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Basics of Artrhoscopt
Basics of Artrhoscopt
SEMINAR ON
BASICS OF
ARTHROSCOPY
MODERATORS:
DR. RAMESH R.
PROFESSOR
AND UNIT
CHIEF
Arthroscope : 30 degree
70 degree
Fibreoptic cables
light sources
Accessory instruments
Television cameras
Probe
Scissors
Basket forceps
Grasping forceps
Knife blades
Motorized shaving systems
electrosurgical lasers &
radio surgical instruments
ARTHROSCOPY : EQUIPMENTS
ASSEMBLY
irrigation fluid bags
y connector
T. V. monitor
POWER
camera
light source
Arthroscope
Fibreoptic cable
MONITOR
It is the device that
projects the image
created by the
arthroscope and the
camera head.
CAMERA HEADS
arthroscope
LIGHT SOURCE WITH FIBRE OPTIC
CABLES
Light source
arthroscope
INSTRUMENTS AND EQUIPMENT
ARTHROSCOPE
H o p k n s opttcat ( r o d lens) s y s e m
ilhunination oupling
t.ripl t optic
gla fib r ( G F ) t n e t a l t.ub u \ I T )
GF l\1T
GRl.i. Tr lay l n au·gap n
(B) (C)
Certain features determine the optical
characteristics of an arthroscope. Most important
are the diameter, angle of inclination, and field of
view.
The angle of inclination, which is the angle between
the axis of the arthroscope and a line
perpendicular to the surface of the lens, varies
from 0 to 120 degrees.
Angle of
inclination
The 25- and 30-degree arthroscopes are most commonly
used. The 70- and 90-degree arthroscopes are useful in
seeing around corners, such as the posterior compartments
of the knee
Field of view refers to the viewing angle
encompassed by the lens and varies according to
the type of arthroscope.
0°
Straight view not
recommended
30 °
Increase the field of vision
(90 )
70 °
For viewing special regions
75°
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ACCESSORY INSTRUMENTS
The basic instrument kit consists of the following:
arthroscopes (30- and 70-degree); probe; scissors;
basket forceps; grasping forceps; arthroscopic
knives; motorized meniscus cutter and shaver;
electrosurgical, laser, and radiofrequency
instruments; and miscellaneous equipment.
OS
0 LEFT
R D 0
S C LE
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MOTORIZED SHAVING SYSTEMS
Consists of an outer, hollow sheath and an inner,
hollow rotating cannula with corresponding
windows .
The window of the inner sheath functions as a two-
edged, cylindrical blade that spins within the outer
hollow tube.
Suction through the cylinder brings the fragments of
soft tissue into the window, and as the blade
rotates, the fragments are amputated, sucked to the
outside, and collected in a suction trap.
Uses :
Designed for meniscal cutting or trimming, for
synovial resection, and for shaving of articular
cartilage.
ELECTROSURGICAL, LASER, AND
RADIOFREQUENCY
INSTRUMENTS
Electrocautery has been used as an arthroscopic tool
for cutting and hemostasis most often after arthroscopic
synovectomy and subacromial decompression.
It also has been used for both cutting and hemostasis in
lateral retinacular release for malalignment of the
patella.
Reported complications of radiofrequency meniscal ablation
include articular cartilage damage, osteonecrosis, and
tissue damage caused by the irrigant.
IMPLANTS
Suture anchors
Meniscal repair devices
Devices for tendon and ligament fixation and
articular
cartilage repair.
Suture anchors
MISCELLANEOUS EQUIPMENT
Sheath
Blunt trocar
Sharp Trocar
CARE AND STERILIZATION OF
INSTRUMENTS
Arthroscopy equipment that is heat stable may be
autoclaved for sterility.
Advantages :
1) Increased visibility
Disadvantages :
1)Blanching of the synovium, which makes
differentiation and diagnosis of various synovial
disorders difficult, and
2)The possibility of ischemic damage to muscle and
nervous tissue with prolonged tourniquet time of more
than 90 to 120 minutes.
Contraindications :
Thrombophlebitis and significant peripheral
vascular disease
LEG HOLDERS
Improved visualization
Time consuming
Expensive
CONTRAINDICATIONS
RELATIVE CONTRAINDICATIONS
Damage to Compartment
syndrome
Cruciate ligaments
Nerves
Ligaments and
tendons
DAMAGE TO INTRAARTICULAR
STRUCTURES
Most common complication of knee arthroscopy
Damage to the articular cartilage surfaces by the tip of
the arthroscope or the operating instrument is the most
common complication.
It leads to progressive chondromalacic changes and
degenerative arthritis.
Prevention :
ELBOW
Brachial artery may be damaged during
establishment of either the anteromedial or
anterolateral portal.
PREVENTION
By using gravity inflow or lower pump pressures
and ensuring adequate outflow, most of these
complications can be avoided.
NERVES
CAUSES
PREVENTION :
By using LMW heparin 12 hours prior to surgery
and continuing 48 hours postoperatively
INFECTION
RISK FACTORS
The use of intraarticular corticosteroids
0.03% incidence
If an instrument breaks, the surgeon should
immediately close the outflow cannula but the
inflow should be left open to keep the joint
distended.
If the broken instrument is in the visual field, total
attention to keeping it in view and removing it is
essential.
If the broken piece is located, a suction apparatus
or a magnet may be introduced through an
accessory portal to stabilize and remove the small
broken fragment.
KNEE
In general, knee arthroscopy is performed for diagnosing and treating a variety of
knee problems. The common indications are:
1. Meniscal tears
2. ACL tears
3. PCL tears
4. Removal of loose bodies
5. Synovectomy (removal of diseased synovial tissue) in cases of:
a. Rheumatoid arthritis
b. Infections (pyogenic arthritis, tuberculous arthritis)
c. Pigmented villonodular synovitis
d. Synovial chondromatosis (multiple loose bodies)
6. Joint debridement & washout for osteoarthritis
7. Articular cartilage injuries and defects requiring:
a. Abrasion arthroplasty
b. Mosaicplasty
c. Autologous cartilage implantation (ACI)
8. Lateral retinacular release for patellar maltracking
9. Patellar clunk syndrome following total knee replacement
10. Evaluating knee joint prior to doing Unicompartmental knee replacement (UKR)
or High tibial osteotomy (HTO)
11. Arthroscopic assisted fixation of tibial plateau fractures
PATIENT POSITIONING
STANDARD PORTALS
saphenous vein
and nerve
lateral
collateral
ligament
postero
mediaJ postero1at
portal ral
portal
n mius
Anteromedial
Anterolateral
Posteromedial
Superolateral
ANTEROLATERAL
Almost all structures clearly visualised except
PCL
Anterior portion of lateral meniscus
Periphery of posterior horn of medial meniscus
1cm above lateral joint line
1cm lateral to patellar tendon
Chondral pathology
Synovial disease
Instability
Joint sepsis
PORTALS
Anterior portal
1 cm superior
and anterior to
the anterior
Anterolateral portal edge of the
greater
trochanter .
Lateral portal 1 cm posterior and
superior to the greater
trochanter.
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