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 Pietro Randelli
David Dejour
C. Niek van Dijk
Matteo Denti
Romain Seil Editors

Arthroscopy
Basic to Advanced

123
Arthroscopy
Pietro Randelli • David Dejour
C. Niek van Dijk • Matteo Denti
Romain Seil
Editors

Arthroscopy
Basic to Advanced
Editors
Pietro Randelli Matteo Denti
San Donato Milanese Istituto Clinico Humanitas
Milano Rozzano
Italy Milan
Italy
David Dejour
Lyon Romain Seil
France Clinique d’Eich
Centre Hospitalier Luxemburg
C. Niek van Dijk Luxemburg
Academic Medical Centre Luxembourg
Orthopedic Surgery
Univ of Amsterdam
Amsterdam
The Netherlands

ESSKA ASBL
Centre Médical
Fondation Norbert Metz
76, rue d’Eich
1460 Luxembourg
Luxembourg

ISBN 978-3-662-49374-8 ISBN 978-3-662-49376-2 (eBook)

DOI 10.1007/978-3-662-49376-2

Library of Congress Control Number: 2016939390

© ESSKA 2016
This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or
part of the material is concerned, specifically the rights of translation, reprinting, reuse of
illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way,
and transmission or information storage and retrieval, electronic adaptation, computer software,
or by similar or dissimilar methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this
publication does not imply, even in the absence of a specific statement, that such names are
exempt from the relevant protective laws and regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information in
this book are believed to be true and accurate at the date of publication. Neither the publisher nor
the authors or the editors give a warranty, express or implied, with respect to the material
contained herein or for any errors or omissions that may have been made.

Printed on acid-free paper

This Springer imprint is published by Springer Nature

The registered company is Springer-Verlag GmbH Berlin Heidelberg
Preface

Dear colleagues and friends,

Arthroscopy represents a powerful tool in the diagnosis and treatment of a
huge range of orthopedic diseases, becoming day by day more indispensable.
The development of newly arthroscopic techniques allows a better treat-
ment of our patients with enormous benefits like pain reduction and faster
recovery thus promoting a standard of care that needs to be reached
worldwide.
In order to spread this knowledge as much as possible, the ESSKA board
has decided to work for 4 years in the creation of this book. The aim of this
collection of precious chapters has been to provide the “state of the art” about
all available arthroscopic techniques divided per joint.
Some of the most important arthroscopists from different regions of the
world have contributed to this book, and I would like to thank these leaders
for their precious work.
I would like to quote as well all the editors of the book, for their sustain,
and especially David Dejour and Niek Van Dijk, for their help to collect and
review the papers of the knee and ankle sections, respectively.
All members of my team deserve to be thanked, especially Paolo Arrigoni
and Davide Cucchi who worked very hard on this project.
From the production point of view, I would like to thank Mrs. Gabriele
Schroeder and Mr. Claus-Dieter Bachem from Springer, for their support in
the achievement of such a huge work.
I think that all the readers will be able to take advantage of this book in
their daily practice and that this work will deserve to be quoted as a master-
piece in the field.
This book is dedicated to our families and friends who have made possible
to all authors and editors to spend days and weeks to create this book without
feeling guilty about the time we spend away from them.

Milano, Italy Pietro Randelli

v
Contents

Part I General Content

1 History of Arthroscopy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Lars Goebel and Henning Madry
2 Surgery Set-Up, Instrumentations
and Electronic Equipment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Pietro Simone Randelli and Davide Cucchi
3 Standard Operative Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Petri Sillanpää, Paolo Arrigoni, and Davide Cucchi
4 Regional and General Anesthesia, Pain
and Bleeding Control in Shoulder Arthroscopy
and Upper Limb Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Paolo Grossi, Emilio Grilli, and Simone Repaci
5 Common Nerve Blocks of the Lower Limb . . . . . . . . . . . . . . . . . 59
Andrea Tognù, Daniele Genco, Luca Josca,
Stefano Giarratana, and Paolo Grossi

Part II Knee
David Dejour

6 Knee Arthroscopy: General Setup, Portal Options,

and How to Manage a Complete Arthroscopic
Investigation. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Nicolas Pujol and Philippe Beaufils
7 Traumatic and Degenerative Meniscus Lesions:
Diagnosis and Classification. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79
Michael Hantes, Vasilios Raoulis, and Roland Becker
8 The Role of Meniscectomy in the Treatment
of Traumatic Meniscus Tears: Technique
Results Indications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
Philippe Beaufils and Nicolas Pujol

vii
viii Contents

9 The Role of Arthroscopy in the Treatment

of Degenerative Meniscus Tear . . . . . . . . . . . . . . . . . . . . . . . . . . 107
Hélder Pereira, Ibrahim Fatih Cengiz,
Joana Silva-Correia, Joaquim Miguel Oliveira,
Rui Luís Reis, and João Espregueira-Mendes
10 Arthroscopic Meniscectomies for Congenital
Meniscus Lesions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119
Romain Seil, Tracey Gillman, Georges Assad,
Klaus Dueck, and Dietrich Pape
11 Meniscal Repair: Indications, Techniques,
and Outcome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125
Hélder Pereira, Ibrahim Fatih Cengiz,
Joana Silva-Correia, Pedro L. Ripoll, Ricardo Varatojo,
Joaquim Miguel Oliveira, Rui Luís Reis,
and João Espregueira-Mendes
12 Meniscal Allograft Transplantation: Indications,
Technique and Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
Peter Verdonk, Nick Smith, Rene Verdonk,
and Tim Spalding
13 Implantable Devices for Cartilage Repair
in the Knee: Scaffolding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153
Stefano Zaffagnini, Alberto Grassi,
Tommaso Roberti di Sarsina,
Giulio Maria Marcheggiani Muccioli,
Margherita Serra, and Maurilio Marcacci
14 Cartilage Lesions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165
Peter Angele, Giuseppe M. Peretti,
and Johannes Zellner
15 Cartilage Repair: Autograft Osteochondral
Grafting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173
Tim Spalding
16 Cartilage Repair: Arthroscopic Microfractures . . . . . . . . . . . . 189
Patrick Orth and Henning Madry
17 Cartilage Repair: Scaffolding . . . . . . . . . . . . . . . . . . . . . . . . . . . 197
Elizaveta Kon, Giuseppe Filardo, Luca Andriolo,
Francesco Perdisa, Francesco Tentoni,
and Maurilio Marcacci
18 ACL Tear: Complete and Partial, Associated
to Medial and Lateral Damage . . . . . . . . . . . . . . . . . . . . . . . . . . 209
Rainer Siebold and Georgios Karidakis
19 General Technical Consideration in Arthroscopic
Anterior Cruciate Ligament Reconstruction . . . . . . . . . . . . . . . 217
A. Stoehr, A. Hochrein, and H.O. Mayr
Contents ix

20 Arthroscopic Anterior Cruciate Ligament

Reconstruction with Bone-Patellar Tendon-Bone . . . . . . . . . . . 223
Matteo Denti, Alessandro Quaglia, and Pietro Randelli
21 Arthroscopic Anterior Cruciate Ligament
Reconstruction with Hamstring Tendons . . . . . . . . . . . . . . . . . . 229
Marco Valoroso, Guillaume Demey,
Panagiotis G. Ntagiopoulos, and David Dejour
22 Anterior Cruciate Ligament Reconstruction
with a Single-Bundle Autologous Quadriceps
Tendon . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239
Jacques Menetrey, Etienne Cavaignac,
and Philippe Tscholl
23 ACL Reconstruction, Single-Bundle Allograft . . . . . . . . . . . . . . 257
Jakob Van Oldenrijk, Peter A.J. De Leeuw,
and Gino M.M.J. Kerkhoffs
24 ACL Reconstruction in Immature Athletes . . . . . . . . . . . . . . . . 269
Romain Seil, Julien Coquay, Alexander Hoffmann,
and Franck Chotel
25 Revision Anterior Cruciate Ligament
Reconstruction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 285
Etienne Cavaignac, Philippe Tscholl,
Marco Valoroso, and Jacques Menetrey
26 PCL Tear: Complete, Partial, and Associated
with Medial or Lateral Damage. . . . . . . . . . . . . . . . . . . . . . . . . . 307
Chase S. Dean, Robert F. LaPrade, and Lars Engebretsen
27 Posterior Cruciate Ligament-Deficient Knee:
Indications for Reconstruction . . . . . . . . . . . . . . . . . . . . . . . . . . 325
Matteo Denti, Pietro Simone Randelli, Luca Mangini,
and Davide Cucchi
28 Patellofemoral Instability: Classification,
Indications for Surgery and Results . . . . . . . . . . . . . . . . . . . . . . 343
Paolo Ferrua, Panagiotis G. Ntagiopoulos,
Roch Mader, and David Dejour
29 Synovitis of the Knee . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 373
Massimo Berruto, Antonella Murgo, Paolo Ferrua,
Francesco Uboldi, Daniele Tradati, Stefano Pasqualotto,
and Bruno Michele Marelli
30 Arthroscopic Treatment of Knee Stiffness . . . . . . . . . . . . . . . . . 387
Massimo Berruto, Paolo Ferrua, Stefano Pasqualotto,
Andrea Parente, Francesco Uboldi, Eva Usellini,
and Bruno Marelli
31 Arthroscopic Fixation of Fractures Around the Knee. . . . . . . . 399
Pietro Randelli, Davide Cucchi, Filippo Randelli,
Chiara Fossati, and Paolo Cabitza
x Contents

Part III Shoulder

Pietro Randelli

32 Shoulder Arthroscopy: General Setup,

Portal Options, and How to Manage a Complete
Shoulder Investigation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 421
Radu Prejbeanu, Ion Bogdan Codorean,
and Stefania Tanase
33 Arthroscopic Anatomy of the Shoulder . . . . . . . . . . . . . . . . . . . 431
Roman Brzóska, Wojciech Solecki,
and Adrian Błasiak
34 Shoulder Instability: Traumatic and Atraumatic . . . . . . . . . . . 441
Maristella F. Saccomanno and Giuseppe Milano
35 Anterior Traumatic Instability Without
Glenoid Bone Loss. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 457
Vivek M. Morey, Giuseppe Porcellini, Fabrizio Campi,
Paolo Paladini, and Giovanni Merolla
36 Anterior Traumatic Instability with Glenoid
Bone Loss . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 473
Ettore Taverna and Riccardo D’Ambrosi
37 Posterior Shoulder Instability . . . . . . . . . . . . . . . . . . . . . . . . . . . 483
Ladislav Kovacic, Lennard Funk,
and Pascal Gleyze
38 Humeral Avulsion of the Glenohumeral
Ligament Lesion (aHAGL and pHAGL):
Current Concepts in Treatment and Management . . . . . . . . . . 499
Philipp Proier, Stefan Buchmann, and Andreas Imhoff
39 Multidirectional, Microinstability,
and Acquired Instability. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 511
Alessandro Castagna, Mario Borroni,
and Giacomo Delle Rose
40 Shoulder Instability Associated to Humeral
Head Defects . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 515
Grégoire Ciais and Philippe Hardy
41 Subacromial Impingement Syndrome . . . . . . . . . . . . . . . . . . . . 523
Giuseppe Sforza and Paolo Consigliere
42 Calcifying Tendonitis of the Rotator Cuff . . . . . . . . . . . . . . . . . 541
Olaf Lorbach and Romain Seil
43 Rotator Cuff Tears . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 551
Mark Tauber
44 Treatment of Partial Cuff Tears . . . . . . . . . . . . . . . . . . . . . . . . . 563
Klaus Bak
Contents xi

45 Subscapularis Tears . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 571

Maristella F. Saccomanno and Giuseppe Milano
46 Arthroscopic Repair of Full-Thickness
Rotator Cuff Tears . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 581
Pietro Randelli, Paolo Capitani,
Liborio Ingala Martini, and Vincenza Ragone
47 Biological Augments in Rotator Cuff Repair . . . . . . . . . . . . . . . 591
Christophe Charousset and Amine Zaoui
48 Massive Cuff Tears . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 597
António Cartucho
49 Long Head of the Biceps Pathology . . . . . . . . . . . . . . . . . . . . . . . 609
Boris Poberaj
50 AC Joint Pathology and Instability . . . . . . . . . . . . . . . . . . . . . . . 615
Natascha Kraus and Markus Scheibel
51 Glenohumeral Cartilage Damage and Arthritis . . . . . . . . . . . . 633
Bartek Kordasiewicz, Claudio Rosso,
and Bruno Toussaint

52 Management of the Stiff Shoulder. . . . . . . . . . . . . . . . . . . . . . . . 663

Lennard Funk and Avanthi Mandaleson

Part IV Elbow
Pietro Randelli and Paolo Arrigoni

53 Elbow Arthroscopy: General Setup, Portal

Options and How to Manage a Complete
Elbow Investigation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 675
E. Guerra, A. Ritali, A. Marinelli, G. Bettelli,
M. Cavaciocchi, and R. Rotini
54 Anatomy at Risk, Portals, and Relevant
Attentions to Reduce the Risk of Nerve Injury
of the Elbow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 683
Paolo Arrigoni, Riccardo D’Ambrosi, Enrico Guerra,
and Pietro Randelli
55 Arthroscopic Treatment of Elbow Synovial
Chondromatosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 691
Joseph Pooley
56 Lateral Elbow Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 703
Srinath Kamineni and Domingo Molina
57 Elbow Stiffness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 713
Bo Sanderhoff Olsen
58 Elbow Fractures Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 725
André Thès and Philippe Hardy
xii Contents

59 Osteochondritis Dissecans of the Capitellum . . . . . . . . . . . . . . . 733

Miguel Trigueiros
60 Arthroscopic Synovectomy for Rheumatoid Elbow. . . . . . . . . . 745
Mehmet Derviş Güner and Mehmet Demirtaş
61 Elbow Instability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 753
John T. Heffernan, Michael O’Brien,
and Felix H. Savoie III
62 Endoscopic Approach to Cubital Tunnel Syndrome . . . . . . . . . 763
Fabrizio Campi, Giovanni Merolla, Paolo Paladini,
and Giuseppe Porcellini
63 Elbow Arthroscopy: Difficult Cases
and Ulnar Nerve Preservation . . . . . . . . . . . . . . . . . . . . . . . . . . . 773
L.A. Pederzini, F. Di Palma, F. Nicoletta, and E. Tripoli

Part V HIP

64 General Aspects on Hip Arthroscopy . . . . . . . . . . . . . . . . . . . . . 787

Filippo Randelli, Fabrizio Pace, Daniela Maglione,
Sara Favilla, Paolo Capitani, and Marco Brioschi
65 Hip Arthroscopy: Diagnostic Techniques . . . . . . . . . . . . . . . . . . 803
Ivan Dzaja, Harman Chaudhry, and Olufemi R. Ayeni
66 Arthroscopic Treatment of Femoroacetabular
Cam Impingement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 815
Mohammad Masoud and Michael Dienst
67 Pincer Lesions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 835
Kotaro R. Shibata and Marc R. Safran
68 Hip Arthroscopy for the Treatment
of Osteochondral Defects and Loose Bodies . . . . . . . . . . . . . . . . 847
Nicole A. Friel, Michaela Kopka, Volker Musahl,
and Craig S. Mauro
69 Labral Lesions of the Hip . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 859
Sanjeev Bhatia, Karen Briggs, and Marc J. Philippon
70 Avascular Necrosis, Osteoarthritis and Synovitis . . . . . . . . . . . 867
Nicolas Bonin, Christophe Tissot, and Antoine Dangin

Part VI Wrist
Paolo Arrigoni

71 General Aspects on Wrist Arthroscopy . . . . . . . . . . . . . . . . . . . 881

Loris Pegoli, Alessandro Pozzi, and Paolo Arrigoni
72 Arthroscopic Resection of Wrist Ganglia . . . . . . . . . . . . . . . . . . 891
C. Mathoulin, J. Garret, M. Gras, and V. Mesquida
73 Scapholunate Ligament Injuries . . . . . . . . . . . . . . . . . . . . . . . . . 903
Contents xiii

Jane C. Messina
74 Wrist Arthroscopy in Degenerative Conditions
of the Wrist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 913
Michael Chu-Kay Mak and Pak-Cheong Ho
75 Wrist Arthroscopy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 931
John R. Fowler
76 Arthroscopic Arthrolysis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 935
Riccardo Luchetti, Gregory Bain, Levi Morse,
and Duncan McGuire

Part VII Ankle

Niek Van Dijk

77 Anterior Ankle Arthroscopy: General Setup

and Portal Options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 955
K.T.M. Opdam, R. Zwiers, and C.N. van Dijk
78 Anterior Ankle Impingement. . . . . . . . . . . . . . . . . . . . . . . . . . . . 965
R. Zwiers, K.T.M. Opdam, and C.N. van Dijk
79 Soft Tissue Impingement of the Ankle . . . . . . . . . . . . . . . . . . . . 971
G. Cordier and S. Guillo
80 Anterior Bony Ankle Impingement. . . . . . . . . . . . . . . . . . . . . . . 979
Daniël Haverkamp
81 Osteochondral Defects of the Ankle . . . . . . . . . . . . . . . . . . . . . . 985
Gwendolyn Vuurberg and C. Niek van Dijk
82 Mosaicplasty for Treatment of Osteochondral
Defects of the Ankle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 997
Tamás Gál, Ágnes Berta, and László Hangody
83 Scaffolding as Treatment for Osteochondral
Defects in the Ankle . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1003
Alberto Gobbi, Celeste Scotti,
and Giuseppe M. Peretti
84 HemiCAP for Secondary Treatment
for Osteochondral Talar Defects . . . . . . . . . . . . . . . . . . . . . . . . 1013
Mikel L. Reilingh, Christiaan J.A. van Bergen,
Rogier M. Gerards, Inge C.M. van Eekeren,
and C. Niek van Dijk
85 Retrograde Drilling for the Treatment
of Osteochondral Lesions in the Ankle . . . . . . . . . . . . . . . . . . . 1023
Adam Lomax and James Calder
86 Osteoarthritis of the Ankle. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1033
Milan Handl
xiv Contents

87 Arthroscopic Ankle Arthrodesis . . . . . . . . . . . . . . . . . . . . . . . . 1043

Richard P. Walter and Ian G. Winson
88 Posterior Ankle Arthroscopy: General Setup
and Portal Options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1049
K.T.M. Opdam, R. Zwiers, and C.N. van Dijk
89 Posterior Impingement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1055
Tahir Ögüt
90 Hindfoot Endoscopy for Posterior
Ankle Impingement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1067
P.P. d’Hooghe and C.N. van Dijk
91 Arthroscopy of Subtalar Joint . . . . . . . . . . . . . . . . . . . . . . . . . . 1079
Xavier Martin Oliva, Juan Manuel Rios,
and Matteo Guelfi
92 Subtalar Arthroscopic Arthrodesis . . . . . . . . . . . . . . . . . . . . . . 1089
Peter A.J. de Leeuw and C. Niek van Dijk
93 Peroneal Tendoscopy. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1097
P.A. van Dijk, P.A. de Leeuw, and G.M. Kerkhoffs
94 Tendoscopy of the Achilles Tendon, Peroneal
Tendon and Posterior Tibial Tendon . . . . . . . . . . . . . . . . . . . . . 1105
J.I. Wiegerinck and C.N. van Dijk
95 Achilles Tendon Pathology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1115
Robert Śmigielski and Urszula Zdanowicz
96 Endoscopic Calcaneoplasty . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1125
R. Zwiers, J.I. Wiegerinck, and C.N. van Dijk
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1131
 Part I
General Content
 History of Arthroscopy
Lars Goebel and Henning Madry
The development of arthroscopic surgery can be
regarded as one of the milestones in orthopedic
surgery within the twentieth century, along with
joint arthroplasty and the open reduction and
internal fixation of fractures [1–3].
The origin of arthroscopy comes from the
Greek arthros for joint and scopein for to look.
Physicians have long since attempted to look into
body cavities. Its roots can be traced back to the
time of the Roman Empire. In the ruins of
Pompeii, evidence for the use of vaginal specu-
lums and proctoscopes was made [4, 5].
In modern times it was Philipp Bozzini
(1773–1809), a German doctor from Mainz,
who first invented a primitive endoscope, his
Lichtleiter, to inspect body cavities like the
mouth, nasal cavity, rectum, or female bladder.
When his invention was presented to the Rome
Academy of Science (Italy) in 1806, the poten-
tial of his invention was, however, not acknowl-
edged at all [6] (Table 1.1).
L. Goebel • H. Madry (*)
Center of Experimental Orthopaedics, Saarland
University Medical Center, Kirrberger Straße,
Building 37, 66421 Homburg/Saar, Germany
Department of Orthopaedic Surgery, Saarland
University Medical Center, Kirrberger Straße,
Building 37, 66421 Homburg/Saar, Germany
Cartilage Net of the Greater Region, University of the
Greater Region, 66421 Homburg/Saar, Germany
e-mail: henning.madry@uks.eu
© ESSKA 2016
P. Randelli et al. (eds.), Arthroscopy: Basic to Advanced, DOI 10.1007/978-3-662-49376-2_1
1
Half a century later, Antoine Desormeaux
(1815–1882), a French physician from Paris,
developed in 1853 a gazogene cytoscope, which
used a mixture of gasoline and turpentine to illu-
minate and a system of mirrors to visualize the
bladder. Today, his invention is regarded as the
first instrument for endoscopy [7].
In 1860 Julius Bruck (1840–1902), a German
dentist from Breslau (now Wrocław, Poland),
transluminated the bladder with a diaphanoscope
from the rectum to remove bladder stones [8].
The German urologist Maximilian Nitze
(1848–1906) from Berlin introduced a cysto-
scope in 1876 which already used a heated plati-
num loop for illumination [9]. One year later, his
first public demonstration took place at the
Institut für Pathologie at the Stadtkrankenhaus
Dresden-Friedrichstadt (Germany), the same
place where 50 years later Michael Burman per-
formed his arthroscopic cadaver studies [10]
under the supervision of the German pathologist
Christian Georg Schmorl (1861–1932).
After the invention of Thomas Edison’s light
bulb, Maximilian Nitze and Josef Leiter (1830–
1892), an Austrian surgical instrument maker
from Vienna, designed the first cystoscope with
an incandescent light bulb for illumination in
1886 [11]. Maximilian Nitze was also the first to
take a photograph of the inside of a human blad-
der 4 years later.
The Swedish physician Hans Christian
Jacobaeus (1879–1937) from Stockholm
invented, together with the Georg Wolf company
3
4 L. Goebel and H. Madry

Table 1.1 Selected milestones of the history of arthroscopy within the past two centuries
Milestones in the history of arthroscopy
1806 Philipp Bozzini invents his Lichtleiter, the first primitive endoscope
1853 Antoine Desormeaux develops a gazogene cytoscope to visualize the bladder
1860 Julius Bruck uses a diaphanoscope to transluminate the bladder from the rectum
1876 Maximilian Nitze introduces his cystoscope with a heated platinum loop for illumination
1886 Maximilian Nitze and Josef Leiter design the first cystoscope with an incandescent light bulb
1890 Maximilian Nitze takes the first photograph of the inside of a human bladder
1910 Hans Christian Jacobaeus invents his laparo-thoracoscope
1912 Severin Nordentoft, the first arthroscopist, presents his results on endoscopy of the knee joint in Berlin
1918 Kenji Takagi uses a cystoscope to examine cadaver knees and later patients with tuberculous knees
1921 Eugen Bircher started to perform arthroendoscopies to diagnose meniscal pathologies
1925 Philip Kreuscher publishes his remarkable article on Semilunar Cartilage Disease
1931 Michael Burman performs cadaver studies and publishes his historical paper on Arthroscopy or the Direct
Visualisation of Joints, including the first arthroscopic pictures ever published
1939 Ernst Vaubel publishes Die Arthroskopie, the first book on arthroscopy
1954 Harold Hopkins introduces the principle of glass fiber cold light
1955 Masaki Watanabe, the father of modern arthroscopy, develops the concept of triangulation and removes the
first tumor arthroscopically
1957 Masaki Watanabe publishes his first Atlas of Arthroscopy
1959 The Watanabe No. 21 arthroscope is produced in series
1960 Harold Hopkins develops rod lens systems for arthroscopes
1962 Masaki Watanabe performs the first arthroscopic meniscectomy
1964 Robert Jackson is the first foreign doctor to visit Watanabe acquiring his technique of arthroscopy
1967 The Watanabe No. 22 arthroscope is the first arthroscope to use cold light
1968 Robert Jackson gives first instructional course on arthroscopy at the American Academy of Orthopaedic
Surgeons
1972 John Joyce is the first to organize private arthroscopy teachings
1973 Jan Gillquist promotes the central approach to the knee
1974 Richard O’Connor performs the first partial meniscectomy in North America
1974 The International Arthroscopy Association (IAA) is founded
1975 Harold Eikelaar receives the first PhD degree on arthroscopy
1976 Robert Jackson and David Dandy publish the first textbook in English on arthroscopy of the knee
1976 Lanny Johnson develops the first motorized shaver instrument
1982 The North American chapter of the IAA is converted to the Arthroscopy Association of North America
(AANA)
1984 The European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA) is founded
1985 AANA’s journal Arthroscopy: The Journal of Arthroscopic and Related Research (Arthroscopy) is launched
1993 ESSKA’s journal Knee Surgery, Sports Traumatology, Arthroscopy (KSSTA) commences
1995 The IAA and the International Society of the Knee (ISK) assemble to the International Society of
Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS)
2014 The Journal of Experimental Orthopaedics (JEO), ESSKA’s basic science journal, is introduced

(Berlin, Germany), his laparo-thoracoscope in in Aarhus, presented his work on Endoscopy of

1910. He used this technique for diagnostic pur-
poses in undefined abdominal complaints and
functional impairment and as well to treat pleural
adhesions caused by tuberculosis [12].
In 1912 Severin Nordentoft (1866–1922,
Fig. 1.1), a Danish surgeon and radiologist born
Closed Cavities by the Means of My Trokart-
Endoscope at the 41st Congress of the German
Society of Surgeons in Berlin (Germany) [13].
He described a trocart-endoscope, which was
similar to the Jacobaeus laparo-thoracoscope,
consisting of a 5 mm diameter trocart, a fluid
1 History of Arthroscopy
Fig. 1.1 Severin Nordentoft (1866–1922), today
acknowledged as the first arthroscopist (Are reprinted
with permission)
valve, and an optic tube. Of note, he reported
about its application for endoscopy of the knee
joint, besides suprapubic cystoscopy and lapa-
roscopy [14]. It was thus Severin Nordentoft
who first coined the term arthroscopy for visual-
ization of joint cavities, and, today, he is consid-
ered as the first arthroscopist. Nevertheless, in
his presentation no evidence can be found that he
ever applied his instrument to patients. At that
time, only 90° optic lens systems were available.
Moreover, the lens systems allowed only for a
relatively poor overview of the joint because of
sparse illumination as only about 10 % of the
light of modern optics was transmitted. Severin
Nordentoft already chose sterile saline as optical
medium and advised the use of arthroscopy for
the early diagnosis of meniscal lesions [14].
Interestingly, in the decades thereafter, other
5
Fig. 1.2 Kenji Takagi (1888–1963) (Are reprinted with
permission)
arthroscopic pioneers never referred to him in
their publications.
Kenji Takagi (1888–1963, Fig. 1.2), a Japanese
orthopedic surgeon from Tokyo, applied in 1918
a cystoscope to look inside cadaver knees and
later to examine knees affected by tuberculosis.
His first arthroscope, build in 1920, was 7.3 mm
in diameter, thus relatively big and impracticable
for a use within the knee. He continued sophisti-
cating his cystoscope and developed a total of 12
different arthroscopes, with smaller diameter and
different angels of view, that became the very
prototypes for modern arthroscopes. Also, simple
operations, such as biopsies, could be performed
with operative instruments he invented. He also
discussed distension of the knee with saline solu-
tion to enlarge the joint cavity and to improve
visualization [4, 5].
The Swiss surgeon and politician Eugen
Bircher (1882–1956, Fig. 1.3) started to perform
arthroscopies in 1921 as an attempt to diagnose
meniscus pathologies [15]. He was the first to
publish several papers on the topic of what he
called arthroendoscopy and approximately per-
formed 60 cases until 1926. Eugen Bircher used
this procedure only in advance to arthrotomies.
6 L. Goebel and H. Madry
Fig. 1.3 Eugen Bircher (1882–1956) (Are reprinted with
permission)
Interestingly, Severin Nordentoft and Eugen
Bircher never referred to each other despite both
had presented their results at the annual con-
gresses of surgery in Berlin. Eugen Bircher also
used a 90° optic with a very limited field of view,
a little illumination, and a long dead end of the
arthroscope. By 1930, Eugen Bircher quitted the
use of his arthroendoscopy in favor of air arthrog-
raphy, a radiographic technique expecting better
visualization of joint contours.
Phillip Heinrich Kreuscher (1883–1943), a
son of German immigrants, from Chicago
(Illinois, USA) was the first arthroscopist in
Northern America. After initial studies about the
collapsed lung treatment for pulmonary tubercu-
losis, his academic focus shifted from 1917 onto
athletic injuries and especially to the menisci, the
semilunar cartilages of the knee. In 1925, his
remarkable article on Semilunar Cartilage
Disease: A Plea for the Early Recognition by
Means of the Arthroscope and the Early
Treatment of this Condition was published where
he most likely used a Jacobaeus laparo-
Fig. 1.4 Michael Burman (1896–1974) (Are reprinted
with permission)
thoracoscope [5, 16]. In a letter to Michael
Burman in 1931, he reported 25–30 cases where
he applied his arthroscope, although later he did
no longer perform arthroscopies. Perhaps like
Eugen Bircher, not acknowledged in his time and
possibly frustrated by the technical difficulties,
he instead focused on arthrography as well.
Michael Burman (1896–1974, Fig. 1.4) was a
young American registrar for orthopedics [17]. He
started to work with an arthroscope designed by
Reinhold Wappler (1870–1932), a designer of
electrosurgical instruments, in the anatomy labo-
ratory of the New York University (New York,
USA). In 1931 he succeeded to gain a travel schol-
arship that allowed him to extend his research at
the Institut für Pathologie at the Stadtkrankenhaus
Dresden-Friedrichstadt [10]. Here, he applied dif-
ferent dyes to visualize articular cartilage degen-
eration and extended his cadaver studies. Also the
first hip arthroscopy is attributed to him, while
Kenji Takagi in 1939 performed the first hip
arthroscopy in patients. Michael Burman pub-
lished in 1931 his historical paper Arthroscopy or
the Direct Visualisation of Joints [18]. The 20 col-
ored aquarelles of arthroscopic findings in differ-
ent joints that were included are the first
1 History of Arthroscopy
Fig. 1.5 Ernst Vaubel (1902–1989) (Are reprinted with
permission)
arthroscopic pictures ever published. The images
were painted by Frieda Erfurt in Dresden, the
institute’s medical artist. In the 1950s Burman col-
lected arthroscopic images, but, unfortunately, he
never found an editor who was willing to publish
his Atlas of Arthroscopy [19].
Ernst Vaubel (1902–1989, Fig. 1.5) was a
rheumatologist from Wiesbaden (Germany).
Together with the Georg Wolf company, he
improved with an oblique 45° optic the Jacobaeus
laparo-thoracoscope that was then called
Arthroskop nach Dr. E. Vaubel [20]. In 1939, the
first book ever published on arthroscopy, Die
Arthroskopie, was published by Ernst Vaubel
[21].
Unfortunately, the Second World War (1939–
1945) delayed advancements in medical science,
and for 16 years no paper on arthroscopy was
published [4, 22].
Masaki Watanabe (1911–1994, Fig. 1.6) was
an orthopedic surgeon from Nagano, Japan, who
7
Fig. 1.6 Masaki Watanabe (1911–1994), the father of
modern arthroscopy (Are reprinted with permission)
graduated from Tokyo Imperial University in
1937. He was a scholar of Kenji Takagi [23].
After World War II, he developed and sophisti-
cated endoscopic instruments. His Watanabe No.
21 arthroscope (Fig. 1.7) was produced in series
from 1959. Today, he is considered as the father
of modern arthroscopy, and the Watanabe No. 21
arthroscope was the first model widely accepted
and used. Nevertheless, it had some disadvan-
tages. For example, the incandescent light bulb
sporadically broke within the knee joint, and the
light carrier was susceptible for short circuit.
Notably, Masaki Watanabe also developed the
concept of triangulation in 1955, and it was also
him who first applied knee arthroscopy as thera-
peutic tool to remove a giant cell tumor in 1955
from the recessus superior. In 1962, he per-
formed an arthroscopic partial meniscectomy.
Also he was the first to obtain color photographs
from the inside of a knee joint (Fig. 1.8). Yet, a
color movie on arthroscopy presented at the
Société Internationale de Chirurgie Orthopédique
et de Traumatologie (SICOT) congress in 1957 in
Barcelona (Spain) attracted only very few people.
8 L. Goebel and H. Madry
Fig. 1.7 The Watanabe No. 21 was the first arthroscope
produced in series. It had an offset light bulb and an
arthroscopic valve (Are reprinted with permission)
Fig. 1.8 Arthroscopic picture of a torn medial meniscus.
The first arthroscopic partial meniscectomy was per-
formed by Masaki Watanabe in 1962 (Are reprinted with
permission)
His first Atlas of Arthroscopy [24] was published
in 1957 in English with illustrations by Fujihashi,
followed by a second edition in 1969 containing
illustrated color photographs.
Harold Horace Hopkins (1918–1994) was a
British physicist born in Leicester, East Midlands.
He developed both the principle of glass fiber
cold light in 1954 and the optical rod lens system
in 1960 [25, 26]. At first glass fibers were used
for flexible gastroscopes. The first arthroscope to
use cold light was the Watanabe No. 22
arthroscope built by Tsunekichi Fukuyo in 1967.
Interestingly, Masaki Watanabe himself was not
convinced and went on using his Watanabe No.
21 arthroscope with an offset tungsten bulb.
While most American pioneers used this conven-
tional arthroscope as well, European arthrosco-
pists used cold light instruments starting from
around 1969, produced by German manufactur-
ers Karl Storz (Tuttlingen, Germany) and Richard
Wolf (Knittlingen, Germany). The implementa-
tion of rod lenses and cold light significantly
improved the visibility, and arthroscopies became
safer and more reliable.
Robert W. Jackson from Toronto (Canada)
went to Tokyo (Japan) on a traveling fellowship in
1964 to study tissue culture techniques [27]. After
many inquiries he found Watanabe at Tokyo
Teishin Hospital. Curiously, even in his own
country, Masaki Watanabe’s work was unknown,
and Robert Jackson was the first foreign doctor
visiting him. For months twice a week, he watched
him and acquired the technique of arthroscopy,
and, in return, taught Masaki Watanabe English.
Before returning to the University of Toronto in
1965, he purchased a Watanabe No. 21 arthro-
scope. In the first year, he used it already on 25
cases, while frequently being criticized and ridi-
culed by his colleagues. Despite this challenging
environment, 70 cases were accomplished in
1966 and the numbers of case steadily grew there-
after. Other surgeons from North America became
aware of this technique. In 1968, Robert Jackson
gave the first instructional course on arthroscopy
at the American Academy of Orthopaedic
Surgeons (AAOS) [28]. From 1973 he invited
Richard L. O’Connor to join him in these courses.
In 1976, together with David Dandy, he pub-
lished the first textbook in English on arthroscopy
of the knee.
Richard L. O’Connor (1933–1980) visited
Masaki Watanabe in 1971 and 1972 and learned
the technique from him. With Richard Wolf
Medical Instruments Corporation (Vernon Hills,
Illinois, USA), new instruments and arthroscopes
were developed. He performed in 1974 the first
partial meniscectomy in North America. It was
also him who introduced a rod lens-type opera-
tion arthroscope [5].
1 History of Arthroscopy
Lanny L. Johnson was one of the leading prac-
titioners and innovators of arthroscopy in North
America. He promoted the concept of multiple
punctures to explore all regions of a joint and was
a pioneer of arthroscopic shoulder surgery and
rotator cuff repair, while other diarthrodial joints
were also subjected to arthroscopy by him. Lanny
Johnson developed many arthroscopic instru-
ments, most notable the first motorized shaver
instrument in 1976 in cooperation with Dyonics
(Andover, Massachusetts, USA). Johnson was
also one of the first arthroscopic surgeons video-
taping his arthroscopies [5].
In 1972, John J. Joyce III (1914–1991) was
the first to organize a private arthroscopy teach-
ing course at the University of Pennsylvania
(Philadelphia, Pennsylvania, USA) [5].
Harold R. Eikelaar from the Netherlands was
the first recipient of a PhD degree on arthros-
copy in 1975. Together with the Storz company,
he developed the first 30° forward oblique
arthroscope.
Ejnar Eriksson was the first professor for sports
traumatology at the Karolinska Institute
(Stockholm, Sweden) and hosted, as first one,
many arthroscopy courses in European countries.
Jan Gillquist, a Swedish orthopedic surgeon,
in 1973 promoted the central approach through
the patellar tendon to the knee.
Within the last decades, several arthroscopic
associations were set up. The International
Arthroscopy Association (IAA) was founded on
April 26, 1974, when there were plans for a sec-
ond private course on arthroscopy, after the first
one was held 1973 by John Joyce in Philadelphia.
Masaki Watanabe was elected as its first presi-
dent, while the IAA’s purpose was set to foster by
means of arthroscopy the development and dis-
semination of knowledge in the fields of orthope-
dics and medicine in order to improve the
diagnosis and treatment of joint disorders.
Initially, the IAA was constituted solely out of
two chapters, North America and Japan. At first,
every 3 years IAA meetings were held corpo-
rately with the SICOT, beginning 1975 in
Copenhagen (Denmark), and from 1987 biennial
meetings were held with the International Society
of the Knee (ISK). In 1995 the ISK and IAA
9
Fig. 1.9 Logo of ISAKOS, the International Society of
Arthroscopy, Knee Surgery and Orthopaedic Sports
Medicine (Represents the official logo of the above named
society and was taken from the respective official
website)
joined to form the International Society of
Arthroscopy, Knee Surgery and Orthopaedic
Sports Medicine (ISAKOS, Fig. 1.9), with its first
meeting being held in Buenos Aires in 1997 [5, 7,
19, 27, 28].
The North American chapter of the IAA was
converted into the Arthroscopy Association of
North America (AANA, Fig. 1.10) in 1982 as it
became apparent that a different kind of organi-
zation was needed for Northern America to sat-
isfy the educational needs of the increasing
number of arthroscopists. Further being closely
related to the IAA, meetings were now held
annually. Its journal Arthroscopy: The Journal of
Arthroscopic and Related Research (Arthroscopy)
was launched in 1985.
In Europe, similar to the AANA, the European
Society of Sports Traumatology, Knee Surgery
and Arthroscopy (ESSKA, Fig. 1.11) was
founded 1984 in West Berlin by Ejnar Eriksson
from Sweden. Its clinical journal Knee Surgery,
Sports Traumatology, Arthroscopy (KSSTA) was
launched in 1993, with Eriksson serving as editor
in chief. ESSKA inaugurated also its basic sci-
ence Journal of Experimental Orthopaedics
(JEO) in 2014.
10
Fig. 1.10 Logo of AANA, the Arthroscopy Association
of North America (Represents the official logo of the
above named society and was taken from the respective
official website)
Fig. 1.11 Logo of ESSKA, the European Society of
Sports Traumatology, Knee Surgery and Arthroscopy
(Represents the official logo of the above named society
and was taken from the respective official website)
Similarly, the Asia Pacific Orthopaedic
Society for Sports Medicine (APOSSM) was
founded in 1995 together with ISAKOS. In 2012
APOSSM took its progression further to the
development of its new society, the Asia-Pacific
Knee, Arthroscopy and Sports Medicine Society
L. Goebel and H. Madry
Fig. 1.12 Logo of APKASS, the Asia-Pacific Knee,
Arthroscopy and Sports Medicine Society (Represents the
official logo of the above named society and was taken
from the respective official website)
Fig. 1.13 Logo of SLARD, the Sociedad
Latinoamericana de Artroscopia Rodilla y Traumatología
Deportiva (Represents the official logo of the above
named society and was taken from the respective official
website)
(APKASS, Fig. 1.12). Also, for South and Latin
America, the Sociedad Latinoamericana de
Artroscopia Rodilla y Traumatología Deportiva
(SLARD, Fig. 1.13) was established.
Teaching the art of arthroscopy began at first
one-on-one with the instructor and the student
looking through the same optic. It was later
1 History of Arthroscopy
facilitated by beam-splitting devices, allowing
both to look at once into the joint [5]. Nevertheless
it was still extremely susceptible for moving the
arthroscope away. Later, flexible fiber optics
were available, further facilitating teaching [26].
With the implementation of television monitors,
slides, or videos, it was possible to better demon-
strate pathological conditions, as well as techni-
cal processes. Models out of rubber and plastic
were developed for teaching, while today cadaver
teaching centers represent the state of the art.
In the last decades, indications for arthroscopic
therapies have been continuously expanded [29].
Almost every joint may be assessed and treated
by arthroscopy. At the same time, techniques and
indications are further sophisticated, e.g., for
meniscal repair [30, 31] or anterior cruciate liga-
ment reconstruction [32, 33]. Today, arthroscopy
has to be regarded as the standard technique for
many indications, compared with conventional
methods. Its benefits include, but are not limited
to, a reduced time of the healing process and a
decreased number of complications while a diag-
nosis and definitive operative treatment are facili-
tated [3]. Future inventions may lead to
three-dimensional arthroscopy, e.g., the invention
of manual movable optics allowing the surgeon
to turn the optic from 0 to 90°.
While in the early days, innovations by the
pioneers of arthroscopy were often met with
ignorance and skepticism, arthroscopic opera-
tions now represent one of the key technological
advancements of the past 100 years in orthopedic
and trauma surgery.
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 Surgery Set-Up, Instrumentations
and Electronic Equipment
Pietro Simone Randelli and Davide Cucchi
2.1 Surgical Environment
Arthroscopic surgery might be performed in
operative theatre, in outpatient/ambulatory set-
ting or in an office; in any of these settings, basic
requirements such as anaesthesia support, elec-
tric power and suction for fluid management
must be present. Adequate sterilisation of
arthroscopic equipment is also crucial [1, 19, 25].
2.2 Arthroscopy Tower
An arthroscopy tower is a vertical cart with
various shelves on which electronic equipment
for the arthroscopic procedure is placed
(Fig. 2.1). Wheels allow moving the tower to
the optimal position during surgery. Modern
arthroscopy towers have a modular design to
conform to any set-up needed. A monitor is
P.S. Randelli (*) • D. Cucchi
Dipartimento di Scienze Biomediche per la Salute,
Università degli Studi di Milano,
Via Mangiagalli 31, Milan 20133, Italy
IRCCS Policlinico San Donato,
Via Morandi 30, San Donato Milanese 20097, Italy
e-mail: pietro.randelli@unimi.it
© ESSKA 2016
P. Randelli et al. (eds.), Arthroscopy: Basic to Advanced, DOI 10.1007/978-3-662-49376-2_2
2
placed on the top of the arthroscopy tower. A
smaller monitor may be placed on the opposite
side of the main one or on another articulating
arm to allow vision from other points of the
room. The video camera unit and a light source
unit are usually placed on the first shelves
under the monitor, together with possible
external hard drives or documentation system
units; a printer may be placed on the bottom
shelf. A power box for motorised instruments
and one for radiofrequency may be mounted on
the arthroscopy tower or on separate carts. If
used, the irrigation pump is usually placed also
on the arthroscopy tower [1, 18, 19].
2.3 Light Source and Light Cable
A key feature of arthroscopy is to enable visuali-
sation of internal structures with a minimal inci-
sion. To obtain this, light must be brought inside
the joint with an arthroscope. At the beginning of
the arthroscopic and endoscopic era, light was
produced by a candle and delivered through rigid
instruments. Then, a light bulb was mounted on
the tip of the arthroscope; in 1967, fibre optics
were introduced in arthroscopy by Masaki
Watanabe (Fig. 2.2) [6, 15, 24].
Nowadays light is produced by a 100–300 W
xenon lamp or by a LED and delivered to the
arthroscope with flexible fibre optics. Light
intensity and colour temperature are balanced by
13
14
Fig. 2.1 An arthroscopy tower (Courtesy of Arthrex GmbH)
Fig. 2.2 Watanabe’s arthroscope No. 22, the first direct-
view scope with cold light illumination (Reprinted from:
Copyright © 2006 Elsevier Inc., Kieser et al. [15], with
permission from Elsevier)
P.S. Randelli and D. Cucchi
internal feedback sensors and may be controlled
on the camera head or on the arthroscopy tower.
Filters and diffusion discs might be added to
change light quality for special applications.
Light loss must be minimal from light source to
the joint; the quality of light delivered in the joint
is affected by light source’s intensity and colour
temperature, area of the transverse section of the
light cable, light leaking in the connectors of the
source-cable-arthroscope unit and possible dam-
ages to single fibres; a safety lock system pre-
vents accidental separation of the light cable
from the arthroscope. Adaptors may be used to fit
cables and arthroscopes from different genera-
tions or manufacturers. The light concentration at
2 Surgery Set-Up, Instrumentations and Electronic Equipment 15

the end of the light cable heats the focal point;
therefore, this part must never be placed on the
patient’s skin or on the drape as long as the light
source is turned on, because of the risk of fire or
burns [1, 18, 19].
2.4 Arthroscopes and Cameras
Arthroscopes are telescopic devices which con-
sist of a magnifying lens system sealed within a
rigid tube; the distal (or objective) end contains
the end of the fibre optics bundle and the first lens
of the optical system. The proximal (or ocular)
end is equipped with adapters to be attached to
the video camera and the light cable. The image
can be transmitted from the objective to the ocu-
lar end through two basic optical systems: a rod-
lens system, composed by long, cylindrical lenses
separated by small spaces, and a single-image
fibre system, which is narrower in diameter and
contains one image-transmitting fibre bundle.
Diameter and length of the arthroscope tube are
variable. Diameter and construction materials are
important to prevent arthroscope bending, which
alters light transmission and image quality.
Important optical characteristics of an arthro-
scope are focal length, field of view and resolu-
tion. Focal length depends on arthroscope length
and lens’s characteristics and influences depth of
field and magnification. The field of view depends
on the arthroscope angle or “offset”; increasing
the offset, the apparent and real field of view will
broaden and the image distortion will increase
(Fig. 2.3). Most of the arthroscopes used today
have a 30° offset, which allows the surgeon to
visualize the articular environment with ease, but
0° and 70°-offset arthroscopes are also available.
Resolution depends on light source and light
transmission, lens integrity, imaging capturing
device and monitor characteristics. The first
arthroscopes were designed for direct observa-
tion (Fig. 2.4). Nowadays, arthroscopes are rou-
tinely connected to a digital video camera,
contained in a piece called “camera head”. A
modern camera head contains usually a three-

Fig. 2.3 Image distortion and changes in apparent and real field of view using arthroscopes with different offset
(Reprinted and modified from: Andrews and Timmerman [1], with permission from Elsevier)
Another random document with
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neither the one nor the other, even on land which is, as was
remarked before, capable of yielding a handsome revenue! And here
let it not be supposed that I am speaking of extreme cases only, or
that there are but few woods in this state: the cases are numerous: I
have seen, and could point out many, but this I shall not do: I rather
choose to leave these observations with “all whom they may
concern,” to work conviction where they are seen to be just, quite
indifferent as to the effect which they may produce on the minds of
any who may oppose them.
And now let me ask—if this be the state of many woods—if neither
a crop of timber nor of underwood is found—to what is it owing? the
reply is not difficult: it is mainly attributable to proprietors themselves,
and to their agents: to woodmen in a subordinate degree. In proof of
my first position, I would respectfully remark, that if a gentleman
chooses to sacrifice every thing to the idea of having good covers;
and, supposing that any thing which interferes with the primeval
state of his woods, is incompatible with this object, refuses to do any
thing at them, the woodman may not bear the blame. Again: if a
proprietor happen, unfortunately, to have such an aversion to felling
timber—and there are many such—that he will sooner let it rot down,
or allow one tree to destroy another; or again; suffer the timber trees
to stand so thickly that they not only totally destroy each other, but
the underwood below also, the woodman ought not to be censured;
except indeed, he have advised such a course, which I can hardly
think any man accustomed to woods could do, in the present day.
Once more; if gentlemen lack the moral courage—and I have met
with some of this description—to treat with the contempt which it
deserves the vulgar meddling, the idle tattle of those who are ever
ready to say, when timber is felled, that the owner’s poverty, and not
his will, consents to the deed, we are furnished with abundance of
reasons for the serious waste of property that is going on, but the
woodman is not in fault, neither ought he to be blamed. Lastly: if
proprietors commit the management of their woods to persons who
are wholly incompetent—as is too often the case—to discharge the
duties confided to them, I cannot see that the men are to be
condemned, but rather their employers. Wherever such
“mismanagement” prevails as I have attempted to describe, and
have seen so much cause to lament, it may generally, I think, be
traced, either to ignorance on the part of woodmen, or inattention on
the part of their employers: but it will be quite clear to all, who will
allow themselves time to think on the subject, that the grossest
mismanagement is to be met with, not on first, nor even on second,
but on third, and fourth-rate estates, where regular woodmen are not
kept, and below that grade downwards, to property which is in the
hands of Trustees, or mainly under the control of Solicitors, or
Corporate bodies; or, which is probably worse than all, under the
supreme direction of men who having, during the whole of their
business life, had too many Stewardships, &c. for any human being
to look after and manage well, cannot of course be deemed capable
of judging rightly on a subject which requires the closest possible
attention, the nicest discrimination, and an extended and varied
experience.
Much mischief has also arisen from the employment by
gentlemen, and by their agents, of persons, who, while they may,
usefully and creditably, fulfil their duties as village carpenters and the
like, cannot possibly possess those enlarged, comprehensive views,
which are necessary to the proper management of timber generally,
and Ancient Woods especially. I must here protest against the
conclusion being drawn, that I am doing injustice to any class of men
in remarking, as I have done, on their manner of discharging the
trust committed to them. As to the professional gentlemen, either
their engagements, their position, or their habits, interpose an
insurmountable difficulty, and relieve them from the charge of wilful
neglect: and as to the others it is no injustice to them to affirm, as I
do most positively, that there are principles and considerations
involved in this subject, which they can, in no wise, grasp or
comprehend: and so perfectly clear is this to me, so fully am I borne
out by a long course of “observation and experience,” that I have
never yet seen one solitary instance, where the timber taken down in
thinning, either in woods or plantations, when in such hands, has
been properly done; and in very few cases indeed, either here, or
higher up the scale, without the most serious blunders. One case
has fallen under my observation this Winter, (1842,) where oak
timber trees were selected and marked for sale, which were exactly,
in every respect, such as a good judge would wish to see in every
wood; and not only, not too thick, but, from the same injudicious
mode of selecting and marking at previous auctions, much too thin.
They were also in a state of high vigorous health, and moreover,
there was no underwood which could be benefited! I admit that this
was a more flagrant outrage against the principles which ought to
rule in selecting, than is usually committed, but the work is hardly
ever done as it ought to be.
But whatever difference of opinion may arise among practical
men, upon the points now under consideration, and on whomsoever
the blame may rest, it is unquestionable that the actual state of a
large proportion of our Ancient Woods is very bad indeed: they are
either crowded with inferior oak timber, along with the most
miserable rubbish as underwood; or, if they contain any thing
valuable in either the one or the other, no principles, or rules of any
kind, are applied in the management of them; and, consequently,
they are, on some account or other, and of course more or less
rapidly, passing through the stage of deterioration, and are annually
losing to their owners, a heavy per centage on their value. In many
cases, the oak, from ages of “mismanagement,” is stunted in growth,
and of a form, and shape, totally unsuited to the place where it
stands; and the underwood consists of that alone which is
indigenous to the soil, and which, therefore, no neglect can destroy,
nor any culture improve: in addition to all this, they are often, nay
almost always, on clayey, retentive soils, ruined with water: they are
periodically shut up, for from eighteen to twenty-five years, during
which time, it is impossible to do any thing at them; and, when they
are cleared of the underwood, instead of the opportunity being
gratefully seized, for the purpose of effecting those operations which
can only be carried on at such a time, they are shut up again, and
left in their original state—except indeed they may have been
despoiled of some of their oak—nothing being done at them, or, if
any thing, probably so little, or so ill done, that no good result is
produced. But what ought to be the course pursued at such a time?
Why, as it is only during the year of “hagging,” and the following
season, that any work of magnitude, any improvement worth
mentioning, can be carried on; a proprietor should more carefully
examine his woods when they have been cut, than he would any
other description of property: he should himself, if he understand it—
which, however, is very seldom the case—or if he do not, by a
person who is conversant with such matters, make a most rigid, and
particular survey, in order to satisfy himself as to what ought to be
done; and this he must do immediately when the underwood is cut,
or rather, as soon as any considerable portion is done, so that he
may have before him all the time which he can possibly command,
for carrying on, and completing, his improvements. He must not be
deterred from commencing them by any consideration of the
remoteness of the prospect of return upon his outlay; but, instead of
visiting the sins of his fathers upon the generations following him, he
must, if the case demand it, make a present sacrifice, for the benefit
of his posterity: I say if the case demand it, but this will not very
frequently happen, as there are very few instances of
“mismanagement” where the fear of cutting timber has not been one
of the principal causes of that mismanagement; and where this is so,
there is at once found a source from whence may be obtained the
means of amply paying for any outlay that may be required. I have
thus far remarked only on what may, and what ought to be done,
when Ancient Woods come to be felled in the regular way, and at the
usual time and age; but there are vast numbers of cases where, first,
the condition of the woods is so bad, that all considerations about
the usual time, are merged in the necessity for immediately
commencing the work of renovation; and, secondly, the instances
are not few, where the same course is desirable, in order that a more
profitable way of disposing of the produce may be introduced, to
supersede the old jog-trot mode of getting rid of it.
With regard to the first, it will at once be perceived, by a practical
eye, and a sound judgment, whether a wood is in such a state, as to
the prospect of a crop, that it is the proprietor’s interest to make a
sacrifice in the underwood and cut it, although it may sell for nothing
but faggots, rather than finish, or run out, the term, at the end of
which it would be cut in the usual course. I have seen hundreds of
such cases: there are many in almost every neighbourhood where
woods exist at all; and I confidently ask, what would be the use, or
how would it be possible to show the propriety, of completing the
term of the cycle, if, first, the wood contained nothing valuable as
underwood; and if, secondly, it contained a considerable portion of
timber that required immediate attention, on some account or other?
I should, for instance, instantly determine to cut, where I found a
wood crowded with a class of unhealthy oaks, or other timber: but it
is not necessary to particularize, as I would not pretend to give such
directions here as would enable a gentleman to decide, for that could
only be done after inspection. So many points have to be
considered, that a careful survey of a wood must be made. This
done, fortunately there is no difficulty in coming to a correct
conclusion upon such a question as this. A practical man, who
understands what he is about, will be in no danger of committing an
error in the decision to which he will be led, for these are not
subjects on which a difference of opinion might naturally arise upon
an examination taken. The various considerations for cutting, or
forbearing to cut, would so certainly present themselves to the mind
of a person really competent to judge, that I should say there would
be no doubt whatever, of his deciding correctly, if he were not
interfered with by the personal wish, or taste, of his employer. It is
with this as with most other subjects:—wherever men understand
what they are about, and are guided and governed by fixed
principles, matters go on well; but the misfortune, with regard to
woods, is, that ages of “mismanagement,” and other causes,
interpose obstacles and difficulties which it will be no slight task to
overcome. To give a brief summary of my views upon this important
point, I would remark, that no wood ought to be allowed to run out its
term which is not stocked as it ought to be, or which, if stocked
tolerably well, is suffering injury from imperfect drainage. As I have
just said, these points must be determined by an examination of the
wood by some person whose judgment may be relied upon; but any
gentleman may see at once, if he will, that if a wood is really in the
state which I have supposed, viz., without either timber or
underwood worth standing, &c. it would be perfectly absurd to let it
stand; for at the end of the cycle it would be very little better than at
the beginning, and so much more time would be irrecoverably lost.
As to the second point—the improvement of revenue to be derived
from a different mode of disposing of the produce, I am of opinion
that much might be done, in many places, without laying an
increased tax on the local buyers, who are generally either farmers,
or their tradesmen, the wheelwrights and carpenters of every
neighbourhood, and who already pay quite enough for what they get;
and especially the former, to whom I would much sooner
recommend their landlords to allow an abatement, as an
encouragement to them to keep their fences, gates, &c. in good
order, than any thing in the shape of an advance. But still, much may
be done to increase the returns from woodland property, by an
improved system of management, and, first, I should advise a careful
assortment of the stuff after it is felled: I would here, as in every thing
else, classify, by which means, the different kinds, as well as the
different sizes, and shapes, will come into the hands of such persons
as they may exactly suit, instead of jumbling all sorts together, so
that a buyer is obliged to purchase that which he does not want, in
order to come at another portion of the same lot which he is desirous
of having.
Secondly: There is room to doubt, I think, as hinted before,
whether mistakes are not often made, in not adapting the produce of
woods better as to its age, both to the local demand, and the
interests of the proprietor.
Thirdly: So numerous are the facilities in the present day, to what
they used to be, for the transmission of produce of every kind from
one place to another, and so many demands have, by commercial
enterprize, been opened out, which were altogether unknown a
quarter of a century ago, that it may, even as to heavy produce, like
that of woods, be always questioned, when the demand is slack, and
when prices are low, whether the local market be indeed the best
market, or whether the produce may not be much better disposed of
in some other way. That this sometimes occurs, I can prove from my
own experience in many cases, but I will mention only one, which
was that of an Ancient Wood, a twentieth portion of which was felled
every year, and in which, from “mismanagement,” a large quantity of
the stuff was annually left unsold, but where, after the introduction of
a better system, the whole was disposed of without difficulty.
 Fourthly: A great increase of revenue may be derived from a better
mode of managing the stock, both of timber and underwood: the
latter may, by timely and judicious pruning, by a proper attention to
draining, &c. be brought to maturity at a much earlier period than it
has hitherto been done in many places, and thus, of course, be
made to return a greater rent.
It is incredible how little is done to Ancient Woods compared with
what ought to be done, in the way of draining, pruning, stubbing up
rubbish, and filling up with young plants; although it is manifest that,
whenever a wood is opened, these important operations should
claim the very particular attention of the proprietor or his woodman.
But they do not receive it; and hence one cannot wonder at the
stunted, unhealthy appearance, which many woods exhibit. They are
almost always without any effective drainage, it being generally
thought quite sufficient to open out a few paltry drains, which the
falling leaves of the first Autumn will choke up. It will indeed very
seldom be found, that even the outside ditches are well looked after:
whereas it should always be the anxious concern of the woodman to
provide, as well as he possibly can, for the effectual drainage of a
wood after being felled, not only during a year or two, but for the
term of the whole cycle. Of course I am aware that the leaves must
fall, and, consequently, that the free egress of the water must, in
some degree, be impeded, but, nevertheless, it is in the power of the
woodman to provide, in a great measure, if not wholly, against this
contingency, by making a sufficient number of ditches, of ample
capacity, and by putting them in the best direction. But instead of
this, it will very rarely be found, as I have just now said, that even the
outside ditches are properly attended to. The consequence is, that
the oaks, and our best underwood, the ash, not liking too much
moisture, become diseased, and make comparatively slow progress:
in fact, their existence is shortened by it, as the former will be found
upon cold clay land, having a strong subsoil, to be very stunted and
sickly in their appearance, and ultimately to die at the top, when, of
course, they must be cut down; while the latter will much sooner
become hollow, and they too, will finally perish. A small outlay in
draining, if judiciously expended, would, in most cases, prevent
these effects, and as it would only require to be done once in fifteen
or twenty years, it could not lay more than a trifling charge upon the
land.
Pruning is also a very necessary operation in Ancient Woods, both
of the oak and of the underwood. I shall not here enter upon an
inquiry into the general question of pruning, but, continuing to treat
my subject practically, venture to remark, that, as our woods are now
circumstanced, pruning, of some kind or other, is, as far as the oak is
concerned, quite indispensable. Whether it should be by fore-
shortening, close pruning, or some other method, must be
determined upon an examination taken, but I do not hesitate to
express my belief, that the pruning of oak trees in woods, may be
almost wholly dispensed with, after the few first years, if they are well
trained from the beginning; but that being the case with very few,
pruning must be resorted to. And as to the underwood, the question
has still less difficulty in it. When a wood is well stocked with
underwood of the right sort, the object to be aimed at by the
woodman is to bring it to maturity as soon as possible, and one
means which he possesses, if he will make use of it, is pruning;
which he should commence, after one year’s growth, and
occasionally repeat—say on the fourth and sixth years, allowing the
intervals to pass without interfering with it. If this operation be
performed as it ought to be, the stools will have a number of poles
proportioned to their size and capacity of supporting them, and the
poles themselves will not only be more of an uniform size, but they
will be much straighter, and on every account better adapted to the
use for which they may be intended. But if a wood be stocked with
nothing but rubbish, such as hazel, birch, alder, &c. it will not be
worth pruning, and the best course to take with it, would be to stub it
up, and get rid of it altogether.
Finally, on this point, and more particularly with reference to
timber, if the pruning be judiciously done, it will tend greatly to
improve the health of the wood, but the indiscriminate use of the
pruning knife might do much harm, it should, therefore, only be done
under the most careful direction.
Stubbing up rubbish, such as thorns, briers, birch, and, in many
places, hazel, is much to be recommended, as by this means, light
and air will be admitted more freely, and the health of the wood
promoted, and, of course, its growth facilitated. It is perhaps just
possible, that there may be a few cases where the demand may be
such for birch, hazel, or alder, as to warrant a woodman in keeping
them as a part of his stock; but I have generally found, upon inquiry,
that they have fetched such a miserable price, as to yield very little
more than would pay expences.
The absolute necessity of filling up with young plants must be
universally admitted, although in practice, it is very rarely done, or, if
done at all, it is very generally so ill done, as to produce no
perceptible improvement in the stock.
It too often happens that sufficient care is not bestowed in
selecting the plants. They are frequently put in too small, and when
they are long enough, they are often deficient in thickness. All plants
put into old woods, should be of good size, stiff, and well rooted.
Again: it will be admitted, that they are often planted in a most
slovenly and careless manner.—The following is a specimen of what
I have seen. The workman takes his spade, and inserts it in the
ground as far as it will go, in a sloping direction; he then raises it to a
perpendicular position, which, of course, produces a “nick,” into
which he thrusts the plant, and having put his heavy foot upon it,
there and thus, he leaves it to its fate, and pursues his ill-directed
labour, without a gleam of light breaking in upon him, as to the
possibility of his being more usefully employed, or doing his work in
a more effective manner! In this way, or in some such way as this,
thousands of acres of Ancient Woods are treated every year; but it
must be clear to every one, that such a practice is a disgrace to
those who pursue it. If the workmen are asked their opinion of it, they
will, in most cases, assure you, that the plants will “all grow,” but the
misfortune is, that experience is against them. Both theory and
practice are directly opposed to their view. But independently of
facts, which every where condemn such methods, no one
acquainted with the rudiments of the subject, needs to be told, that it
is utterly unlikely that either an oak or an ash plant should grow,
under the manifest disadvantages in which it is placed, when its
roots are thus jumbled together, and forced into a “nick” fit only for a
willow set; and when, moreover, it has to commence its course in
competition with other underwood, which has already possession of
the ground. It is absurd to suppose that it should succeed.
I do not presume to say that some woods do not receive different
treatment, in all respects, to that which I have denounced: that would
not be true; but these are the exceptions, and even where the
management is best, there is much to complain of.
In commencing the subject of Planting, I am impressed with a
sense of the importance which should be attached to it in such a
work as this. I mean planting by way of filling up, in Ancient Woods. I
am quite aware that it demands such a largeness and
comprehension of view, that it might well be supposed likely to
discourage one of stouter nerves than mine. It is important because,
first, every wood in the kingdom ought to be well planted, whether it
is or not: It is so, secondly, because there are very few that are
properly planted.
As I have stated before, the infancy of a wood, or plantation, is the
only time when it cannot be expected to pay. After it has arrived at a
certain age, say from fifteen to twenty years, it ought to begin to
make some return. In woods, if they are properly planted, it will
necessarily be small during the first two cycles of twenty years each.
It must be observed, that I am here speaking of the first forty years of
an Ancient Wood, supposing it to have been thoroughly purged of its
rubbish, retaining all the valuable stock, and to have been re-
planted. The return must be small, because the oaks will have been
planted thickly, in order that they may acquire great length of bole:
and this being the case, whatever underwood may have been put in,
it will be treated with direct reference to the health and prosperity of
the entire class of timber trees. After the expiration of the first cycle,
that portion of the stuff put in for underwood will be cut over, and
such pruning of the oak as may be required (which will be very
slight) will be done, care being taken never to lose sight of the
principle of classification of the oaks, into certain families of larger or
smaller size, according to the term which a skilful woodman will allot
for their entire existence. This is of immense consequence, and will
embrace calculations, and a knowledge of the habits of trees, which
can only be acquired by “close observation and long experience.”
Where a sufficient number of oaks have been introduced, the
underwood will yield very little return per acre, even at the end of the
second cycle; but if the wood has been well managed, it will have
been kept alive and tolerably healthy; and when it is cut, at the end
of forty years, a considerable number of oaks of a useful size for
farmers, wheelwrights, &c. will be taken down: this will admit light
and air, and in a slight degree, perhaps, improve the position of the
underwood during the course of the third cycle.
I need not pursue the subject farther here, having, I trust,
succeeded in opening to the reader a general view of the plan which
should be pursued. But there are other woods where a larger
portion, both of oak and of underwood, will be found, and where,
consequently, it will be more the object of the woodman to improve
by less extensive measures than would be adopted in such a case
as the one just referred to. It will mostly be best to do this by pruning,
stubbing, and planting—always supposing that an effectual drainage
has been secured—and here I would remark, that whenever planting
is done in a wood, it should be as well done as circumstances will
possibly allow. Instead of the “nick” system, or any similar plan, the
woodman should dig holes for the underwood in the Autumn, and
plant in February, or early in March. For oak, he should dig a larger
hole, in the Autumn, give it a Summer fallow, and put in a vigorous,
stiff plant, the Autumn following, or in the February next but one. If
some such plan as this were pursued, there is not much fear but the
plants would grow, and in this way woods may be gradually brought
into a prosperous state, instead of their being, as they now are, in
the aggregate, a comparatively valueless property to their owners.
I may here illustrate my view by a reference to a particular case,
which came under my professional notice. It was a wood held on
lease by a gentleman, under an ecclesiastical body, the lease being
for a certain number of years, renewable upon the payment of a fine
every seven years. Some dissatisfaction was felt by the lessee at the
amount of the fines demanded, and the lease was permitted to
lapse, at which time the intrinsic value of the stock, whether of timber
or underwood, was literally nothing. The oak was all gone, as it was
quite natural that, with a lease so framed, it should be, and the
underwood, instead of being usefully and beneficially occupying the
ground, of which it then had entire possession, was not worth the
trouble of cutting! How different would have been the position of the
lessors in this instance, I need not say, if, during the two last cycles,
when the oaks were becoming very thinly scattered, the underwood
had been cherished, as it most undoubtedly ought to have been. The
neighbourhood was one where there was plenty of demand for the
produce of woods; the particular wood referred to, would have been,
on every account, as good a cover, and all parties would have been
alike interested in the continuance of the lease.
But as I must now very shortly bring such of my “Remarks” as
refer to “Ancient Woods,” to a close, it may be as well just to run over
the whole subject in a recapitulary form, so as to present it to the
reader in a sort of bird’s-eye view.
I have, then, endeavoured to show, that the present state of the
Ancient Woods of this kingdom is very far from what it ought to be,
and fully proves that their owners have paid little attention to them:
that they are almost valueless to them, simply and only for want of
better management: that they are capable of such a degree of
improvement as would insure from them a fair, reasonable return: I
have endeavoured to show this by contrasting the plans of
woodmen, if they can be said to have any, with those which, in my
judgment, ought to be pursued; and I am not aware that I have, upon
any one point, exposed the errors of their course, without suggesting
that which I conceive would be the right one. It is quite impossible,
however, to lay down in a book like this, or in any other, specific rules
or directions which shall constitute a sufficient guide for the manager
of woods, out of the difficulties of a false position, or enable him to
reform the errors of a vicious practice: for, first, not one woodman in
fifty would be convinced, by any process of reasoning, that the
present state of woods is so bad as I have described it to be; and if
they would not admit the existence of the evil, they would not be
likely to perceive the value of any remedial measures that might be
recommended. Next: a difficulty would every where present itself, if
woods were improperly treated, from the woodman feeling that the
introduction of any new plans would, necessarily, involve the
condemnation of his own. Besides all this, as I have remarked
before, so many things have to be considered as to the state of a
wood, before a safe opinion could be given as to the best course to
be taken with it, that nothing less than a minute examination,
affording the opportunity of duly weighing all the circumstances of
each particular case, would justify any man in suggesting a specific
course.
In proof of this, I would offer the example of a wood which I will
suppose to be of forty years standing, and to have been started with
as many oak plants as would suffice to insure a sufficient number of
timber trees, possessing ample length of bole, or stem. Upon the
plan of management which I have suggested, there would be, at the
second cutting of the under wood, a certain number of oaks to cut
out also, and from the stools of these, there would start young
shoots, which, if properly dealt with, would, with those which would
spring from every subsequent cutting, furnish a succession of timber
trees; but if no care were taken in nursing them, the probability is,
that they would be unfit for timber, and that it would therefore be
necessary, occasionally, to introduce a small number of maiden
plants, even as early as the expiration of the second cycle.
 CHAP. II.
PLANTATIONS.

In order to afford some facility to the reader in perusing what I may

write, I shall divide what I have to say into several distinct heads;
and, first, as to the

Present Modes of Planting.

Much may, and probably ought, to be said, on the errors of bad
planters: it is indeed a prolific, as well as an important subject; and if
there were any solid ground on which to rest a hope that an
exposure of all the mistakes which are made in planting, would lead
to the abandonment of such plans and practices as would be shown
to be wrong, it would be a duty worthy the exercise of talents of the
highest order. It does not, however, absolutely require the aid of
brilliant talent, or fervid eloquence, to place these matters in their
proper light before those who are most concerned; a plain reference
to facts will be quite sufficient for that purpose.
The case of an Ancient Wood in an unthrifty and unprofitable
condition, does not stand out so prominently—it is not so glaringly
discreditable to its owner, as is a Plantation in the same state, which
has been made by himself; for as to the former, the fact that “it
always was so,” is, to a certain extent, an excuse for bad
management; and in truth, it will generally be found a very difficult
affair, as I have hinted before, to establish a new system where the
prejudice of ages, in favour of an old one, will meet the person who
may attempt it, at every turn; but it is not so as to Plantations; when,
therefore, a gentleman decides to plant, and has himself to do with
the work from the beginning, both his interest, and his duty, point out
the necessity of his seeing that it be well done; but the very reverse
of this, is the average of the general practice, as I shall presently
show. It would be quite foreign to my purpose, to refer to the minor
shades of difference which exist in the practice of planters: such
difference indeed may be met with, between plans which are each in
themselves excellent; I shall content myself, therefore, with referring,
and that in general terms, to the most glaring mistakes which are
committed, giving a few examples.
To an eye that can take in the whole, it is lamentable to see the
effects of ignorance and neglect, in the original formation, as well as
in the subsequent treatment, of Plantations! With many, it seems to
be expected that they will thrive and prosper, no matter how they
may be put in, whereas the very contrary is the fact. With many
planters there is a vague, indefinite notion—of course there is no
calculation—that when once they are planted, trees will grow, not
only without labour or culture, but under such adverse circumstances
as at once convince the experienced planter of the utter impossibility
of their doing so. As I have elsewhere said, a young child, a young
animal, and a young tree, all require the greatest possible attention,
and the tenderest treatment; and the blighting effects which must
result, and which do result, from the absence of early attention, are
to be seen quite as strongly marked in the last, as in the other two.
In numerous instances—and this I shall call mistake the first—the
trees are put in without any previous preparation of the soil. It is not
possible, in the ordinary run of cases, to commit a greater error than
this. It is, emphatically, to build upon a bad foundation, and it is very
rarely indeed that Plantations, so commenced, ever make any thing
out. When I say this, I do not mean to assert that they never become
trees of any size: unfortunately they do, in some situations, and men
are so ignorant—there is so little real scientific knowledge of the
subject to be met with anywhere—that the most erroneous
conclusions are drawn from this fact. The question as to what a
Plantation might have done, or what it would have done, if it had
been properly treated, is never thought of! No one ever dreams of
instituting a comparison between such a Plantation as it is, and as it
ought to have been. And yet this is the very first question which
should be asked, or rather which should be anticipated.
But the majority of Plantations, which are commenced without any
preparation of the soil, are complete failures, as may be seen by any
one who chooses to take the trouble to examine for himself.
Influenced by a most mistaken notion of economy, many persons
plant their trees on land which is already fully occupied—it may be,
by ling, by bracken, or by long grass, or twitch—and in most cases of
this sort, the greater number die; but there may probably remain a
few which sustain a feeble existence, so as just to make a show of a
Plantation, and the owner seldom gives himself the trouble to
attempt to ascertain why it is no better. The method usually adopted,
when planting is done in this way, is, to dig small holes at fixed
distances, into which the plants are put by the workman in the best
manner that he can, and they are left to fight their way as best they
may.
Mr. Withers, of Holt, in Norfolk, has ably, and indignantly,
denounced the hole-digging system, and has shown, most clearly,
the advantage of “the highest degree of culture,” for raising timber,
whether as a pecuniary question, or where it is wanted for merely
ornamental purposes. It is true that an opinion at variance with his,
has been given by some, but every practical man will, at once,
perceive where the truth lies; nor will he be at any loss, whether, in
the preparation of a field for planting, to follow the directions of Sir
Henry Steuart, or those of Mr. Withers.
It was the practice of the latter gentleman, to trench his ground
from “fourteen to eighteen inches deep,” and on poor land, to “put on
as much manure as if turnips were intended to be sown,” and to hoe
and keep clean the land, for seven years after planting. The results
were, extraordinary rapidity of growth, and a consequent early and
ample return upon the capital invested, in addition to the full
accomplishment of an object, which is, of course, ardently desired by
every planter: viz.: the pleasure of seeing rapidly rise up before him,
a healthy and most promising race of trees.
The second mistake which I shall notice is a very common one;
and is committed by those who prepare the land well, but, by a bad
selection of plants, either as to age, or kind, or both, render success
impossible. The error as to age consists, most frequently, in their
being too old: that as to the kind, in not choosing such as are
adapted to the nature of the soil.
A third class of planters may be met with, who, to a certain extent,
avoid all the mistakes previously referred to, but who commit the
unaccountable blunder of throwing the various kinds promiscuously
together, without any regard to congeniality as to the plants; and in
this case, the trees that are really valuable are overtopped, and
mastered by a set of worthless trash, which, when full grown, are
hardly worth the trouble of cutting down. When a Plantation is made
in this barbarous manner, and left in this state for twenty years, or
even less, no subsequent efforts, however sound the judgment
which is exercised may be, can wholly repair the mischief which is
done. By this mistake, an immense loss of property accrues to the
proprietor, and the worst of all is, that the trite consolation is not left
him, that what is “his loss, is another’s gain,” for here nobody is
benefitted; while to himself there is superadded the mortification of a
loss of time, “which no man can restore.”
That the strong language which I have here employed is fully
justified, will at once be admitted by every reflecting person, who has
any acquaintance with these matters; for it will appear at the outset,
that if a slow-growing tree is planted close to one which will grow half
as fast again, and if the slow grower is the tree intended for timber,
the latter must inevitably be so much damaged as to affect its health
for ever, if something be not done to relieve it.
I shall not, in this place, “remark” more particularly on this point,
than to say, that I have often seen the oak in this relative position,
with the alder, the birch, the poplar, the larch, and other trees.
To imagine that a comparatively slow-growing tree can be placed
in near contiguity with another whose rate of progress is much
quicker, without receiving injury, is to manifest a want of knowledge
of the habits of trees, which may be excused in an amateur planter,
but which cannot be overlooked in a practical man, who is well paid
for his services.
A fourth error which is committed, is one upon which I have slightly
touched already, and refers to the question of adaptation of the kind
of tree planted, first, to the nature of the soil planted upon, and next,
if the object of the planter be profit, to the local demand.
Most serious mistakes have been committed upon both these
points, even by men whose writings have procured them a niche in
the Temple of Fame. Under this head a few cases will now be
referred to.
It is impossible, at this distance of time, to fix the exact amount of
blame, or responsibility, which of right attaches itself to the name of
Pontey, for instance, who planted an immense tract of land near
Lincoln, belonging to that splendid charity, Christ’s Hospital: tradition,
which, however, may do him injustice, accuses him of having
contracted to plant with Larch and Oak, and having, on some
pretence or other, substituted Scotch Fir.
Whatever was the precise amount of responsibility attaching to
him, I know not; he might be following out the letter of his
instructions, for ought that I can tell, but it is quite certain that, even
with the then imperfect knowledge which was possessed of the value
of larch, a very great mistake was committed, in planting nearly a
thousand acres of land, which was well adapted both for oak and
larch, with profitless rubbish like that which is now seen upon it. A
work of that magnitude ought not to have been intrusted to any one
who, either from mercenary motives, or from limited views, was
capable of falling into such a gross error, as to the interests of his
employers. It is no exaggeration to say, that if the Skellingthorpe
Plantation had been planted, as it ought to have been, with oak and
larch, together with a few spruce firs, and if Pontey had left suitable
instructions with those who had to take care of it, after his
superintendence had ceased, it would now have been, at the most
moderate computation, fifteen hundred per cent. more valuable than
it is!
If it were private property, I should not presume to add what I now
feel myself at perfect liberty to do, with reference to its present
condition, and the future prospect respecting it.
It is at present, almost universally, a Scotch Fir Plantation: these
are of a most miserable size, compared with what they might have
been, under good management, and they are withal very coarse.
There may be seen amongst them, just Larches enough to
perpetuate the folly of the original planter; and to excite, at his
periodical sales, the keen regret of the present Steward, that he has
not more of them to sell. There are also a few oaks, of such quality
as fully to prove that they would have thriven well—had they been
planted. Further: the Scotch firs are so thick, and they are feathered
down so low, that the Plantation is not healthy. It is true that, under
the present much improved management, an attempt is being made
to remedy this evil, and it is quite clear, that the condition of the trees
will gradually be bettered, but the misfortune is—and here I come to
speak of the prospects of the Plantation—that they are not worth
culture. I have no hesitation in stating this to be my deliberate
opinion. The timber, if timber it can be called, is worth almost nothing
now, and, in such a locality, I can see no probability of its ever
realizing, so as to justify those in whose care it is placed, in
continuing it as it is. The plain and obvious course of the managers
of this fine estate, then, is to stub up the Scotch fir, and replant the
land with oak and larch.
In further proof of the propriety of this opinion, I would remark that,
in this locality, both oak and larch fetch very high prices, and there
are probable grounds for expecting that they always will do so; while,
if the present race of Scotch firs should stand as long again as they
have already stood, they will make comparatively little.
It is not too much to say, that if this Plantation were the property of
a private gentleman, the Scotch firs would be extirpated as speedily
as possible, and a systematic plan, providing that a certain number
of acres should be stubbed and re-planted every year, would at once
be laid down; but public bodies are not so easily moved, and it is
therefore to be feared, that, in this case, the public will not, for some
time to come, derive that benefit from the property, which would
certainly be the result of proper management.
The whole might be re-stocked with suitable kinds of trees, without
any considerable outlay to the hospital, if arrangements were made
with a party capable of carrying out some such comprehensive plan
as the following; viz.: An agreement with a responsible person,
carefully worded, providing that he should stub, or grub up, a
stipulated number of acres at the commencement of a sort of lease,
taking the stuff, either in part payment, or wholly, if it were sufficient:
and that he should, on such terms as could be agreed upon,
continue to grub up, and plant, a specified number of acres every
succeeding year.
In twelve years, if the work were well done, there would be some
return from the thinnings of the piece first planted; and the rate of
return and profit, would, from that time, continue to increase every
year, until an amount would be realized which would much more
than equal the largest expectations of the Governors.
I shall only mention one case more, as to the want of adaptation of
the kind of tree to the soil, and to the local demand, and that is a
wood belonging to the Right Honourable Lord Middleton, at
Stapleford, near Newark, and which, some years ago, consisted
almost entirely of Scotch fir. It is now of an age and size that enables
me to cite it in proof of the opinion which I have given, relative to the
prospect for the Skellingthorpe Plantation. The timber has arrived at
a good marketable size, and is sold at as high a rate as there is any
reason to suppose would be made of the Skellingthorpe Scotch,
when it shall have reached to the same size. That price is apparently
moderate, but it is so inferior in quality, or, perhaps, it is more correct
to say, such a bad opinion is formed of it, by most people, that when
it is converted into boards or scantling, the price it fetches is so low
as to hold out little inducement to Timber merchants to purchase it.
And as to the grower, I am persuaded that, if simple interest upon
the original investment were to be calculated, up to the time when
the wood first began to clear its own expences, and added to the first
cost, it would not be found that there is much surplus over the
necessary expences of management. At all events it would be seen
there, as well as at Skellingthorpe, from the little Larch and Oak
which they have had to sell, that the returns are comparatively small
to what they would have been, if Larch had first been planted along
with Oak. This large Plantation will, in the course of a few years,
under the present enlightened and skilful management, to a great
extent, be cleared of the Scotch firs; in place of which, the noble