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Proceedings of the
10th International Congress of World
Equine Veterinary Association
Jan. 28  Feb. 1, 2008 - Moscow, Russia
Next Congress:
Reprinted in IVIS with the permission of the Conference Organizers http://www.ivis.org/
Published in IVIS with the permission of the WEVA Close this window to return to IVIS
ORTHOPAEDIC SURGERY
EQUIPMENT AND TECHNIQUES OF ARTHROSCOPY
Hans Wilderjans, Dipl. ECVS
Dierenkliniek De Bosdreef, Spelonckvaart 46, 9180 Moerbeke-Waas, Belgium
Equipment:
Several companies offer a large selection of instruments in equine arthroscopy and we all
know that as a starting less experienced arthroscopic surgeon there is a tendency to purchase too
many instruments or instruments that have no optimal use in equine arthroscopy.
The aim of this lecture is to demonstrate the type of instrument, I believe, should be present
in a basic and in a more advanced arthroscopy set.
Basic arthroscopy set: Hand equipment.
Arthroscope 30 or 25 �, 4 mm " is a multifunctional arthroscope which can be used in all
equine joints including the smaller DIP and PIP joint and navicular bursa.
Arthroscope sleeve:
Always 2 arthroscope sleeves should be present in a basic set. It allows you to move the
arthroscope to another places in the joint or tendon sheath and coming back to the first insertion
point without loosing time and distension.
For example:
In a stifle: 1 sleeve between middle and lateral patellar ligament, 1 sleeve suprapatellar.
In the digital flexor tendon sheath: 1 sleeve proximal and 1 sleeve distal to the palmar
annular ligament.
One or 2 stopcock for ingress and egress: 1 is enough, the second one can sometimes
disturb proper positioning of the scope.
Two rotating stopcocks can be handy when you use both fluid and gas distension.
Always use rotating stopcock so the ingress line can be positioned away from the limb or
instruments.
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Proceedings of the 10th International Congress of World Equine Veterinary Association, 2008 - Moscow, Russia
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Trocar or obturator:
Each sleeves comes with an obturator, which can be blunt, conical, blunt or sharp (= trocar).
The conical blunt is the most versatile. The sharp one is only used to penetrate thick muscle
mass (e.g. suprapatellar insertion through quadriceps muscles).
Blunt obturator
Egress canula:
A 4.5 mm " canula is normally used to flush the joint.
The canula comes with a blunt or sharp obturator.
blunt obturator for egress canula
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Blunt Probe:
This is a standard piece of equipment, which is used to probe the joint and can be used to
feel the quality of cartilage or intra-articular ligaments.
Elevator
An elevator is needed to separate the fragment from the parent bone. It needs to be strong,
slightly sharp but not cutting and also with a strong end that does not break easily.
Ideally you need 2: 1 longer stronger one and one shorter smaller one.
commonly used elevator for medium sized fragments (hock and stifle OCD)
Long and stronger elevator for large fragments, 4 and 6 mm "
Elevator for smaller fragments in smaller joints (for example the distal interphalangeal joint).
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Curved fragment elevator
Rongeurs:
Rongeurs are a very important tool in equine arthroscopy. They have to be strong, long
enough and slightly coned tip to facilitate easy entry into the joint.
Minimum 3 rongeurs size small (3 X 7 mm), medium (4 X 7 mm) and large (6 X 10 mm). The
nose of the rongeur needs to be somewhat conical to facilitate easy entry in the joint.
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Proceedings of the 10th International Congress of World Equine Veterinary Association, 2008 - Moscow, Russia
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Curette
Are needed to debride osteo-chondral defects or subchondral cysts.
Make sure you have a small (3 X 4 mm), medium (4 X 8 mm) and large (5 X 9 mm), curette
and 1 medium size curved curette.
Open ring curettes can be useful in some situations.
Light source:
Preferably a min. of 300 W light source to be able to maintain enough light in the bigger
joints (e.g. suprapatellar pouch of the stifle) and to be able to produce good quality pictures or
video.
Light Cable:
The bigger the diameter of the cable the more light it will produce.
Make sure the cable is not too short in case multiple joints need surgery (min. 2.50 m).
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Fluid irrigation:
Distension of the joint or tendon sheath can be achieved with a motorized pump or pressure
bag.
A pressure of around 150 mmHg is normally sufficient to perform most surgeries with
enough visualisation.
Gas insufflation can be used in combination with fluid irrigation:
It can be helpful in removing free-floating fragments in large joints such as the
femoropatellar joint.
Advanced set:
For stifle surgery:
Long irrigation egress canula to flush the suprapatellar pouch in the femoropatellar joint.
40 cm long and 5.5 or 8 mm ".
The 400 mm long 5.5 mm " egress / flushing canula
The 400 mm long 8 mm " egress / flushing canula
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Cutting instruments:
Cutting instruments can be helpful to dissect a bony fragment from its ligament attachments
(e.g. plantar proximal P1 fragment or apical sesamoid bone fractures).
One should always be very careful not to exercise too much force on those cutting
instrument. The blade breaks of easily resulting in a free-floating piece of metal in the joint.
Straight, left and right curved and banana knifes are used in equine arthroscopy.
Their use is less common when a radiofrequency or electrosurgical cutting devices are used
too cut ligamentous attachments.
straight knife
left curved knife
right curved knife
banana knife
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Hook knife:
To perform tenoscopic guided palmar/plantar annular ligament desmotomies.
Micro picks:
To perform an osteostixis of the subchondral bone.
15� curved microfracture
Long strong grasping forceps for large equine fragments:
This is a very important and wonderful tool to remove large fragment from a hock or stifle
joint with less chance of loosing the fragment or breaking the instrument.
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This large fragment grasping forceps from wolf is an excellent piece of equipment to remove
large fragments up to 3-5 cm from equine joints (hock and stifle joint).
Tooth system/2/4 claws/handles with locking mechanism and rotatable.
Arthroscopic scissor:
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Current uses:
To enlarge the opening between the tarsocrural joint and PIT joint (proximal intertarsal joint).
To create an opening in the septum between the medial and lateral FT joint (femorotibial
joint).
To create an opening between the FP joint (femoropatellar joint) and FT joint.
Punch and suction punch
To cut through solid soft tissue, to debride tendon and ligament, to clean out longitudinal
tears in tendons.
Chisel:
Narrow chisel to remove bone exostosis or some firmly attached fragment or to split a large
bony fragment in smaller pieces.
Techniques for equine arthroscopy:
Positioning of the patient is very important to be able to perform a quick and successful
arthroscopic surgery. Bad positioning of the horse can sometimes be the reason why some
fragments cannot be seen or not be accessed.
Most of the arthroscopic procedures are performed in dorsal recumbency. This also allows
quick switching from one joint to another without compromising sterility and without turning the
horse over to the other side.
During the talk the different positions of the leg for each joint will be demonstrated.
Good positioning, careful aseptic surgical preparation and draping is paramount for a
successful surgery and this will often take longer than the surgical procedure itself.
The basic techniques of arthroscope, arthroscope and instrument placement in relation to
the fragment(s)/ lesion(s) will be explained.
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Proceedings of the 10th International Congress of World Equine Veterinary Association, 2008 - Moscow, Russia