Page 66 - Clinical Manual of Small Animal Endosurgery

54 Clinical Manual of Small Animal Endosurgery

Table 2.2 Arthroscopic grades of articular cartilage lesions (modified Outerbridge scale)

Grade Findings
0 Normal cartilage
I Chondromalacic cartilage (soft and swollen)
II Fibrillation
Superficial fissuring or erosion or pitting of the cartilage surface
Lesions do not reach subchondral bone
III Deep fissuring that reaches subchondral bone or deep ulceration that does not reach
subchondral bone
IV Exposure of subchondral bone
V Eburnated bone

examination of the joint normally follows the order of the structures
outlined above. Hence, the light post is rotated craniodistally and the
arthroscope is tilted craniodistally while the trochlear notch is main-
tained in view and followed proximally, leading to the anconeus. Reversal
of this manoeuvre and continued tilting of the scope caudally with
further caudal rotation of the light post enables examination of the distal
ulnar trochlear notch and the caudomedial aspect of the radial head.
Insertion of the scope slightly deeper into the elbow joint reveals the
lateral coronoid and the axial edge of the lateral part of the humeral
condyle. Tilting the camera further caudally brings the medial coronoid
into view and the cranial and central parts of the coronoid are examined
by inserting the scope slightly further into the joint.
The entire coronoid region is inspected for signs of cartilage damage
and fragmentation of the craniolateral aspect of the medial coronoid.
The medial aspect of the radial head should also be examined for signs
of cartilage injury/disease. Progressive rotation of the light post distally
while also tilting the camera distally enables inspection of the medial
aspect of the humeral condyle, working from cranial, passing over the
central region and finishing with the caudal portions of the condyle. The
scope should be retained deep within the joint initially to inspect
the axial component of the condyle, looking for evidence of the cartilage
fissure that can occur with incomplete ossification of the humeral condyle
in dogs of susceptible breeds. Gentle traction on the scope may be neces-
sary to view the medial, abaxial condyle and care should be taken to
avoid pulling the scope from the joint cavity during this manoeuvre. The
central and cranial portions of the humeral condyle should be examined
carefully since chondral lesions are common here, where the condyle
articulates with the ulnar coronoid.
Following a visual assessment of the joint space an instrumented
inspection of the structures may be indicated. The instrument portal is
cranial to the arthroscope portal, in the region of the medial collateral
ligament (see Chapter 3 for more details). The arthroscope is positioned
to view the coronoid process and a needle (e.g. 22 gauge) is inserted
almost parallel to the arthroscope aiming to place the needle tip into the