73: Arthroscopy - Smith Flashcards Preview

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Flashcards in 73: Arthroscopy - Smith Deck (13)
1

review anterior portal locations

*anterolateral (just lateral to peroneus tertius tendon)

anterocentral

*anteromedial (just medial to tibialis anterior tendon)

 

* 97% of arthroscopy can be done through these portals

2

review posterior portal locations

posteromedial

posterolateral

trans-achilles

3

indications for arthroscopy

  • 25% of all diagnostic cases provide benefits
    • get better just by looking around the jt - due to insulflation breaking up some ankle adhesions
  • When there is absence of a diagnosis in a symptomatic ankle
  • To evaluate chronic pain
  • Trauma
  • Non-traumatic

4

contraindications for arthroscopy

  • local/systemic infection (septic joints are ok)
  • ankylosis (no jt space)
  • DJD with jt space narrowing

5

advantages of arthroscopy

  • Early ROM
  • Less morbidity Vs. Open surgery
  • Less post-op recovery Vs. Open surgery
  • No ligament damage
  • Cost

6

noninvasive vs invasive ankle distraction

  • Non invasive - literal pulling
    • “Uncontrolled”
      • Gravity
      • Force
    • “Semi-controlled”
    • Guhl
      • No more than 30# (135N)
      • Relax every 30-40 minutes
    • Dowdy et al
      • Nerve conduction change with 1 hour
  • Invasive
    • Indications
      • Noninvasive Inadequate
      • Ex-Fix with controlled distraction
    • Contraindications
      • RSD
      • Open Physis
      • Osteopenia
      • Infection
    • Disadvantages
      • Risk of neurovascular damage
      • Pin site infection
      • Pin Failure
      • Stretching of Ligaments
      • Ligamentous disruption
      • Inability to manipulate ankle positioning

 

7

what is used to insulflate the joint?

marcaine

- put it in until you meet resistance

8

what is an open arthrotomy?

be prepared to open the jt if ...

instrument breaks

something is too big to get through canula

don't give arthroscopic privileges without arthrotomy priv

9

principles of arthroscopy

****

  • Pistoning-Increases or decreases magnification (in and out)
  • Rotation-Allows for an oblique view
  • Sweeping - med/lateral motion
  • Triangulation - knowing where things are in relation to your hands

10

synovectomy

chondroplasty

abrasion arthroplasty

  • removing scarred, thickened, hypertrophic synovium, chronic or acute synovitis
  • removing bits of cartilage
  • power removal of soft cartilage spots, may even go subchondral

11

review the gutter anatomy

12

complications

  • General
    • Infection
    • anesthesia
    • thrombophlebitis
  • Specific
    • Compartment syndrome
    • broken instruments
    • nerve entrapment
    • capsule tear and cartilage damage

13

post op management

  • Day 1-5
    • ROM (active and passive), NWB, RICE and NSAIDS
  • Day 5-7
    • First Dressing, ROM and WB to tolerance
  • Day 10-14
    • Suture removal, WB and physical therapy

encourage lots of movement!!

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