?

A

Medial and lateral portions of the coronoid process, medial collateral ligament, radial head, anconeal process, trochlear notch, and humeral condyle

38
Q

Is it normal for the central portion of the trochlear to be devoid of cartilage during arthroscopic examination of the elbow?

A

Yes. The underlying bone is smooth and different in color compared to patients affected by cartilage injury.

39
Q

What size arthroscope is typically used for carpal arthroscopy?

A

1.9mm.

Typically placed lateral or medial on the dorsal aspect of the joint.

40
Q

What structures of the carpus can be commonly view arthroscopically?

A

Distal articular surfaces of the ulna and radius, and the ulnar carpal bone, intermedioradial carpal bone, accessory carpal bone, palmar radiocarpal ligament, palmar ulnocarpal ligament, and synovium.

41
Q

What is the most common indication for hip arthroscopy?

A

Assessment of cartilage and soft tissue disease before DPO or TPO.

42
Q

What are the portal locations for arthroscopy of the hip joint?

A
43
Q

What structures can be observed in arthroscopy of the hip joint?

A

Ligament of the head of the femur, femoral head, acetabulum, acetabular labrum, transacetabular ligament, and joint capsule.

44
Q

What are the two arthroscopic techniques for stifle evaluation based on portal number?

A

Two or three portal techniques.

The three portal technique results in less fluid extravasation than the two portal system. However, placement of the dedicated egress portal is associated with iatrogenic cartilage damage.

45
Q

What structures can be visualized during stifle arthroscopy?

A
46
Q

What are two intra-articular instruments that can be used in maintain the stifle in tibial thrust to facilitate viewing of the menisci during stifle arthroscopy?

A
  1. Ventura stifle thrust lever.
  2. Canine stifle distractor.
47
Q

What instrument is shown?

A

Stifle distractor.

48
Q

What instrument is shown?

A

Leipzig stifle distractor. Pins are placed in the proximal end of the tibia and distal end of the femur to facilitate distraction of the stifle.

These distractors are somewhat invasive and morbidity has been associated with their use.

49
Q

What size arthroscope is typically used for arthroscopy of the tarsus?

A

1.9mm. Typically performed through plantar portals (although dorsal portals can also be used).

50
Q

What structures can be evaluated during arthroscopy of the tarsus?

A

Distal end of the tibia and trochlea of the talus.

51
Q

What percentage of movement of the tarsus occurs at the tarsocrural joint?

A

90-95%

Musculoskeletal (38 decks)

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