ARTHROSCOPIC

EQUIPMENTS AND
INSTRUMENTS
MODERATOR- DR
SHIVARAJ
PRESENTER- DR
PRITHVIRAJ P
MEANING OF
ARTHROSCOPY
• THIS WORD ARTHROSCOPY CAME FROM “GREEK,"ARTHRO" (JOINT)
AND "SKOPEIN" (TO LOOK).
• THE TERM LITERALLY MEANS "TO LOOK WITHIN THE JOINT SIMPLY
AS IF YOU SEE A ROOM THROUGH A KEY – HOLE INSTEAD OF
OPENING DOORS.
• IT OFFERS A HIGH DEGREE OF ACCURACY COMBINED WITH LOW
MORBIDITY FOR MAKING DIAGNOSIS AND OFFERING TREATMENT.
ARTHROSCOPY : EQUIPMENTS
ASSEMBLY
 ARTHROSCOPE
• An arthroscope is an optical instrument
used in medical procedures.
• Three basic optical systems have been
used in rigid arthroscopes:
• Classic thin lens system
• Rod-lens system designed by Professor
Hopkins
• Graded index (GRIN) lens system.

• Advancements in arthroscope design have

been made possible by fiberoptic
technology, magnifying lenses, and digital
monitors.
 ARTHROSCOPE ANGLES

• Arthroscopes come in different

angles
• The 30 degree arthroscopes is the
most common
 ARTHROSCOPE ANGLES
• 70 degree arthroscopes are used for seeing around corners, such as the posterior
compartments of the knee.
• However, the higher degree arthroscopes can make orientation by the observer more
difficult.
 FIELD OF VIEW
• Field of view refers to the viewing angle encompassed by the lens and varies
by the type of arthroscope.
• The 1.9-mm scope has a 65-degree field of view.
• The 2.7-mm scope has a 90-degree field of view.
• The 4.0-mm scope has a 115-degree field of view.
• Wider viewing angles make it easier for the observer to orient themselves
 ROTATION OF ARTHROSCOPES
• Rotation of forward oblique viewing (30 degree) arthroscopes allows a larger
area of the joint to be observed.
• Rotation of 70 degree arthroscopes produces an extremely large field of view
but may create a central blind area directly in front of the scope.
 TELEVISION CAMERAS
• McGinty and Johnson were among the first to
introduce television cameras to the
arthroscopy system.
• Advantages of using television cameras
include:
• Providing a more comfortable operating position
for the surgeon.
• Avoidance of contamination of the operative field
by the surgeon's face.
• Involvement of the rest of the surgical team in the
procedure.
 TELEVISION CAMERAS
• Early cameras were bulky and inconvenient, but smaller
solid-state cameras have been developed
• These small cameras can be directly connected to the
arthroscope.
• Improvements in camera chip and electronic circuitry have
led to reductions in size and better high-definition digital
resolution.
• Some cableless arthroscopic systems transmit the video
signal from an arthroscope with its miniature light source.
• Cameras using three-chip technology offer greater color
resolution.
• Digitalization of the video signal has improved high-quality
imaging.
 ACCESSORY INSTRUMENTS
• The basic instrument kit for arthroscopy
includes:
• Arthroscopes (30- and 70-degree)
• Probe
• Scissors
• Basket forceps
• Grasping forceps
• Arthroscopic knives
• Motorized meniscus cutter and
shaver.
• Electrosurgical, laser, and
radiofrequency instruments.
• Miscellaneous equipment.
 ACCESSORY INSTRUMENTS
• These instruments are used for most routine arthroscopic surgical procedures.
• Additional instruments are available and occasionally used for special circumstances.
• Procedure-specific instrumentation has been developed for various specialized procedures,
such as cruciate ligament reconstruction, meniscal repair, osteochondral transplantation, hip
arthroscopy, and small joint arthroscopy.
• Surgeons may have personal preferences regarding the type, design, and manufacturer of
these instruments.
• Advanced shoulder procedures have seen the redesign of instruments for passing, retrieving,
and tying sutures, particularly for soft-tissue repair procedures of the capsule, labrum, and
rotator cuff.
PROBE
• The probe is a crucial diagnostic instrument in arthroscopy.

• Often referred to as "the extension of the arthroscopist's

finger”.

• It plays a significant role in both diagnostic and operative

arthroscopy procedures.

• Considered the safest instrument for learning triangulation

techniques.

• Essential for palpating intraarticular structures and planning

surgical approaches.

• Provides a tactile sensation for distinguishing between

normal and abnormal structures.

• "Seeing and feeling" with a probe is preferred over just

visual observation.
 PROBE
• Common uses of the probe include:
• Assessing the consistency of structures like articular
cartilage.
• Determining the depth of chondromalacic areas.
• Identifying and palpating loose structures within the
joint, such as meniscal tears.
• Maneuvering loose bodies into more accessible positions
for grasping.
• Palpating the anterior cruciate ligament and assessing
tension in ligamentous and synovial structures.
• Retracting structures within the joint for better exposure.
• Elevating a meniscus to view its undersurface.
• Probing fossae and recesses within the joint, such as the
popliteal hiatus.
 PROBE
• Most probes are right-angled and have a tip size of 3 to 4 mm.
• The known size of the probe's hook can be used to measure the size of intraarticular lesions.
• The arthroscope magnifies the view, and the closer the arthroscope is to the target, the greater the
magnification.
• Care should be taken while using the probe, with much of the palpation within the joint being
performed using the elbow of the probe rather than the tip or toe of the instrument.
ARTHROSCOPIC SCISSORS
• Arthroscopic scissors typically have a diameter of 3
to 4 mm. Angulated
• They are available in both small and large sizes.
• Scissor jaws may come in two configurations:
straight or hooked.
• Hooked scissors are preferred because they tend to Curved
hook tissue and pull it between the cutting edges,
preventing material from being pushed away, which
can happen with straight scissors.
• Optional accessory scissor designs include:
• Right-curved scissors
• Left-curved scissors
• Angled cutting scissors
ARTHROSCOPIC SCISSORS
• The difference between curved and
angled designs lies in the location of the Angulated

angulation:
• Curved scissors have a gently curved shank to
accommodate right and left positioning.
• Angled scissors, often with a rotating jaw
mechanism, cut at an angle to the shaft of the Curved
scissors.

• These accessory designs are particularly

useful for detaching difficult-to-reach
meniscal fragments during arthroscopic
procedures.
 BASKET FORCEPS
• The basket or punch biopsy forceps is commonly
used in operative arthroscopic procedures.
• It has an open base that allows each punch or tissue
bite to drop freely within the joint.
• This design eliminates the need to remove the
instrument from the joint and clean it with each use.
• Small tissue fragments that drop into the joint can
be irrigated out or removed with suction.
• Basket forceps come in sizes ranging from 3 to 5
mm and have both straight and curved shaft
options.
• They are particularly useful for trimming the
peripheral rim of the meniscus or cutting across
meniscal and other tissue.
 BASKET FORCEPS
• Wide, low-profile baskets are excellent for meniscal
work.
• Basket forceps may have straight or hooked jaws,
with the hooked configuration being preferred.
• Different angles (e.g., 30, 45, and 90 degrees) are
available, which are useful for trimming the anterior
portions of the meniscus.
• They are also available in 15-degree down-biting
and up-biting curves to facilitate access to posterior
meniscal horn during resection.
• Proper technique involves making small bites to
avoid excessive pressure on the joints and pins,
reducing the risk of breakage.
 HINGED SUCTION PUNCH
• Hinged, jawed suction punches are designed to
cleanly bite small bits of tissue (e.g., meniscus)
and suction them from the joint.
• These punches have a channel in the shaft for
efficient removal of tissue fragments from the
joint.
• They are particularly useful for preventing tissue
fragments from obstructing the surgeon's view
within the joint.
• However, they may be too large to access tight
posterior areas.
 GRASPING FORCEPS
• Grasping forceps are used to retrieve material
from the joint, such as loose bodies or synovium.
• They can also be used to place tissues, like
meniscal flaps, under tension while cutting with
another instrument.
• Most grasping forceps have ratchet closures on
the handle to secure tissue within the jaws.
• The jaws may be single- or double-action, with
different tooth designs for securing grasped
tissue.
• Double-action grasping forceps, where both jaws
open, are preferred for securing
osseocartilaginous loose bodies
 KNIFE BLADES
• Most arthroscopic knives are
disposable, single-use
instruments.

• Various blade designs are

available, including hooked or
retrograde blades, down-cutting
blades (straight and curved),
and end-cutting blades.

• Some blades have magnetic

properties for retrieval if they
break inside the joint.

• Blades should be inserted

through cannula sheaths or
retractable sheath mechanisms
to minimize exposure
 MOTORISED SHAVING SYSTEMS
• Motorized shaving systems consist of an outer, hollow sheath and an inner, hollow
rotating cannula with corresponding windows.
• The inner sheath's window acts as a spinning blade that cuts soft tissue as it rotates
within the outer tube.
• Suction through the cylinder collects the tissue fragments.
• These systems offer various cutting tips and diameters, often ranging from 3 to 5.5
mm, with variable sizes for different joint access.
• Foot pedals control motor speed and direction, including reversing the rotation of the
cutting blade intermittently to improve cutting efficiency and reduce clogging.
 ELECTROSURGICAL, LASER, AND
RADIOFREQUENCY INSTRUMENTS
• Electrocautery is used for cutting and hemostasis in arthroscopic procedures.
• Radiofrequency systems produce heat energy and are available in monopolar and bipolar types.
• The depth of tissue penetration, amount of cell death, and temperature control are current
controversies in radiofrequency use.
• Reported complications of radiofrequency meniscal ablation include articular cartilage damage and
tissue damage caused by the irrigant.
 IMPLANTS
• Various implants, including suture anchors, meniscal repair devices, and
devices for tendon and ligament fixation, are used in arthroscopic
procedures.
• Suture anchors are used to attach ligaments and tendons to bone without the
need for creating bony tunnels.
• Meniscal repair devices allow all-inside meniscal repair without arthroscopic
knot-tying.
• Implants can be made from metal or biodegradable materials, depending on
the application and preference.
 MISCELLANEOUS EQUIPMENT
• Various sheaths and trocars are
required for arthroscopic surgery to
accommodate the arthroscope and
accessory equipment.
• Sharp instruments should preferably
be placed through sheaths to protect
the soft tissues of the skin portals.
• Motorized instruments can be used
with or without a sheath.
• Some systems allow the
interchangeability of cannulas for
inflow, arthroscope, and motorized
shaver systems.
 MISCELLANEOUS EQUIPMENT
• Disposable plastic cannulas with sealed ends
help reduce fluid extravasation.
• Special tools like "switching sticks" and
dilators are used for maintaining portals and
exchanging larger operating cannulas.
• Traction devices are designed for better
exposure in joints like the shoulder, elbow,
and ankle.
• Procedure-specific instruments have been
developed for various arthroscopic
procedures
 IRRIGATION SYSTEM
• Irrigation and distention of the joint are essential in
arthroscopic procedures.

• Joint distention is maintained with lactated Ringer

solution.

• Inflow of the solution may pass through the arthroscopic

sheath or a separate portal via a cannula.

• A 6.0- or 6.2-mm sheath is recommended for adequate

flow with the scope.

• Lactated Ringer solution is preferred due to its

physiologic properties and minimal impact on synovial
and articular surfaces.`
 IRRIGATION SYSTEM
• Gravity and arthroscopic pumps are used to deliver fluid, and inflow
can be through the arthroscopic sheath or a separate inflow sheath.

• Elevating the solution bag above the joint level increases joint
distention pressure.

• Arthroscopic pumps should be used with caution, and muscle

compartments and soft-tissue spaces should be monitored closely.

• Distention pressures vary based on the joint and type of pump but are
generally maintained within a safe range.

• Adding epinephrine to the solution can improve visibility and reduce

the need for tourniquet inflation in some cases.

• Distention pressures in the elbow and ankle should be maintained at

approximately 40 to 45 mm Hg using gravity inflow.

• Pumps are generally not used for distention in small joints.

 REFERENCES
• CAMPBELL’S OPERATIVE ORTHOPAEDICS
THANK YOU