Page 64 - Clinical Manual of Small Animal Endosurgery

52 Clinical Manual of Small Animal Endosurgery

which can identify pathological changes that are not immediately evident
from visual inspection alone.
Recording the arthroscopic findings on a standardised chart (see Table
2.1) of the joint space enables a logical and reproducible method of
documenting articular health and disease. A standardised recording chart
for each joint enables comparison of arthroscopic findings within a single
patient, when monitoring serial changes and for comparison between
patients. Furthermore, the adoption and use of universally accepted
charts for mapping the findings of arthroscopic investigations will
facilitate exchange and sharing of information that is readily widely
understandable.
Cartilage lesions are graded according to a modified Outerbridge
system that has gained wide acceptance in veterinary orthopaedics (see
Table 2.2).

Investigative arthroscopy of the elbow joint

A medial approach enables examination of the majority of the structures
that are commonly affected in diseases of the elbow joint. A 2.4 mm
arthroscope is suitable for large-breed dogs and for immature medium-
sized dogs that have marked joint effusion and joint laxity, since the
2.4 mm scope can be inserted readily into these joints. A 1.9 mm scope
is better suited for smaller dogs and for those without marked effusion
and joint laxity. The ideal position for the arthroscope portal is distal
and slightly caudal to the medial epicondyle (see Chapter 3 in this volume
for more details), since this gives a good view of the entire medial side
of the joint including:
• the anconeus,

• the ulnar trochlear notch,
• the coronoid (lateral, central and medial),
• the radial head (medial aspect),
• the medial aspect of the humeral condyle (cranial, central and caudal
regions),
• the lateral aspect of the humeral condyle (axial region).

Following scope insertion into the joint and transfer of fluid ingress onto
the arthroscope cannula it is helpful to establish a good egress, adjusting
the position of the needle used for the initial distension of the joint, or
replacing it with a larger gauge (19 gauge or larger). Once any bleeding
resulting from insertion of the arthroscope has been flushed away, a
systematic exploration of the joint can be performed. The camera is
maintained in an upright orientation such that the proximal aspect
of the joint is always at the top of the viewed image and a systematic