ISSN 2398-2977      

Joint: arthroscopy - overview

pequis

Synonym(s): Arthroscopy


Introduction

  • Arthroscopy is a useful tool for both diagnosis and treatment of joint lesions but it is a procedure which should only be carried out by specialists in the field.
  • In recent years its use has almost completely superceded arthrotomy.
  • Reduced surgery and convalescence time combined with a good prognosis for the horse to return to full soundness has contributed to its popularity.
  • As a result, many more horses are being treated surgically for joint conditions whose treatment might otherwise have been left to conservative management.

Uses

Diagnostic applications
  • Assessment of soft tissue structures of joints - ligaments, synovium and cartilage.
  • Assessment of joint surface and bone - osteoarthritis, fractures, cartilage and subchondral lesions.
  • Tenosynovioscopy   Tenosynovioscopy  .
  • Evaluation of soft tissue lesions in articular ligaments, menisci, plicae, synovium, fibrous joint capsule.

Therapeutic applications

  • Fracture repair or removal of fragment(s).
  • Debridement of articular cartilage defects.
  • Removal of osteochondral fragments.
  • Joint lavage.
  • Arthrodesis.

Carpus

Elbow

  • Diagnostic evaluation of the joint in caess of lameness localized to the elbow joint   Elbow: arthroscopy  .
  • Surgical treatment of sepsis of the elbow joint and occasionally osseous cyst-like lesions and osteochondrosis   Elbow: osteoarthritis  .

Fetlock

Stifle

Tarsus

Shoulder

Other applications

Advantages

  • Continual lavage for treatment of infection.
  • Manual removal of fibrin from joint   →   reduced number of bacteria sequestered with protection of fibrin masses.

Disadvantages

  • Usually not used until site of pain or lameness has been localized to specific joint.

Obstructed field of view

  • Hemarthrosis:
    • Pre-existing pathology.
    • From debrided bone and soft tissues.
    • Not a problem while joint is distended.
    • Becomes a problem when the joint is re-entered, after allowing the joint to collapse.
    • Flush, then close the outflow cannula and redistend.
    • Bleeding from subchondral bone is a useful indicator for the depth of debridement, so may need to release fluid during procedure to assess surgery and hemorrhage.
  • Synovial villi:
    • Inadequate fluid distension.
    • Fluid movement, eg due to open outflow portal or instrument portal.
    • Fibrosis of joint.
    • Subcutaneous extravasation of fluid.
    • Examine joint at start with closed outflow portal.
    • Remove small fragments before creating larger portal for removal of large fragments.
    • Reinsert instrument to block a large portal.

    Do not block the outflow portal with a finger as   →   extravazation of fluid.

    • Individual villi can be removed surgically with hand tools or motorized instruments.
  • Extravasation of fluid:
    • More common problem in the antebrachiocarpal (radiocarpal) joint.
    • Once present, limits the extent of joint distension   →   reduced visualization   →   may need to delay procedure several days.
    • Associated with the instrument portal and excessive manipulation of instruments   →   opening up a subcutaneous plane for fluids to leak into.
    • Also due to combination of open inflow cannula and blocked outflow portal at the skin or subcutaneous level, ie when instrument is inserted.
    • May be due to subcutaneous insertion of trocar or scope.
    • Reduce inflow pressure while fragments are removed.
    • Turn-off fluid while portals are created.
    • Avoid entering tendon sheaths and burse.
    • No long-term consequences have been observed.

Other intra-operative complications

  • Articular cartilage damage:
    • Iatrogenic injury during surgery with arthroscope, trocar or instruments.
    • Use careful technique.
    • Ensure joint distension is adequate.
  • Intra-articular broken instruments:
    • Cracked arthroscope lens - of no consequence to patient.
    • May be due to contact with instrument or flexion of leg while scope is still in the joint.
    • Other instruments may break in the joint - retrieve any fragments with forceps or magnetic retrievers.
  • Intra-articular foreign bodies:
    • Small metal fragments from instruments.
    • Flushing should remove them.

Requirements

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Preparation

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Procedure

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Aftercare

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Marshall K M & Adkins A R (2014) Synovial herniation as a complication of arthroscopy in a Thoroughbred yearling. Equine Vet Educ 26 (6), 288-291 VetMedResource.
  • Barrett M R, Frisbie D D, McIlwraith C W & Werpy N M (2012) The arthroscopic and ultrasonographic boundries of the equine femorotibial joints. Equine Vet J 44 (1), 57-63 PubMed.
  • Fowlie J G et al (2011) Comparison of conventional and alternative arthroscopic approaches to the palmar/plantar pouch of the equine distal interphalangeal joint. Equine Vet J 43 (3), 265-269 PubMed.
  • Muurlink T, Walmsley J, Young D & Whitton C (2009) A cranial intercondylar arthroscopic approach to the caudal medial femorotibial joint of the horse. Equine Vet J 41 (1), 5-10 PubMed.
  • Byron C R & Goetz T E (2007) Arthroscopic debridement of a palmar third metacarpal condyle subchondral bone injury in a Standardbred. Equine Vet Educ 19 (7), 347-347 VetMedResource.
  • Minshall G J & Wright I M (2006) Arthroscopic diagnosis and treatment of intra-articular insertional injuries of the suspensory ligament branches in 18 horses. Equine Vet J 38 (1), 10-14 PubMed.
  • Booth T M & Fraser B (2004) Equine arthroscopic surgery. Part 4 - the inter-carpal joint. UK Vet (5), 5-9.
  • Booth T M (2004) Equine arthroscopic surgery. Part 3 - preoperative assessment, patient preparation and management. UK Vet (1), 8-11.
  • Booth T M (2003) Equine arthroscopic surgery. Part 2 - technique and training. UK Vet (7), 16-18.
  • Booth T M (2003) Equine arthroscopic surgery. Part 1 - instrumentation and equipment. UK Vet (5), 14-18.
  • Trotter G W et al (1996) Advances in equine arthroscopy. Vet Clin North Am Equine Pract 12, 261-281 PubMed.
  • Vatistas N J et al (1995) Comparison of arthroscopy and arthrotomy for the treatment of osteochondritic lesions in the femoropatellar joint of horses. Vet Rec 137, 629-632 PubMed.

Other sources of information

  • Richardson D (2004) Arthroscopic Surgery in Standing Horses. In: Proc 43rd BEVA Congress. Equine Vet J Ltd, UK. pp 157.
  • McIlwraith C W (1990) Diagnostic and Surgical Arthroscopy in the Horse. Lea & Febiger, USA.

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