Arthroscopic surgery - Introduction, indications, advantages and procedure.

ARTHROSCOPIC
SURGERY
- Roshan Samuel. P

CONTENTS
 Introduction
 Types
 Indications
 Instruments
 Procedure
 Advantages
 Limitations
 Complications
 Bibliography

INTRODUCTION TO ARTHROSCOPY
• Diagnostic arthroscopy: A technique of surgery on the joints in which tip of a thin
(4 mm diameter) telescope called arthroscope is introduced into a joint, and the inside of
the joint examined.
• Arthroscopic surgery: Once the diagnosis is made, necessary correction can be
done by introducing microinstruments through another small skin puncture.
• This technique has revolutionised the treatment of joint disorders.
• Arthroscopy has been gaining importance with the growth of sports medicine.

SITES
Knee
Shoulder
Ankle
Elbow
Wrist

INDICATIONS
Cartilage conditions:
1. Excision of damaged cartilage.
2. Mosaicplasty
Synovium conditions:
1. Synovial biopsy
2. Synovectomy
Meniscal pathology:
1. Repair
2. Resect
Ligament structures:
1. Repair
2. Reinforce
3. Reconstruct
Patellar problems:
1. Maltracking
2. Lateral release of patella
Joints pathology:
1. Arthrolysis
2. Debridement
3. Shaving
4. Stabilization as in recurrent dislocation of
shoulder
5. Excision of the joints (e.g. ACM joint)
6. Fusion of the joints
7. To detect and reconstruct tibial plateau
fractures

INSTRUMENTS
To visualise inside the
joint:
To perform basic
operations:
To perform complex
operations:
•Arthroscope
•Light source
•Fibre-optic cable
•Video camera
•TV monitor
•Probe
•Cutter
•Grasper
•Scissors
•Knives
•Motorized shaver
•Underwater cutting cautery
[Electrocautery]
•Laser
Arthroscope is a 4 mm telescope
having a 30o forward oblique angle.

PROCEDURE – KNEE ARTHROSCOPY
1. Done under spinal or general anesthesia.
2. Tourniquet is applied.
3. Legs are positioned properly.
4. Painting and draping of the limb is done.
5. The arthroscope and instruments are introduced through small cuts called portals, the
most common one being anterolateral portal located just lateral to the patellar
ligament.
6. Arthroscope is introduced via the anteroateral port.
7. The joint is distended with running RL or saline.

8. Through a anteromedial portal the instruments are introduced.
9. The joint structures are now visualized on a TV monitor.
10. Thorough inspection of the joint structures is done.
11. Achieve triangulation by bringing the scope and the instruments in front of the
telescope.
12. Joint is continuously irrigated.
13. The required procedure is carried out.
14. Thorough joint lavage is done.
15. Compression bandage applied.
16. Mobilize the patient the same day or the next day.

ADVANTAGES
• Minimally invasive technique
• Day-care surgery
• Little immobilisation required
• Barely visible scars
• Possible under local anaesthesia
• Better assessment of the joint
• Dynamic assessment of the joint possible
• New diagnostic and research possibilities

LIMITATIONS
• Steep learning curve.
• Sophisticated instrumentation.
• Good infrastructure needed.
• Instruments are costly and expensive.
• Not useful in conditions like infection, bleeding diathesis, neuropathic conditions, etc.
• Not useful in recurrent dislocations as in shoulder and patella

BIBLIOGRAPHY
• Essential Orthopedics by J. Maheshwari
• Textbook of Orthopedics by John Ebnezar

Arthroscopic surgery - Introduction, indications, advantages and procedure.

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