1. SEMINAR (14-11-09) TOPIC : ARTHROSCOPY PRINCIPLES

3. CHANGE :the golden rule of life So the same here From invasive to less invasive…… & now the pendulum is swinging ….from open to close arthroscopic techniques .

6. light sources

7. Accessory instruments

8. Television cameras

9. Probe

10. Scissors

11. Basket forceps

12. Grasping forceps

13. Knife blades

14. Motorized shaving systems

17. Usually probes are right angled & tip size of 3 – 4 mm to measure size of defects.

18. FUNCTIONS : -To palpate intraarticular structures. -To feel consistency. -To determine depth. -To probe fossae & recess -To maneuvered intraarticular structure.

20. 300 – 350 watts required.

21. Tungsten, halogen & xenon sources.

22. Can produce low & high intensity output.

26. ANGLES : right / left, usually with a rotating of jaw mechanism, actually cut at an angle to shaft of the scissors. -useful in detaching difficult to reach meniscal fragments.

28. Jaws : straight / hooked

29. Basket in assortment of 30 , 45 , 90 degree.

30. Also as 15 degree up & down – biting.

34. Both clockwise & anticlockwise rotation. Reversing the rotation improves cutting efficiency & minimises Clogging with debris.

36. Works in a non-electrolyte medium like distilled water, Carbon dioxide or glycine.

39. For adequate flow 6.0 – 6.2 mm should be used with scope

40. Older intraarticular electrocautery system requires non-electrolytic system like glycine.

41. Continuous irrigation is by pump through canula or through arthroscopic sheath.

43. Ingress = egress to maintain hydrostatic pressure & distention within joint.

44. For each foot of elevation of solution bag above joint = 22 mm of hg pressure

46. Sensor mechanism to check over distention.

47. Distention is essential for arthroscopic viewing as it pushes synovial folds & other soft tissues out of the way in viewing area, expands internal capacity of joint, allowing greater maneuverability of arthroscope, defining proper portal entry points

52. DOCUMENTATION DOCUMENTATION OF PROCEDURE VERY NECESSORY

54. Low temperature sterilization process

55. CIDEX is used for cold disinfection of equipments between successive procedures during whole day.

56. Knives, forceps etc.: by steam autoclaving.

58. Smoothening of Torn cartilage

59. Damaged ligaments reconstruction

60. Loose bodies removal

61. Joint effusions

62. Biopsy procedures

63. Fracture fixation

65. Cricket too …..!!!! Knee injuries Throwing – shoulder injuries

67. When risk of joint sepsis from a local skin infection.

70. Now the other side????? Very few Technically demanding Specialized equipments required Needs excellent psychomotor co-ordination ADVANTAGES FAR OUTWEIGH DISADVANTAGES

72. Damages to related structures.

73. Hemarthrosis (most common postop.)

74. Thrombophlebitis

76. Synovial herniation & fistulas

77. Instrument breakage

79. Under anesthesia make small cuts in the skin around joint.

80. A sterile fluid is pumped into joint and then the arthroscope is inserted.

81. Examine joint by images from arthroscope

82. If necessary, other instruments inserted for procedure i.e. repair any damage or remove material that causes symptoms.

84. Involves use of one or more instruments inserted through separate portals and brought into the optical field of the arthroscope, the tip of the instruments and arthroscope forming apex of a triangle

85. Separates the arthroscope from operating instruments, allowing the viewing arthroscope to be enlarged and increasing the field of view.

86. Improves depth perception, and most significantly permits independent movement of arthroscope & surgical instruments.

88. Shoulder: Rotator cuff tendon tears, impingement syndrome, and recurrent dislocations

89. Knee: Meniscal (cartilage) tears, chondromalacia (wearing or injury of cartilage cushion), and anterior cruciate ligament tears with instability

90. Wrist: Carpal tunnel syndrome

91. Loose bodies of bone and/or cartilage: for example, knee, shoulder, elbow, ankle, or wrist

92. Some problems associated with arthritis also can be treated.Most frequent conditions found during arthroscopy meniscal (cartilage) tears, rotator cuff tear

94. Repair or resection of torn cartilage (meniscus) from knee or shoulder

95. Reconstruction of anterior cruciate ligament in knee

96. Removal of inflamed lining (synovium) in knee, shoulder, elbow, wrist, ankle

97. Release of carpal tunnel

98. Repair of torn ligaments

99. Removal of loose bone or cartilage in knee, shoulder, elbow, ankle, wrist. combined arthroscopic and standard surgical procedures

101. As OPD basis

102. supports for 3 to 7 days, weight bearing on the operated leg as tolerated.

103. Rest, ice packs, and elevating the limb also recommended.

104. Physiotherapy not required in all patients, should be individualised.

105. drive at least a week before patients can depending on operated.

106. sitting job at one week after surgery.

107. 3 weeks to recover fully for routine daily activities.

108. 3 months before one can comfortably return to sports..NOW WHAT AFTER ARTHROSCOPIC SURGERY?

109. ..THANK YOU