Książki

No one suspected in the mid-1970s that endo time mastering video arthroscopy. The older generation must overcome the problems of scopic visualization of the joints would devel op so swiftly into the class of operative proce working abstractly "off the screen" without dures known as arthroscopic surgery. In the looking directly at the joint itself. German-speaking countries arthroscopy was Particular difficulties are encountered by limited in the 1970s to a few operators who colleagues who are faced with the need to underwent a "natural" learning process in perform arthroscopic surgery but are not fa volving arthroscopic inspection, confirmation miliar with diagnostic arthroscopy. Unlike by arthrotomy, and use of the arthroscope to their predecessors, they can no longer follow verify clinical diagnoses. Video technology the natural process of "learning by doing." was not available, so an assistant wanting to They cannot contemplate the joint pathology view the joint interior had to peer through an displayed on the monitor and then check their accessory eyepiece. arthroscopic findings in an open arthrotomy.

Basic Principles of Knee Arthroscopy: Normal and Pathological Findings Tips and Tricks

1 Historical Background.- 1.1 Early Instruments for Endoscopic Examinations.- 1.2 Eugen Bircher.- 1.3 Kenji Takagi.- 1.4 Development of Diagnostic Arthroscopy.- 1.5 Development of Arthroscopic Surgery.- 1.6 Outlook.- 2 Indications for Arthroscopy of the Knee Joint.- 2.1 Diagnostic Indications.- 2.1.1 Hemarthrosis.- 2.1.2 Locking.- 2.1.3 Recurrent Effusion.- 2.1.4 Cartilage Injuries.- 2.1.5 Pain of Unknown Etiology.- 2.1.6 Meniscal Tears.- 2.1.7 Detection of Associated Injuries for Preoperative Planning.- 2.1.8 Arthroscopy in Children and Adolescents.- 2.1.9 Arthroscopy for Settling Liability Judgments.- 2.1.10 Control Arthroscopy.- 2.2 Therapeutic Indications.- 2.3 Contraindications to Arthroscopy.- 3 Equipment.- 3.1 Arthroscope.- 3.1.1 Sheath.- 3.1.2 Telescopes.- 3.2 Lighting System.- 3.2.1 Light Source.- 3.2.2 Light Cables.- 3.3 Video System.- 3.3.1 Video Camera.- 3.3.2 Monitor.- 3.4 Arthroscopic Media.- 3.4.1 Fluid.- 3.4.2 Gas.- 3.4.3 Combination of Gas and Fluid.- 3.5 Irrigation System.- 3.5.1 Fluid Inflow.- 3.5.2 Fluid Outflow.- 3.6 Probing Hook.- 4 Preparation of the Patient and Equipment.- 4.1 Anesthesia.- 4.1.1 General Anesthesia.- 4.1.2 Regional Anesthesia.- 4.1.3 Local Anesthesia.- 4.2 Positioning.- 4.2.1 Extended Leg Position.- 4.2.2 Flexed Leg Position.- 4.3 Bloodless Field.- 4.4 Draping.- 4.4.1 Problems with Fluid Runoff.- 4.5 Equipment Preparation and Layout.- 4.5.1 Preparation of the Video Camera.- 4.6 Facilities.- 4.7 Care and Maintenance or Arthroscopic Instruments.- 4.7.1 Telescopes.- 4.7.2 Operating Instruments.- 4.8 Basic Equipment Requirements.- 5 Preoperative Examination under Anesthesia.- 6 Portals.- 6.1 Arthroscope Portal.- 6.1.1 High Anterolateral Approach (Standard Approach).- 6.1.2 Anterolateral Approach.- 6.1.3 Transligamentous Approach (Gillquist's Approach).- 6.1.4 Midpatellar Lateral Approach.- 6.1.5 Problems of Arthroscope Insertion.- 6.2 Instrument Portals.- 6.2.1 Cannula Technique.- 6.2.2 Medial Suprameniscal Approach.- 6.2.3 High Medial Approach.- 6.2.4 Suprapatellar Approaches.- 6.2.5 Posterior Approaches.- 6.2.6 Problems with the Instrument Portal.- 7 Basic Principles of Arthroscopy.- 7.1 Movements of the Arthroscope.- 7.1.1 Advancing and Retracting the Scope.- 7.1.2 Sweeping the Scope.- 7.1.3 Rotating the Scope.- 7.2 Position of the Light Post.- 7.3 Movements of the Knee.- 7.3.1 Flexion and Extension.- 7.3.2 Internal and External Rotation.- 7.3.3 Medial and Lateral Opening.- 7.3.4 Anterior and Posterior Drawer.- 7.4 Direct Manual Maneuvers.- 7.5 Orientation.- 7.5.1 Basic Rules.- 7.5.2 Intraarticular Orientation.- 7.6 Principle of Triangulation.- 7.7 Rendezvous Technique.- 8 Examination Procedure - Normal and Pathologic Findings.- 8.1 Retropatellar Space.- 8.2 Suprapatellar Pouch.- 8.2.1 Suprapatellar Plica.- 8.3 Lateral Recess.- 8.3.1 Lateral Aspect of the Lateral Meniscus.- 8.3.2 Popliteus Tendon, Popliteal Hiatus.- 8.3.3 Outerbridge Ridge.- 8.4 Femoropatellar Joint.- 8.4.1 Centering and Lateralization of the Patella.- 8.4.2 Femoral Trochlea.- 8.5 Anteromedial Capsule.- 8.5.1 Mediopatellar Plica.- 8.6 Medial Compartment.- 8.6.1 Medial Meniscus.- 8.6.2 Medial Femorotibial Joint.- 8.7 Intercondylar Area.- 8.7.1 Posterior Horn of Medial Meniscus, Posteromedial Recess, Posterior Cruciate Ligament.- 8.7.2 Infrapatellar Plica.- 8.7.3 Anterior Cruciate Ligament.- 8.8 Moving the Leg to the Figure-4 Position.- 8.9 Lateral Compartment.- 8.9.1 Lateral Meniscus.- 8.9.2 Lateral Femorotibial Joint.- 8.9.3 Popliteal Hiatus.- 8.9.4 Posterolateral Recess.- 8.10 Summary.- 8.11 Completing the Examination.- 9 The Articular Cartilage - Normal and Pathologic Findings.- 9.1 Normal Findings.- 9.2 Chondromalacia.- 9.2.1 "Chondropathy".- 9.3 Degenerative Changes.- 9.4 Traumatic Cartilage Lesions.- 9.4.1 Cartilage Contusions.- 9.4.2 Cartilage Fissures.- 9.4.3 Chondral and Osteochondral Fractures.- 9.5 Osteochondritis Dissecans.- 10 The Synovium - Normal and Pathologic Findings.- 10.1 Normal Findings.- 10.1.1 Synovial Biopsy.- 10.2 Posttraumatic Synovial Changes.- 10.3 Synovial Changes in Rheumatoid Arthritis.- 10.4 Pigmented Villonodular Synovitis (PVNS).- 10.5 Gout and Chondrocalcinosis.- 10.6 Synovitis Secondary to Psoriasis.- 10.7 Postarthrotomy Changes and Reactions to Implants.- 10.8 Synovial Chondromatosis.- 11 Problems in Arthroscopy.- 11.1 Poor-Quality Monitor Image.- 11.1.1 Dark Image.- 11.1.2 Image too Bright.- 11.1.3 Unsharp Image.- 11.1.4 Foggy Image.- 11.1.5 Image Flicker or Flutter.- 11.1.6 Persistent Image Features.- 11.1.7 Image Off-Center.- 11.2 Inadequate Joint Distention.- 11.3 Yellow-Out.- 11.4 Red-Out.- 11.5 No Picture.- 11.6 Extravasation of Irrigating Fluid.- 11.7 Inadequate Visualization of the Joint Compartments.- 11.8 Visualization of the Posterior Horn of the Medial Meniscus.- 11.8.1 Applying Valgus Stress to the Slightly Flexed Knee.- 11.8.2 Applying Manual Pressure from the Front of the Joint.- 11.8.3 Optimum Placement of the Instrument Portal.- 11.8.4 Instrument Manipulations.- 11.8.5 Manipulating the Meniscus with Suction.- 11.8.6 Instrument Selection.- 12 Complications.- 12.1 Articular Cartilage Damage.- 12.2 Carrying Particles of the Incise Drape into the Joint.- 12.3 Instrument Breakage.- 12.4 Nerve Injuries.- 12.5 Vascular Injuries.- 12.6 Ligament and Bone Injuries.- 12.7 Infection.- 12.8 Compartment Syndrome.- 12.9 Hemarthrosis and Postoperative Effusion.- 12.10 Thromboembolitic Complications.- 12.11 Synovial Fistula, Synovial Hernia.- 12.12 Reflex Sympathetic Dystrophy.- 12.13 Skin Complications.- 12.14 Lost Tissue Fragments.- 12.15 Special Complications of Gas Arthroscopy.- 12.16 Arthroscopy of the "Wrong" Knee.- 12.17 Other Rare Complications.- 12.18 Late Complications.- 13 Patient Information.- 13.1 Selecting Patients for Arthroscopy.- 13.2 Preoperative Patient Conduct.- 13.3 Preoperative Interview.- 13.4 Postoperative Consultation.- 14 Documentation.- 14.1 Written Documentation.- 14.1.1 Operation Report.- 14.1.2 Documentation Sheets.- 14.2 Photographic and Video Documentation.- 14.2.1 Photographic Documentation.- 14.2.2 Video Documentation.- 14.2.3 Video Printers.- 15 Training in Arthroscopy.- 15.1 Attending an Arthroscopic Course or Workshop.- 15.2 Practice on a Knee Model.- 15.3 Visiting an Experienced Arthroscopist.- 16 Spectrum of Arthroscopic Surgery.- 16.1 Advantages and Disadvantages of Arthroscopic Surgery.- 16.2 Arthroscopic Surgical Instruments.- 16.3 Arthroscopic Surgery.- References.