Arthroscopy A diagnostic and therapeutic tool for the orthopedic patient

1
ArthroscopyA diagnostic and therapeutic tool for
the orthopedic patient

• Barbro Nordquist, DVM
• Puget Sound Veterinary Referral Center

2
Human Arthroscopy

• Interest dates back to Roman times
• The lichtleiter-1806
• Incandescent light bulb-1879
• Cystoscope developed
• Arthroscopy-1918
• Evaluation of the human stifle
• Modern arthroscopy-1959

3
Veterinary Arthroscopy

• Large animal arthroscopy-early 1970s
• Well accepted mid 1980s
• Small animal arthroscopy-late 1970s
• Further evaluated in 1980s

4
Advantages

• Enhanced visualization
• Improved precision
• Magnification
• Evaluation of different compartments
• Decreased post operative pain
• Earlier return to normal activity

5
Disadvantages

• Steep learning curve
• Video game players at advantage
• Potential need for conversion
• Based on arthroscopic findings
• Cost of instrumentation
• Purchase
• Repair

6
Potential Complications

• Extravasation of fluid into soft tissues
• Collapses the joint
• Increased surgical time
• Iatrogenic trauma to joint surface
• Experience
• Inappropriately sized scope
• Infection
• Nerve damage

7
Instrumentation

• Arthroscope
• Various sizes
• Diameter
• Length
• Lens angle
• External end
• Camera
• Light source
• Cannula interlock

8
Instrumentation

• The tower
• Monitor
• Light source
• Documentation
• Video recording
• Still images
• Irrigation
• Shaver

9
Instrumentation

• Hand instruments
• Probes
• Grasping forceps
• Knives
• Curettes
• Shaver/burr

10
Diagnostic work up

• Radiographs
• Elbows 3 views
• Shoulder 2 views
• Stifle 2 views
• Sedation
• Dexmedetomidine 2.5 mcg/kg IV along with
  Hydromorphone 0.05 mg/kg IV

11
Elbow Joint

• Pathology
• Ununited anconeal process
• Medial coronoid disease
• Osteochondritis dissecans
• Incongruity

12
Elbow Joint
13
Elbow Joint
14
Elbow Joint
Please follow YouTube link to view presentation
with video
15
Elbow Joint
16
Elbow Joint
17
Elbow Joint
18
Elbow Joint
19
Elbow Joint
20
Elbow Joint
21
Shoulder Joint

• Pathology
• Osteochondritis dissecans
• Biceps tenosynovitis or tendon tear

22
Shoulder Joint
Please follow YouTube link to view presentation
with video
23
Shoulder Joint
24
Shoulder Joint
25
Shoulder Joint
26
Stifle Joint

• Cranial cruciate ligament rupture
• Meniscal injury
• Osteochondritis dissecans

27
Stifle Joint
28
Stifle Joint
29
Stifle Joint
30
Other Joints

• Less frequently done
• Hip joint
• Prior to TPO
• Tarsal joint
• Limited joint space
• trauma

31
When to Refer
32
Acknowledgements

• The team at the AEC/PSVRC for organizing this
• Dr. Kei Hayashi at UC Davis and Matt Willis from
  Karl Storz for providing images
• Dr. Mark Fuller for the shoulder joint video
• To all of you for coming