Page 87 - Clinical Manual of Small Animal Endosurgery

Operative Arthroscopy 75

Fig. 3.11 Elbow arthroscopy. Diseased coronoid is removed using a
motorised burr.

noidectomy. The efficacy of outcome of this more substantial coronoid
debridement technique has not yet been objectively studied or reported
despite widespread use of the technique. An arthroscopically assisted
osteotome technique has been described to perform a subtotal ostectomy
of the coronoid process, which may be indicated to remove the diseased
coronoid tissue in its entirety. Clinical reports of efficacy or superiority
of this technique are currently lacking. A large, modified instrument
portal is used to insert an arthroscopic osteotome and following the
osteotomy of the coronoid process the fragment is retrieved using large
crocodile forceps. Some workers perform one or other of these more
radical debridement procedures for the treatment of all of the arthro-
scopic manifestations of coronoid disease because the arthroscopic
appearance does not seem to correlate with the extent of the disease in
the underlying subchondral bone.
When the arthroscopic view, assisted by probing when necessary,
reveals a separated fragment of the coronoid process, it is common
practice to remove the fragment en masse. Soft-tissue attachments are
severed using the meniscectomy tool, which is a protected knife, enabling
safer cutting in the limited distant view. Soft-tissue attachments generally
require severance cranial and lateral to the fragment. Once the fragment
is loosened, grasping forceps are inserted and judiciously manipulated
so that the fragment occupies the entire length of their jaws, thus max-
imising the grip on the fragment. The fragment is carefully retrieved
using an initial twisting motion to tear remaining soft tissues prior to
retrieval through the instrument cannula. When the fragment is large,
resistance is detected as the open jaws of fragment holders impinge
upon the cannula. Under such circumstances, the grip is maintained on
the fragment and the grasping forceps are withdrawn concurrently with