Dr. Gilley On: The Use of Arthroscopy in Small Animal Orthopedics
(Continued from cover page)
… extravasation of fluid in the surrounding soft tissues, which usually resolves within 24 hours after the procedure. Although uncommon, iatrogenic peripheral nerve damage can occur if the portals are improperly placed.
Instrumentation And Preparation Of The Patient
Typical scope sizes for small animal arthroscopy are 2.7 mm, 2.4 mm, and 1.9 mm. The 1.9-mm scope is very delicate, but is useful for scoping a small carpus or tarsus. The viewing fields can be straight, 30-degree oblique, and 70-degree retrograde. The 30-degree oblique is the scope most often utilized. Video arthroscopy is typically used, which allows magnification of the image and multiple people to observe. This also prevents contamination, while providing freedom to perform the surgical correction of the problem.
The video camera and a light source attach to the arthroscope and project the image on a monitor. Fluid ingress of lactated ringers or saline is necessary and is accomplished using gravity, pressure bags, or by special fluid pumps. The fluid pumps allow accurate control of joint distention and flushing the joint, which helps maintain visualization. Cannulas are needed to protect the arthroscope and can be used to facilitate outflow of fluids from the joint. Hand instrumentation is used to treat surgical lesions. Many different types of graspers, ronguers, knives, curettes, and probes are available. A motorized shaver is extremely useful to debride, flush, and suction cartilage and bone debris from the joint.
Clipping, surgical preparation, and draping of the patient are the same as for arthrotomy. Finding the access to the joint portals is done first with a needle to ensure the correct location. The joint is distended and the outflow and arthroscopy cannulas inserted. A third portal is made for instruments to definitively treat any lesions. A complete examination of the joint should be done before any specific treatment is instituted. Lesions can be documented with printers, VCRs, or digital capture units.
After completion of the procedure, bupivicaine can be infused into the joint to decrease postoperative pain. All the instruments are then removed from the ports and a single skin suture closes each portal. A modified Robert-Jones bandage is typically used overnight for distal joints to reduce swelling and help make the patient comfortable.
Diagnosis and Treatment of Orthopedic Conditions with Arthroscopy
| Joint | Indication |
Shoulder |
|
Elbow |
|
Carpus |
|
Hip |
|
Stifle |
Meniscal examination and meniscectomy
|
Tarsus |
|