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Arthroscopy 1060.e1

Arthroscopy Client Education
Sheet
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• Postoperative analgesia may include nonster-
Difficulty level: ♦♦♦
oidal antiinflammatory drugs (NSAIDs), • When placement of the arthroscope is
confirmed, the scope cannula should be
Overview and Goal tramadol, or a combination of both. connected to the irrigation tubing; the joint
Arthroscopy is a minimally invasive surgical can then be lavaged and explored.
procedure where a rigid endoscope is used Anticipated Time • Localization and placement of instrument
to view the internal anatomy and pathol- Depending on the procedure: 30-90 minutes portals vary based on the joint involved
ogy of joints. Arthroscopy can be used as and proposed surgical procedure to allow
a method of diagnosing and treating joint Preparation: Important triangulation and access to specific anatomy
disease. Checkpoints within the joint.
Arthroscopy is performed far more com- • Educate the clients on the risks and complica- ○ Instrument portal placement is facilitated
monly in dogs than cats. The most common tions associated with arthroscopic surgery. by the use of a hypodermic needle and Procedures and Techniques
joints treated with arthroscopic surgery are the • Always speak with clients about the chance visualization with the arthroscope. Care
shoulder, elbow, and stifle joint. Occasionally, that a procedure will need to be converted must be taken not to place the needle at
the hip, carpus, and tarsus may also be evaluated to an open approach. too oblique of an angle, creating a poorly
by arthroscopy. • Organize all instruments before beginning positioned portal.
arthroscopic procedures. • After proper positioning of the instrument
Indications portal is confirmed, the portal is expanded
• Joint exploration Possible Complications and using a #11 blade and small hemostats.
• Biopsy Common Errors to Avoid (Common portal size ≈1 cm)
• Culture • Infection • An outflow or egress portal can be established
• Fragment removal • Hemorrhage based on surgeon preference by inserting a
○ Osteochondritis dissecans (OCD) lesions, • Dehiscence needle into the joint in an area that is not
fragmented medial coronoid, and others • Extravasation of fluid into soft tissues vital to the surgical procedure.
• Debridement • Cartilage and ligamentous damage • After the arthroscope, instrument portal, and/
○ Cranial cruciate ligament, meniscal tears or egress have been established, the specific
• Lavage Procedure arthroscopic procedure or final joint explore
• Video assistance with fracture stabilization Arthroscopic procedures vary greatly based on may be performed.
the joint involved and the specific procedure • The conclusion of most arthroscopic
Contraindications to be performed. However, outlined below is procedures involves joint irrigation and
• Local soft-tissue infections a general guideline for gaining access to any portal closure. The use of long-acting local
• Small patient size joint and establishing common portals. anesthetics has become popular as part of
• Severely arthritic joints • Perform routine sterile surgical clipping and pain management after arthroscopy.
preparation over the target joint.
Equipment, Anesthesia ○ The surgical preparation should always Postprocedure
Common arthroscopic equipment includes be large enough for the conversion to an • Depending on the amount of extravasation
instruments for viewing and image capture. open joint exploration if needed. and the type of surgical procedure performed,
In small animals, the most common endoscope • Position the patient in the specific recum- a soft padded bandage may be placed to
diameters are between 1.9 and 2.7 mm. Also, bency that allows the best access the joint apply compression over the surgical site for
there are a myriad of small hand tools for of interest. the first 12-24 hours.
manipulation of tissues: • Drape the patient in a fashion that the • Postoperative antibiotics are not typically
• Arthroscope procedure can be converted to an open prescribed. Surgical times are usually
• Cannula arthrotomy. short, and the large volumes of irrigation
• Camera ○ Based on surgeon preference, the limb may fluid flushed through the joints during the
• Monitor be wrapped in a clear adhesive drape to procedure minimize risk of infection.
• Light source aid in anatomic localization of pertinent • Postoperative pain management is usually
• Irrigation landmarks. based on a short course of NSAIDs ± an
• Egress • The joint should initially be distended with oral opioid such as tramadol.
• Hand instruments saline using a syringe and a 20-gauge, 1- to
○ Graspers, punches, curettes, blades, probes, 1.5-inch hypodermic needle. Alternatives and Their
and awls ○ To confirm needle placement, synovial Relative Merits
• Power shavers fluid should be aspirated before saline • The major alternative to arthroscopic joint
• Joint distractors infusion. evaluation and surgery is an open arthrotomy
• Limb positioners • Once distended, based on landmarks specific procedure.
• Electrosurgical instruments to each joint, a small (≈0.5 cm) stab incision ○ The advantage to arthrotomy is lower
Anesthesia: is made through the skin and soft tissue equipment cost and less surgeon expertise
• Routine anesthetic protocols are suitable (excluding the joint capsule) with a #11 required.
for most arthroscopic procedures; patients blade.
are typically otherwise healthy animals • Next, the arthroscope cannula attached to a Pearls
with arthroscopy performed on an elective blunt obturator is introduced into the joint. • Due to the steep learning curve encountered
basis. ○ Care should be taken not to damage when learning arthroscopic surgery, it is
• Local anesthesia is recommended (e.g., articular cartilage or other vital soft-tissue advised that all procedures be performed
epidural or local nerve blocks) to increase structures within the joint when using on synthetic or cadaveric models before
patient comfort postoperatively. sharp instruments or cannulas. attempting on a clinical case.

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