Rigid endoscopy: arthroscopy | BSAVA Library

Rigid endoscopy: arthroscopy

image of Rigid endoscopy: arthroscopy
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The use of rigid endoscopy for joint surgery has been the standard in human and equine orthopaedics for over three decades. The use of arthroscopy in small animals for the treatment and diagnosis of joint diseases has increased dramatically in the last 10-15 years due to advances in equipment and techniques. Numerous benefits of arthroscopy have been cited, including improved viewing and magnification of lesions, decreased operative time, minimal joint trauma, and lower patient morbidity. There is, however, a considerable learning curve, and these advantages can only be achieved through practice and an understanding and correct selection of arthroscopic equipment. This chapter provides am introduction to small animal arthroscopy through its indications, ancillary procedures, instrumentation and current applications.

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13.1 Dedicated arthroscopic suite for minimally invasive surgical techniques.
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13.2 Arthroscope tip, showing the arrangement of components.
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13.3 1.9 mm, 2.4 mm and 2.7 mm arthroscopes.
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13.4 Field of view for a 2.7 mm arthroscope. The 2.4 mm arthroscope has a similar field of view.
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13.5 A 2.7 mm arthroscope plus protective cover, cannula and obturators. Sharp and blunt obturator tips.
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13.6 A basic arthroscopy instrument kit.
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13.7 Instrument cannulae for elbow and shoulder arthroscopy, with switching stick (top).
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13.8 A 2 mm 90 degree probe.
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13.9 Grasping forceps: locking and non-locking handles; locking forceps with grasping teeth for large fragment removal; a variety of tips; close-up of rat tooth tip.
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13.10 A 2.0 mm hand burr for curettage of cartilage and bone.
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13.11 Arthroscopic knives: hook; forward cutting.
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13.12 Hand pressure infusion cuff.
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13.13 Dr Fritz aiming device for triangulation of instruments.
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13.14 Four quarter draping of the right elbow for arthroscopy. Hanging limb for routine elbow arthroscopy used for preparation only. The limb is then laid parallel to the table for arthroscopic procedure.
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13.15 Impermeable drape used to prevent strikethrough.
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13.16 Multiarm positional aid and stifle brace for Multiarm attachment. (Courtesy of Veterinary Instrumentation, Sheffield)
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13.17 Shoulder joint. a = Humeral head; b = Subscapularis tendon; c = Medial glenohumeral ligament; d = Glenoid cavity.
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13.18 Model demonstrating the position of portals for shoulder arthroscopy. A = Arthroscope portal; E = Egress portal; I = Instrument portal.
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13.19 Normal arthroscopic anatomy of medial shoulder joint. a = Glenoid; b = MGHL; c = Subscapularis tendon; d = Humeral head.
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13.20 Normal caudal humeral head.
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13.21 Normal caudomedial gutter.
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13.22 Cranial compartment. Normal origin of biceps tendon and cranial joint capsule. Normal variant of biceps tendon. Bipartite biceps tendon.
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13.23 Lateral compartment. Origin of lateral glenohumeral ligament. Normal variant.
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13.24 Positioning of the patient for suspended limb shoulder arthroscopy. Note the position of the head to facilitate easy access to the craniomedial aspect of the shoulder. (Courtesy of C Deintt)
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13.25 OCD: lesion.
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13.26 OCD fragment being grasped. (Courtesy of B Van Ryssen)
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13.27 Incomplete ossification of the caudal glenoid.
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13.28 Subscapularis tear.
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13.29 A 3.0 mm Capsure probe being used to shrink the medial compartment of the shoulder joint.
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13.30 LGHL tear.
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13.31 Arthroscopic repair of a LGHL tear. Placement of the suture anchor. Advancement of the suture material into the joint, to ensure adequate visualization. A lasso is used to extract the suture through the capsular tissue.
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13.32 Transverse ultrasound image of the biceps tendon, showing a hypoechoic ‘core’ lesion.
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13.33 Arthroscopic view of the biceps, showing severe synovial hyperaemia.
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13.34 Normal biceps: with the shoulder in full flexion, the elbow cannot fully be extended. Ruptured biceps: the elbow can be fully extended.
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13.35 Partial rupture of the biceps tendon. Tenotomy using arthroscopic scissors. (Courtesy of B Van Ryssen)
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13.36 Model demonstrating the position of portals for elbow arthroscopy. A = Arthroscope portal; E = Egress portal; I = Instrument portal.
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13.37 Normal arthroscopic anatomy of the elbow: humerus and anconeal process; caudal trochlear notch; central trochlear notch; cranial trochlear notch; lateral coronoid process and radial head; and radial head and intercondylar fossa. CaTN = Caudal troachlear notch; CeTN = Central trochlear notch; CrTN = Cranial trochlear notch; H = Humerus; ICF = Intercondylar fossa; LCP = Lateral coronoid process; RH = Radial head.
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13.38 Varying degrees of pathology, from cartilage fissure to complete displacement of fragment, seen with fragmentation of the coronoid process.
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13.39 Synovitis associated with elbow pathology, in this case a displaced fragmented coronoid visible below inflamed synovium. The yellow discoloration of the bone is caused by necrosis.
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13.40 Non-displaced OCD lesion of the medial humeral head of the humerus.
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13.41 A non-displaced UAP.
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13.42 Significant medial compartment OA. Note the distinct demarcation between the medial and lateral compartments of the joint.
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13.43 Incomplete ossification of the humeral condyle. A circumferential cartilage defect can be seen clearly in the centre of the humeral condyle.
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13.44 Model demonstrating the position of portals for carpal arthroscopy. A1 and A2 = Represent alternative suggested arthroscope portal sites.
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13.45 Normal arthroscopic view of the antebrachial carpal joint. The radius is at the top, with the radiocarpal bone below.
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13.46 Cases of severe carpal synovitis can be investigated arthroscopically. (Courtesy of J Cook)
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13.47 Carpal chip fracture. Fracture . Fragment being removed using 2.7 mm grasping forceps. Power shaver being used to debride the carpal defect in the subchondral bone. (Courtesy of J Cook)
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13.48 Hip portals. Model demonstrating the position of portals for right hip arthroscopy. Clinical arthroscopy of the left hip (dorsal surface uppermost; head is to the left). A = Arthroscope portal; E = Egress portal; I = Instrument portal.
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13.49 Normal arthroscopic anatomy of the right coxofemoral joint. CaAR = Caudal acetabular rim; CaFH = Caudal femoral head; CrAR = Cranial acetabular rim; CrFH = cranial femoral head; JC = Joint capsule. AcF = Acetabular fossa; CaFH = Caudal femoral head; CaJC = Caudal joint capsule; FH = Femoral head; FN = Femoral neck; TL = Teres ligament.
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13.50 Septic arthritis in the hip of a dog presented for total hip replacement. (Courtesy of J Cook)
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13.51 Mildly displaced acetabular fracture with concomitant labral tear. (Courtesy of J Cook)
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13.52 Hyperplastic synovium. This may need removing in order to visualize the intra-articular structures.
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13.53 Placement of a disposable plastic egress cannula into the proximolateral pouch of the stifle. Femoropatellar joint space with the patella above. The egress cannula can just be seen on the left side of the image.
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13.54 Stifle prepared and draped for arthroscopy. Impermeable plastic drape used to prevent breakdown of asepsis.
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13.55 Model demonstrating position of portals for stifle arthroscopy. A = Arthroscope portal; E = Egress portal; I = Instrument portal.
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13.56 Origin of the long digital extensor tendon.
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13.57 Normal cruciate ligament. CaCL = Caudal cruciate ligament; CrCL = Cranial cruciate ligament.
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13.58 Flounce of normal medial meniscus (arrowed). Normal medial meniscus (arrowed).
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13.59 Medial meniscal caudal horn fold. The meniscus (M) appears normal until the joint is flexed. After the stifle is flexed the caudal horn (CH) is folded cranially. Treatment with radiofrequency ablation.
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13.60 stifle OCD lesion of the medial trochlear ridge. FC = Femoral condyle; OCD = OCD lesion.
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13.61 Models demonstrating portals for tarsal arthroscopy: dorsal tarsal portals; plantar tarsal portals. A1 and A2 = Represent alternative suggested arthroscope portal sites.
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13.62 OCD lesion on the lateral trochlear ridge. Synovitis secondary to an OCD lesion; the deep digital flexor tendon is to the left, lateral trochlear ridge to the right. (Courtesy of B Van Ryssen)
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13.63 Tarsal OA with full thickness cartilage loss and two visible wear lines.
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