Arthroscopic surgical instruments,Arthroscopic Instruments at Delhi Institute of Trauma & Orthopaedics (DITO),Sant Parmanand Hospital Dr. Shekhar Srivastav is an Orthopedic Surgeon attached to Sant Parmanand Hospital, Delhi with special interest in Knee & Shoulder surgery. After obtaining his M.S. Orthopedics degree he has undergone training in various centers in India and Abroad which has helped him in understanding the Orthopedics problems and their Management. He did his AO/ ASIF fellowship at University Hospital, Salzburg, Austria in 2006 and recieved training in Arthroscopy & Sports Medicine at TUM, Munich (Germany) & Rush Orthopedics Centre, Chicago( USA). He has an experience of more than fifteen years of diagnosing and treating Orthopedics & Trauma patients. Details at http://delhiarthroscopy.com/index.html

1. ARTHROSCOPY INSTRUMENTSCARE,HANDLING & STERILIZATION
Dr.SHEKHAR SRIVASTAV
Knee & Shoulder Arthroscopy
Delhi Institute of Trauma And Orthopedics
SANT PARMANAND HOSPITAL,DELHI

2. BASIC ARTHROSCOPY SET-UP
Dr.SHEKHAR SRIVASTAV
Knee & Shoulder Arthroscopy
Delhi Institute of Trauma And Orthopedics
SANT PARMANAND HOSPITAL,DELHI

3. SCORECARD
ENDOSCOPIC
Small incision
Less pain
Less morbidity
Accuracy
Early function
Cosmesis
OPEN
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x
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4. ARTHROSCOPY KNEE
One of the Commonest
surgery
Treatment –
Ligamentous and soft
tissue injury of knee
> precise and accurate
than open method
Less morbidity and early
rehab

5. Arthroscopic System
Arthroscope
Light source &
Light Cable
Camera system
Video recorder
Monitor
Arthroscopic
Instruments

6. Arthroscopic Surgical Instruments
Mechanical Instruments- Probes, Punches,
Grasping forceps
Motorised Instruments- Shavers
Electrosurgical Instruments- Electrocautery,
Radiofrequency, Laser
Special Instruments- ACL sets, PCL sets,
Meniscus repair sets, OATS

7. Arthroscope
Optical Instrument
-Eye piece
-Attachment for light cable
-Series of lenses
-Optical fibers for transmitting light into joints

8. Arthroscope
Optical propertiesDiameter of scope
1.9mm , 2.7mm- wrist
& elbow
4 mm – most commonknee shoulder
Angle of Inclination
Field of view

9. Arthroscope
Angle of Inclination- increases field of vision
300 scope
700 scope

10. Arthroscope sheath with blunt
Obturation
Always blunt obturator.
Never sharp
Sheath – 3 parts
– Coupler – secure and rapid
fixation
– Spigot plane – Rotating
– Sheath barrel
Smooth transition from
obturator to sheath
Smooth transition from
scope to sheath

11. Care & Handling
Should always be
inserted into the joint
through sheath
Sudden Movement
should be avoided as it
may cause cartilage
scuffing
Care taken to avoid
damage by shaver or
other electronic surgical
devices
Inspect for any scratch,
dents or irregularity

12. Aging
Manifested by a hazy, murky image
More an arthroscope is used faster it ages
Accelerated by flash sterilizations
Direct Damage of Scope Tip- By
mechanical or motorized instruments
Laser beam accidentally directed towards
scope

13. Light Source & Fibreoptic Cable
300-350 watts reqd.
Tungsten,Halogen & Xenon Source
Life- hrs
Should not be activated till scope is inserted
into the sheath

14. Light Source & Fiberoptic Cable
Fiberoptic Cables-bundled optical glass
fibers
Fragile,handle Carefully
One end connected to light source and
another to A’scope
Length of cable imp
Fiber breakage due to bending stresses
Loss of light transmission
Sterilisation- autoclavable/gluteraldehyde

15. Camera System
Advantages
Comfortable position
for surgeon
Avoidance of
contamination
Participation of rest of
the team
Camera System
-camera- 1 chip/3 chip
-camera cable
-control unit

16. Camera system
Steam autoclaving
can damage camera
casings and seal
Enclose the camera
in sterile, disposable,
clear plastic sleeve
Sterilised – Cidex or
Steris solution

17. Video Recorder & Monitor
Monitor-At least 20 inches
-Placed at cart at
surgeons eye level
Video recorderdocumentation

18. Image Quality
All structures should be uniformly
illuminated from center to periphery
Scope should have satisfactory resolution
Dull & Hazy image
- Check scope for scratches, damages
- Check light Cable
- Check light source

19. Instruments
Basket forceps /
punches
Grasping forceps
Arthroscopic scissors
Probes
Knives

20. Probes
Extension of A’scopist
fingers
Right angled and tip size 34mm
Marking at 5mm
Used to
-Palpate intraarticular
structures
-Determine depth
-To maneuver intraarticular
structures

21. Basket forceps(Punches)
Workhorse of arthroscopic
surgeries
Open base where the cut
tissue is dropped which
can be removed later
No need to remove from
joint with each bite
Shaft- straight/curved
Jaws- straight/angled
Also as 150 up & down
biting

22. Basket forceps(Punches)
Various Jaw Configuration
-Wide angled- rapid & efficient
cutting
-Narrow or scissor punches
Used for-Division of tissue bridges
-R/O deg. Meniscal tissue
-Division of scar tissue
-Detachment of loose
cartilage flap
-Piecemeal removal of soft
tissue bodies
Carefully used in tight joints
as may cause cartilage
scuffing

23. Grasping Forceps
Straight or angled
Used for removal of-Meniscal fragments
-Loose bodies
-Cartilage flaps
-Osteophytes (partially
detached)
-Retrieving synovial biopsy

24. Arthroscopic Scissors & Knives
Used in earlier days
Not used now because of high rate of
implant breakage within joint
Chondral Damage

25. Motorised Instruments ( Shavers)
Control unit
Connecting cable
between handpiece and
control unit
Handpiece
Blades
Suction

26. Motorised Instruments
( Shavers)
Outer hollow sheath & inner
cutting rotating cannula
Tip Dia- 3-5.5 mm
Sucks tissue inside outer
sheath for cutting
RPM
cutting soft tissues- 1200-2000
as burr - 2000-4000
Handpiece – Autoclavable
Shaver blades- Disposable

27. Electrosurgical, Laser & RF
Electrocautery- Hemostasis
Lateral retinacular release
Laser- YAG laser, Excimer Laser
Delievers high energy with precision
Uses- Meniscus tear, Articular cartilage
Drawbacks-Expensive , Osteonecrosis
Radiofrequency –
Uses- Menisectomy, Coagulation, Capsular
shrinkage
Drawbacks- Articular cartilage damage,
Osteonecrosis

28. Basic Arthroscopic Kit
Arthroscope
Light source & cables
Camera system & Moniter
Arthroscopic probe
Arthroscopic Grasper
Arthroscopic Punches (Basket Forceps)2.7 & 3.4 mm upcutting, Rt. & Lt. Rotary
Motorized Shaver

29. Cleaning ,Disinfection & Sterilizability
Remove gross soiling,blood & organic matter
after surgery. Clean the instruments with
sterile water (not saline)
Manual cleaning in enzymatic soak solution
Ultrasonic cleaners- Fine cleaning(hollow &
tubular instrument)
Wiped & dried with clean dry sponge before
storage
Care of the personnel handling instrumentsaerosolization, splashing of infectious material,
injury from sharp objects

30. Cleaning ,Disinfection & Sterilizability
Instruments should be
properly arranged in
trays
Sharp instrument tips
should be covered
with caps
Instruments with
moving parts should
be lubricated after
cleaning with water
soluble lubricant

31. Cleaning ,Disinfection & Sterilizability
Ethylene oxide gas- good disinfectant
Mechanical Instruments( probes, punches,
graspers), Shaver handpiece - Steam
Autoclave
Arthroscope, Light cable – Cidex,
Steris(Paracetic acid solution) – 30 min

32. Diagnostic Arthroscopy
Supra-patellar pouch
Patellar Articular Surface
Medial Gutter
Medial Compartment- Meniscus
Articular cartilage
Intercondylar Notch- ACL
PCL
Lateral Compartment- Meniscus
Articular Cartilage
Lateral Gutter

33. Diagnostic Arthroscopy

34. THANK YOU