Ch 71 Arthroscopy Flashcards
What are the general working length of short and long arthroscopes?
Short - 8.5cm
Long 13cm
Name the following parts
A - eyepiece
B - light post
C - Telescope
What are the light source options?
Xenon
Halogen
metal halide
Xenon most common, increased intensity, higher colour temp and therefore greater visual clarity and colour rendition
What are some research findings regarding irrigation fluid type?
- LRS may be more physiology for cartilage with fewer negative effects on meniscus than saline
- Isotonic solutions (300mOs/L) are actually hypotonic to joint fluid which could increase chondrocyte death.
- Initial evidence the hyperosmolar fluids (up to 600mOs/L) may have chondroprotective effects
Name the following instrument
Pointed grasping forceps without end teeth
Name the following instrument
Arthroscopic punch forceps
Name the following instrument
Arthroscopic curettes
Name the following instruments
Arthroscopic Knives
- A - Hook knife
- B - Meniscal push knife
- C - Bayonet knife
- D - Handle
Name the following instrument
Arthroscopic micropick for microfracture
Name the following instruments
Arthroscopic shaver tips
- A - Radial shaver
- B - Burr
- C - Aggressive cutter
Abrasion arthroplasty remove subchondral bone until bleeding
Name the following instruments
Stifle distractors
- Top - Ventura Stifle Thrust Levers
- Bottom - Canine Stifle Dsitractor
Name the following instrument
Leipzig stifle distractor
What is the post-op infection rate with arthroscopy?
Less than 1%
What is the recommended starting pressure for irrigation fluids?
60mmHg
cannula
- maintenance of the arthroscope portal,
- protection of the arthroscope,
- ingress of fluid
Cannulas are inserted into the joint with the aid of a blunt obturator
Anesthesia and Analgesia
Regional or local (intra-articular) analgesia
Numerous studies, including in vitro and in vivo, have consistently demonstrated chondrotoxicity of local anesthetics when used alone or in combination with corticosteroids.
complications (7)
- fluid extravasation
- neurapraxia,
- increased pain,
- lameness,
- hematoma formation
- infection
- need to to convert to open
Arthroscopy of the Shoulder Joint
lateral arthroscope portal:
- medial glenohumeral (collateral) ligament Y-shaped,
- subscapularis muscle tendon,
- humeral head,
- glenoid,
- supraglenoid tubercle,
- tendon of origin of the biceps brachii muscle,
- joint capsule
- caudal joint pouch
switch sticks from lateral to medial
Arthroscopy of the Elbow Joint
- medial and lateral portions of the coronoid process,
- medial collateral ligament,
- radial head,
- anconeal process,
- trochlear notch,
- humeral condyle
arthroscopic-assisted fracture repair
Arthroscopy of the Carpus
limited to the antebrachiocarpal joint.
Arthroscopy of the Hip Joint
assessment of cartilage and soft tissue disease before double or triple pelvic osteotomy
Arthroscopy of the Stifle Joint
- three-portal method, the stifle joint is not distended, obturator advanced caudal to the patella and proximally
- 3 portal: less fluid extravasation from canine cadaveric
- two-portal technique, the joint is infused with irrigation fluid
- fat pad removal shaver is used on oscillation mode at a speed of approximately 1500 rpm
- caudal aspect of the patella, trochlear groove and ridges, medial and lateral joint pouches, long digital extensor muscle tendon, medial and lateral femoral condyle, intercondylar eminence, and medial and lateral menisci
- Viewing of the menisci is the most challenging part of basic arthroscopy (orcing the joint into valgus, into cranial draw, use a distractor)
- gelpi like distractor: One study demonstrated an average increase of 2.6 mm between the tibial and femoral surfaces, possible iatrogenic damage
Arthroscopy of the Tarsus
30-degree oblique arthroscope of 1.9 mm
Evaluation of Canine Shoulder Arthroscopy for
Anatomical and Safety Considerations
Emily J. Kennedy 2024
Muscular lesions included the deltoideus, cleidobrachialis, omotransversarius,
supraspinatus, infraspinatus, and teres minor muscles. The neurovascular structures
identified were the omobrachial vein, the caudal circumflex humeral artery,
axillobrachial vein, and branches of the axillary nerve. Lesions to the lateral glenohumeral
ligament were noted from the caudal instrument portal and the middle
arthroscope portal. Iatrogenic articular cartilage injuries were identified on the caudal
humeral head and the glenoid.
Quantification of the Field of View for Standard
Lateral Arthroscopy of the Canine Shoulder
Sarah N. Holman 2024
Fifty-eight percent of the cranial border of themedial glenohumeral ligament
was within the arthroscopic view. At a standing angle, 48% of the intra-articular length
of the biceps tendon was within the arthroscopic view, compared to 63% with the limb
flexed. Twenty percent of the subscapularis tendon was within the arthroscopic view.
Conclusion A significant portion of the biceps tendon and medial stabilizing structures
of the canine shoulder are outside the field of view
biceps tendon visible by arthroscopy would be
significantly greater with the shoulder positioned in flexion
Evaluation of a small-bore needle arthroscope for diagnosis and treatment of medial coronoid disease in dogs: a pilot study with short-term assessment
Garnier 2023
firstly assessed in a preliminary cadaveric study
prospectively recruited 15 dogs
width 1.9mm with 2.2 mm cannula (1mm too small/poor image), 0 degree
Needle arthroscopy-assisted removal of osteochondral fragments was
performed in all dogs with satisfactory short-term clinical outcome. NA is a feasible
technique for diagnosis and lesion assessment in dogs with a fissured or fragmented
coronoid process
STudies; in dogs for the assessment of medial shoulder
instability and exploration of elbow joints (both cadaveric and clinical cases) with medial coronoid disease
its small size
and relative flexibility along with the lighter and less
cumbersome hand-piece facilitate its insertion and
manipulation into the joint.
Comparison of needle arthroscopy, traditional arthroscopy, and computed tomography for the evaluation of medial coronoid disease in the canine elbow
Hersh-Boyle 2021
Still images of NAR, STAR, and CT had similar diagnostic value to identify MCP fissures. Still images of TAR was superior to SNAR and CT to identify MCP fragments.
Clinical significance
The diagnostic accuracy of SNAR varied on the basis of the coronoid lesion being evaluated.
Arthroscopic Caudal Cruciate Ligament Damage
in Canine Stifles with Cranial Cruciate Ligament
Disease
Agnello 2022
117 stifles
Caudal cruciate ligament tearing was identified in 94% of stifles. Longitudinal
tearing (76%) was the most common type of damage (45% partial, 31% full thickness).
possibly synovitis is likely a contributor to CdCL injury.
previous experimental study demonstrated significant alterations
in the morphology of the CdCL in the cranial cruciate
ligament deficient stifle, exhibited by degenerative changes
in the histologic appearance, as well as a change in the
diameter pattern of the CdCL collagen fibrils.6 These changes
have been suggested to be due to stifle instability and/or
enzymatic degeneration from the joint synovitis.
This portion of the CdCL therefore is not exposed to the
synovial membrane or synovial fluid and subsequently
appears to be spared from damage as compared with the
rest of the CdCL.
α2-agonists are used in combination
with local anesthetics to perform peripheral nerve blocks, providing a
useful adjunct, because they prolong sensory and motor blockade,
compared to local anesthetics alone
Di Salvo et al. (2016) demonstrated that the exposure of canine chondrocytes to 0.5% lidocaine produced no significant
reduction in cell viability in vitro;
Arthroscopic Articular Cartilage Scores of the
Canine Stifle Joint with Naturally Occurring
Cranial Cruciate Ligament Disease
Agnello 2021
120 joints
Cartilage pathology and synovitis were identified in all joints. Overall cartilage
severity scores were low (median MOCS 1). The median MOCS of the proximal
trochlear groove (2)
Iatrogenic cartilage injury associated with the use of
stainless-steel cannulas and silicone-guarded cannulas
for canine stifle arthroscopy
Cortés 2019
Ex vivo canine cadaver experimental study. trimmed ET tube as guard
Animals: Paired canine stifles from 14 cadavers
Unguarded arthroscopy resulted in more total IACI per joint and larger IACI area
Silicone-guarded arthroscope cannulas decreased IACI number and
size during canine cadaveric stifle arthroscopy
most appeared to be partial thickeness
In conclusion, the use of a laterally placed Leipzig stifle
distractor in canine
stifle joints with a suspected lateral meniscal pathology can
improve the diagnosis and treatment of this pathology in stifle
joints with an intact CCL.
Observer Variability of Arthroscopic Cartilage Grading
Using the Modified Outerbridge Classification System
in the Dog
Deweese 2019
Fifty arthroscopic videos
The overall inter-and intra-observer variability showed fair and substantial strengths of agreement,
respectively. The most extreme scores of 0 and 4 had the best, middle scores of 1, 2 and 3 had decreased strengths of agreement.
Experience of the observer increased the strength of agreement between the scores
.
Clinical Significance The modified Outerbridge classification system is an acceptable
method for the evaluation of canine cartilage. Observer agreement is improved if the
observer has experience
Comparison of iatrogenic articular cartilage injury in canine stifle
arthroscopy versus medial parapatellar mini-arthrotomy in a
cadaveric model
Cleo P. Rogatko
Paired canine stifles from 14 cadavers
Arthroscopy resulted in greater IACI than mini-arthrotomy, including incidence of IACI, number of IACI per stifle and IACI area
Visualization of articular structures was incomplete in 14/14
mini-arthrotomy stifles and 1/14 arthroscopy stifles
Arthroscopy with meniscal probing is the gold standard for the diagnosis
of medial meniscal pathology,1-3 with a low complication
rate and low postoperative morbidity.1-3 In contrast, canine
stifle arthrotomy is more invasive and less diagnostically
sensitive.1
arthrotomy offers advantages in setup time, and
requires less expensive equipment and specialized training.
1,2,5 The mini-arthrotomy may be preferred to the full
arthrotomy due to preservation of the quadriceps muscles,
suggesting less postoperative morbidity,6 and may reduce the
risk of postoperative medial patellar luxation.7 However,
the veterinary literature lacks consistent data regarding the
benefits and complications of the mini-arthrotomy, as well as
comparisons to arthroscopy.
Complete regeneration of articular cartilage in partial
thickness cartilage wounds has not been reported.8-11 In contrast,
lesions which penetrate the subchondral bone are accessible
to reparative cells from the marrow, and can fill by
ingrowth of fibrous tissue, fibrocartilage, or hyaline cartilage.
1
investigators discovered that
performing a medial arthrotomy as the sole (sham) procedure
on normal stifles resulted in osteoarthritis and degenerative
study: arthroscopy alone sequele?
importance in already OA joint?
medial shoulder joint instability
A grading system for this spectrum of MSI has
recently been described.8,12 According to this system,
grade 1 (mild MSI) = laxity without gross tearing of the
MGL or SST; grade 2 (moderate MSI) = partial tear of
the MGL, SST, or both; grade 3 (severe MSI) = complete
tear of the MGL, SST, or both; and grade 4 (luxation) =
complete displacement of the humeral head in relation
to the glenoid cavity
arthroscopy: verification of damage to the MGL, SST, joint capsule,
or a combination of these structures
