1. General Principles of
Arthroscopy
Pumsak Thamviriyarak, MD.
Orthopaedics Department
Khonkaen Hospital
Campbell’s Operative Orthopaedics ed.11

2. Outlines
O Instruments and equipment
O Anesthesia
O Documentation
O Advantages & Disadvantages
O Indications & contraindications
O Basic arthroscopic techniques
O Complications

3. Instruments and equipment

4. Arthroscope
O Optical instrument
O Optical characteristics
O Diameter : 1.7-7 mm
O 4mm is the most commonly used
O Angle of inclination
O 0-120 degrees
O 30 degrees is the most commonly used
O 70-90 degrees : seeing around corners or
posterior compartment
O Field of view

5. Angle of inclination and
field of view

6. Arthroscope
O 2 designs
O Operating arthroscope
O Operative instrument in line with the
arthroscpoe
O Large-diameter sheath
O Viewing arthroscpoe
O 2 portals
O Triangulation techniques
O Smaller size

7. Fiberoptic Light Sources
O Direct viewing via arthroscope :150 watts
O Television systems
O Demand more light intensity
O 300-350 watts
O Tungsten, Halogen, Xenon

8. Fiberoptic Light Sources
O Fiberoptic lighting
O A bundle of specially prepared glass fibers
O Fragile : develop by using liquid light
guides (glycerin)
O Length of cable: 8 inches lost for each foot
of cable

9. Television cameras
O First introduced by McGinty and Johnson
O More comfortable
O Avoidance of contamination by the
surgeon’s face
O Improvement
O Decrease size
O Increase resolution
O Recording device
O Controls the light source

10. Basic instrument kit
O Arthroscopes
O 30 and 70 degrees
O Scissors
O Basket forceps
O Grasping forceps
O Arthroscopic knives
O Motorized meniscus cutter and shaver
O Miscellaneous epuipment

11. Accessory Instruments

12. Probe
O The extension of the arthroscopist’s finger
O To feel the consistency of a structure
O To determine the depth
O To identify and palpate loose structures
O To maneuver loose bodies into more accessible
grasping position
O Etc.
O Most are right-angled
O 3-4mm tip size
O Use the elbow of the probes to palpation

13. Scissors
O 3-4 mm in diameter
O Jaws : straight or hooked
O Hooked scissors are preferred
O Pulling the tissue rather than pushing away
O Right and left curved

14. Basket Forceps
O One of the most commonly used
O Open base that permits the tissue to drop
free within the joint
O Subsequently removed from the joint by
suction
O 3-5mm sizes with straight or curved shaft
O Straight or hooked jaws
O Usually used for trimming the peripheral
rim of the meniscus

15. Grasping Forceps
O Retrieve material from the joint
O Grasping tissue to cutting

16. Knife Blades
O Should be inserted through cannula
sheaths
O Exposed only when it enters the
arthroscopic field

17. Motorized Shaving Systems
O Consisting of
O Outer hollow sheath
O Inner rotating cannula with corresponding
windows

18. Motorized Shaving Systems
O Avoid oversucking : create bubbles in the
joint
O Decrease intensity of suction
O Increase inflow rate
O Closed outflow from the arthroscope

19. Implants
O Suture anchors
O Meniscal repair devices
O Devices for tendon and ligament fixation
O Articular cartilage repair

20. Suture anchors
O Attach ligaments and tendons to bone
without bony tunnel passage of sutures
O Desirable characteristics
O Must fix the suture to the bone
O Permit an easy surgical technique
O Not cause long-term problems

21. Meniscal repair devices
O Allow an all-inside meniscal repair without
the need for arthroscopic knot-tying
O 3 categories
O Arrows
O Darts
O Meniscal screws

22. Device for tendons and
ligaments fixation
O Bone-to-bone or soft tissue-to-bone
fixation
O Biodegradable or nonbiodegradable

23. Miscellaneous Equipment
O Sheaths and trocars
O Blade No.11
O Switching sticks

24. Care and Sterilization of
Instruments
O Fiberoptic arthroscopes and cables
O Best method is
O Gas (ethlyene oxide) :1 hour
O Low-temperature sterilization process (steris)
:30 min
O Most commonly used
O Activated glutaraldehyde (Cidex)
O Knives, graspers, basket forceps,
cannulas
O Steam autoclave

25. Irrigation Systems
O Irrigation and distension
O Essential to all arthroscopic procedures
O NSS or RLS
O Inflow
O Arthroscopic sheath: 6.2mm diameter
O Cannula in separate portal
O Continuous irrigation
O Keep clear viewing
O Maintain hydrostatic pressure and
distension

26. Irrigation Systems

27. Irrigation Systems
O Optimal pressure in the joint
O Knee : 60-80 mmHg
O Shoulder : 30 mmHg below systolic BP
O Elbow and ankle : 40-60 mmHg
O Each foot elevate from the level of the
joint
O Produced 22 mmHg pressure
O Outflow site should be closed during
suction
O Potentially contaminated fluid into the joint

28. Tourniquet
O Contraindications
O History of thrombophlebitis
O Significant peripheral vascular disease
O Advantages
O Increased visibility
O Disadvantages
O Blanching of the synovium
O Difficult to diagnosis synovial disorders
O Ischemic damage if prolonged touniquet time
(90-120min)

29. Leg holders
O Advantages
O Open the posteromedial compartment for
viewing or manipulation of the meniscus
O Disadvantages
O Obstruct the operations in lateral
compartment
O Use in case of medial compartment
disease

30. Leg holders

31. Anesthesia
O Arthroscopy can be performed under
O Local Anesthesia
O Regional Anesthesia
O General Anesthesia

32. Local Anesthesia
O Knee or ankle arthroscopy
O Cooperative patients
O Can be supplemented with Diazepam
O The most cost-effectiveness

33. Regional Anesthesia
O Lower extremities
O Epidural or spinal anesthesia
O Peripheral blocks
O Immediate ambulation
O Require experience anesthesiologist
O Longer time to prepare
O Upper extremities
O Brachial Block

34. General Anesthesia
O Not cooperative patients
O Allergy to local anesthetics
O Less experience surgeon
O In case that need tourniquet to control
bleeding

35. Postoperative pain
O Oral NSAIDs or IM,IV administration
O Reduce swelling
O Increase ROM in early postoperative
period
O 30mL of 0.25% bupivacaine +/-Morphine 3
mg intraarticular or subacromial flow
O Excellent postoperative pain relief
O Catheters should be removed in 48 hours

36. Documentation
O Drawing
O 35-mm reflex camera
O Digital video recordings

37. Advantages of Arthroscopy
O Reduced postoperative morbidity
O Smaller incision
O Less intense inflammatory response
O Improved thoroughness of diagnosis
O Absence of secondary effects
O Neuromas, scars
O Reduced hospital cost
O Reduced complication rate
O Improved follow-up evaluation : second-look
O Possibility of performing surgical procedures that
difficult to perform through open arthrotomy

38. Disadvantages of Arthroscopy
O Temperament to perform arthroscopic
surgery
O Need to maneuver within the tight
confines of the intraarticular space
O Time-consuming procedures in early of
surgeon experience
O Expensive equipment

39. Indications and
Contraindications
O No absolute indications
O Diagnostic arthroscopy
O Preoperative evaluation and confirmation
of the clinical diagnosis
O Documentation of specific lesions
O Contraindications
O Risk of joint sepsis, remote infection
O Ankylosis around the joint
O Capsular disruption

40. Basic Arthroscopic Techniques
O Patience and persistence
O Techniques are mostly self-taught
O Artificial models or amputated specimens for
initially practice
O Perform arthroscopic procedures,
triangulation practice in the company of an
experienced arthroscopist
O Learning curve
O Keep in mind that open arthrotomy when
poorly performed arthroscopic procedures

41. Triangulation Technique
O One or more instruments inserted through
separate portals
O Tip of the instrument and arthroscope
forming the apex of a triangle
O If disoriented and difficulty in triangulation
O Instrument may be brought into the joint to
contact the sheath and sliding to the tip
O Stereoscopic sense and two-handed
ability

42. Complications
O Damage to intraarticular structures: most common
O Damage to Menisci and Fat Pad
O Damage to Cruciate Ligaments
O Damege to Extraarticular structures
O Hemathrosis
O Thrombophlebitis
O Infection
O Tourniquet Paresis
O Synovial Herniation and Fistulas
O Instrument Breakage

43. Thank you