Arthroscopic surgery - Introduction, indications, advantages and procedure.

A basic outline on diagnostic arthroscopy and arthroscopic surgeries

1. Arthroscopic surgery - Roshan Samuel. P

2. contents Introduction Types Indications Instruments Procedure Advantages Limitations Complications Bibliography

3. 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.

4. SITES Knee Shoulder Ankle Elbow Wrist

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

6. 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 30 o forward oblique angle.

7. Procedure – Knee arthroscopy Done under spinal or general anesthesia . Tourniquet is applied. Legs are positioned properly . Painting and draping of the limb is done . 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. Arthroscope is introduced via the anteroateral port. The joint is distended with running RL or saline.

8. 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.

9. 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

10. 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

11. bibliography Essential Orthopedics by J. Maheshwari Textbook of Orthopedics by John Ebnezar

12. Thank you