Page 98 - Clinical Manual of Small Animal Endosurgery

86 Clinical Manual of Small Animal Endosurgery

been reported following surgical stabilisation of the lateral aspect of the
shoulder joint following the identification of injuries to the lateral support
structures. The conventional open surgical technique uses bone anchors
with suture to create prosthetic ligaments. More recently, arthroscopi-
cally placed sutures using a hanging-limb technique and a craniomedial
portal to readily view the lateral aspect of the joint has been described
for the management of lateral glenohumeral ligament rupture (Mitchell
and Innes, 2000; Pettitt and Innes, 2008).
Following a stabilisation procedure for shoulder ligament insufficiency,
the portals are closed prior to instillation with a morphine/ropivacaine
combination (see above) for augmentation of the postoperative analgesia
protocol.

Arthroscopically assisted surgery of the stifle joint

The patient is positioned in dorsal recumbency with the head up on a
table tilted at approximately 30°. A vacuum beanbag secured to the table
is used to keep the patient firmly positioned with the hind limbs able to
hang over the end of the operating table. Following a routine aseptic
hanging-limb preparation the joint is aspirated and instilled with 7.5%
ropivacaine (2 mg/kg). The craniolateral portal is established at a land-
mark just lateral to the patellar tendon. Deep palpation identifies a bony
protuberance on the proximal tibia that is just cranial to the long digital
extensor tendon and a stab incision is made into the stifle joint just
proximal to this landmark (Fig. 3.15). The stifle is held in extension and
a blunt switching stick is inserted through the soft tissues and directed
through the stifle joint, under the patellar ligament and the patella and
pushed against the proximomedial pouch of the stifle joint. Firm pressure
is applied and the skin is incised over the end of the switching stick. A
fenestrated cannula is slipped over the switching stick (Fig. 3.16) into
the stifle joint and the switching stick is removed. Maintaining the stifle
in extension and keeping the tissues of the cranial part of the stifle lax,
the cannula tip is directed over the medial trochlear ridge, settling the
cannula in the medial recess of the stifle joint. Next, the arthroscope and
blunt cannula are introduced through the lateral portal and advanced
beneath the patella until the proximal joint pouch is detected by resist-
ance. The obturator is withdrawn, the light post is attached, the arthro-
scope is inserted and motorised pressure-controlled fluid irrigation is
started. The articular cartilage of the femoral trochlea, the trochlear
ridges and the patella are systematically inspected and the synovium, the
patellar ligament and the recesses of the stifle joint are evaluated, docu-
menting pathological changes on a stifle-joint-specific chart. (see Table
2.4, arthroscopic assessment of the stifle)
The craniomedial portal is established, which will be used as an instru-
ment portal. Prior to making the portal, the arthroscope is parked so
that the tip lies within the intercondylar notch, viewing proximally. A