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Animal Practitioner
Animal Practitioner
Edited By
Timothy C. McCarthy, DVM, PhD
Diplomate, American College of Veterinary Surgeons

ACVS Founding Fellow, Minimally Invasive Surgery (Small Animal Soft Tissue)
ACVS Founding Fellow, Minimally Invasive Surgery (Small Animal Orthopedics)
Veterinary Minimally Invasive Surgery Training (VetMIST)
Beaverton, OR, USA
This edition first published 2021
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Library of Congress Cataloging-in-Publication Data
Names: McCarthy, Timothy C., author.

Title: Veterinary arthroscopy for the small animal practitioner / Timothy
C. McCarthy.
Description: First edition. | Hoboken, NJ : Wiley-Blackwell, 2021. |
Includes bibliographical references and index.
Identifiers: LCCN 2020035416 (print) | LCCN 2020035417 (ebook) | ISBN
9781119548973 (hardback) | ISBN 9781119549017 (adobe pdf) | ISBN
9781119549024 (epub)
Subjects: LCSH: Veterinary arthroscopy. | Veterinary orthopedics. |
Joints–Examination. | Veterinary diagnostic imaging. | Pet medicine.
Classification: LCC SF910.5 .M33 2021 (print) | LCC SF910.5 (ebook) | DDC
636.089/705–dc23
LC record available at https://lccn.loc.gov/2020035416
LC ebook record available at https://lccn.loc.gov/2020035417
Cover Design: Wiley

Cover Image: © Courtesy of Timothy C. McCarthy
Set in 9.5/12.5pt STIXTwoText by SPi Global, Pondicherry, India
10 9 8 7 6 5 4 3 2 1
I dedicate this book to all my patients.
Without their participation, this would not have been possible
vii
Contents
Preface xi
Acknowledgments xiii
About the Companion Website xiv
1 Introduction and Instrumentation 1

1.1 Introduction 1
1.2 Instrumentation and Equipment 3
1.2.1 Arthroscopes 3
1.2.2 Sheaths and Cannulas 5
1.2.2.1 Telescope Sheaths 5
1.2.2.2 Operative Cannulas 6
1.2.2.3 Egress Cannulas 8
1.2.3 Operative Hand Instruments 8
1.2.4 Power Instruments 12
1.2.4.1 Power Shavers 12
1.2.4.2 Radiofrequency/Electrocautery Instrumentation 14
1.2.5 Irrigation Fluid and Management Systems 15
1.2.5.1 Irrigation Fluids 15
1.2.5.2 Gravity Flow 16
1.2.5.3 Pressure Assisted Flow 16
1.2.5.4 Mechanical Arthroscopy Fluid Pumps 16
1.2.6 Video System Tower 17
1.2.6.1 Video Camera 18
1.2.6.2 Video Monitor 19
1.2.6.3 Light Source 19
1.2.6.4 Documentation Equipment 20
References 20
2 General Technique 23
2.1 Anesthesia, Patient Support, and Pain Management 23
2.2 Postoperative Care 23
2.3 Patient Preparation, Positioning, and Operating Room Setup 24
2.3.1 Shoulder Joint 24
2.3.2 Elbow Joint 26
2.3.3 Radiocarpal Joint 28
2.3.4 Hip Joint 29
2.3.5 Stifle Joint 29
2.3.6 Tibiotarsal Joint 31
2.4 Portal Placement-General 31
References 34
viii Contents
3 Shoulder Joint 36
3.2 Portal Sites and Portal Placement 37
3.2.1 Telescope Portals 37
3.2.2 Operative Portals 39
3.2.3 Egress Portals 40
3.3 Nerves of Concern with Shoulder Joint Arthroscopy 40
3.4 Examination Protocol and Normal Arthroscopic Anatomy 41
3.5 Diseases of the Shoulder Diagnosed and Managed with Arthroscopy 47
3.5.1 Osteochondritis Dissecans (OCD) 47
3.5.1.1 OCD Lesion Removal and Management 59
3.5.2 Bicipital Tendon Injuries 73
3.5.3 Soft Tissue Injuries of the Shoulder with or Without Shoulder Instability 81
3.5.4 Ununited Caudal Glenoid Ossification Center (UCGOC) 95
3.5.5 Ununited Supraglenoid Tubercle (USGT) 100
3.5.6 Arthroscopic-Assisted Intra-Articular Fracture Repair 100
3.5.7 Arthroscopic Biopsy of Intra-Articular Neoplasia 101
3.5.8 Glenoid Cartilage Defects 102
3.5.9 Chondromalacia 104
3.5.10 Infraspinatus Muscle Contracture 104
References 106
4 Arthroscopy of the Elbow Joint 108

4.2.1 Telescope Portals (Medial, Craniolateral, Caudomedial, and Caudal) 109
4.2.2 Operative Portals (Craniomedial, Lateral, Craniolateral, and Caudal) 111
4.2.3 Egress Portals 113
4.3 Nerves of Concern with Elbow Joint Arthroscopy 113
4.5 Diseases of the Elbow Diagnosed and Managed with Arthroscopy 122
4.5.1 Elbow Dysplasia 122
4.5.3 Ununited Anconeal Process (UAP) 176
4.5.4 Degenerative Joint Disease (DJD) 180
4.5.5 Assisted Intra-Articular Fracture Repair 180
4.5.6 Biopsy of Intra-Articular Neoplasia 181
4.5.7 Immune-Mediated Erosive Arthritis 182
4.5.8 Incomplete Ossification of the Humeral Condyle (IOHC) 182
4.5.9 Medial Enthesiopathy 183
References 184
5 Radiocarpal Joint 187

5.3 Nerves of Concern with Radiocarpal Joint Arthroscopy 187
5.5 Diseases of the Radiocarpal Joint Diagnosed and Managed with Arthroscopy 189
5.5.1 Fractures 189
5.5.2 Soft Tissue Injuries 190
References 191
Contents ix
6 Hip Joint 192

6.3 Nerves of Concern with Hip Joint Arthroscopy 193
6.5 Diseases of the Hip Diagnosed and Managed with Arthroscopy 196
6.5.1 Hip Dysplasia 196
6.5.2 Arthroliths 202
6.5.3 Soft Tissue Injuries of the Hip Joint 203
6.5.4 Assisted Intra-Articular Fracture Repair 205
6.5.5 Biopsy of Intra-Articular Neoplasia 206
6.5.6 Aseptic Necrosis of the Femoral Head 206
References 206
7 Stifle Joint 207

7.2.1 Telescope Portal 210
7.2.3 Egress Portal 211
7.3 Nerves of Concern with Stifle Joint Arthroscopy 213
7.5 Diseases of the Stifle Joint Diagnosed and Managed with Arthroscopy 221
7.5.1 Cranial Cruciate Ligament Injuries 221
7.5.2 Caudal Cruciate Ligament Injuries 258
7.5.3 Isolated Meniscal Injuries 258
7.5.4 Osteochondritis Dissecans(OCD) 259
7.5.5 Stifle Stabilization Failures 264
7.5.6 TPLO Second Look 264
7.5.7 Patellar Fracture Management 266
7.5.8 Long Digital Extensor Tendon Injuries 268
7.5.9 Popliteal Tendon Avulsion 268
7.5.10 Intra-articular Neoplasia 269
7.5.11 Patellar Luxation 270
7.5.12 Degenerative Joint Disease, Chondromalacia, and Synovitis 270
7.5.13 Discoid Meniscus 273
7.5.14 Osteochondromatosis 274
References 274
8 Tibiotarsal Joint 276

8.2.1 Telescope Portals 276
8.2.3 Egress Portal 278
8.3 Nerves of Concern with Tibiotarsal Joint Arthroscopy 278
8.5 Diseases of the Tibiotarsal Joint Diagnosed
and Managed with Arthroscopy 279
8.5.2 Intra-Articular Fracture Management 286
8.5.3 Soft Tissue Injuries 287
x Contents

8.5.5 Osteoarthritis 289
References 291
9 Problems and Complications 292

9.1 Actual and Potential Complications of Arthroscopy 292
9.1.1 Failure to Enter the Joint 292
9.1.2 Articular Cartilage Damage 292
9.1.3 Soft Tissue Damage 296
9.1.4 Bone Fragment Displacement 298
9.1.5 Operative Debris 298
9.1.6 Red Out 299
9.1.7 Peri-articular Fluid Accumulation 300
9.1.8 Infection 300
9.1.9 Vascular Injury 301
9.1.10 Nerve Injury 301
9.2 Instrument Damage 301
9.2.1 Intra-articular Instrument Breakage 301
9.2.2 Telescope Breakage 302
9.3 Contraindications 303
9.3.1 Patient Size 303
9.3.2 Septic Arthritis 303
9.3.3 Anesthesia Risk 303
References 304
Index 305
xi
Preface
While writing this book, my 50 year anniversary of grad- interviewed with the head of the program and, during
uation from Veterinary School occurred. Fifty years! the interview, it was obvious that if I applied for the
This has been an incredible journey! Beyond my wildest masters degree program there was no chance that I
dreams. I never thought that I would be where I am would be accepted but if I applied for the PhD program
today and would have done the things that I have done. I was guaranteed to be accepted. Interesting but it
I never dreamed that the first edition of this book would worked. Six years later I passed the ACVS examination
be translated into Russian or that I would be invited to and became a board-certified surgeon and, in a few
Russia to launch its sale and teach Russian Veterinarians. years later, won my PhD. ACVS recently initiated fel-
I never dreamed that I would travel to teach in 14 coun- lowship training in minimally invasive surgery, and I
tries and 23 states. That I would publish books about my was selected as a founding fellow in this program for
professional work. both small animal soft tissue surgery and small animal
It is amazing that I was even able to become a orthopedics, the only veterinarian to qualify for both
Veterinarian. I am so dyslexic that I struggled to learn to categories.
read. When I started the fifth grade, I was reading at a At my 25 year class reunion, I was informed that at a
second grade level. Spelling was impossible. In the third previous time I had been unanimously selected as the
grade, I was able to get 49 out of 50 words WRONG on a classmate least likely to go back to school AND they
review spelling test even after spending uncountable were “Stunned” that I was board certified. My reply was
hours with my parents trying to learn spelling using that no one is more stunned than I.
flash cards. People with really bad handwriting are Getting into endoscopy happened totally by chance. I
probably dyslexic and with really bad handwriting no got a call from a local veterinarian asking if I wanted to
one can tell how the word was spelled. I think that I got buy a used gastroscope that he had. As a surgeon, I had
into Veterinary School with the lowest grades in the his- never really thought about doing GI endoscopy but
tory of Veterinary Medicine, but Baxter Black and I thought, “hey why not” since no one in the area was
debate who’s was worst. If it were not for Dr. Don Bailey, providing this service. I did not buy that endoscope but
I would not have been accepted. He worked for Dr. bought another one that was in better shape for $550
Davis, who was head of the admission committee when with a light source and all the instruments that I needed.
I applied, all through Veterinary School and graduated A little later, I bought a laparoscope to do liver biopsies
at the top of this class. I managed to not flunk out and and then an arthroscope. I never thought that I would
graduated at the bottom of the class, again Baxter Black pay for this equipment, but I thought it would be fun, I
and I argue about who was really “last in class.” And might be able to practice better medicine, and I could
they call the person who graduates last in class “Dr.” afford the expense.
It was obvious in my first job out of school that I I started putting endoscopes everywhere and added to
wanted to do surgery. Residency programs for advanced the list of procedures that could be performed by trying
training were a new entity 50 years ago and they were new things on my patients. Many of the endoscopic first
few and far between. Then how does someone with ever procedures were performed on patients with clini-
grades barely above 2.0 get into a residency program? cal problems. Using the axiom of “Above all do no
NOT! I finally thought that I needed to try CSU, my harm” and combining endoscopy with transition to tra-
“amalater.” They did not have a residency program, but ditional approaches, there were an unbelievingly low
there was the graduate program at the Surgery Lab. I number of problems or complications. Very few firsts
xii Preface
were planned or thought about ahead of time and many with my first Psychologist, I unloaded everything that
were spur of the moment events added to an already was bothering me, things that I never thought I would
ongoing procedure or immediately before surgery by ever tell anyone, at the end of the session she said that I
asking the question, can I do this with a scope? In cases saved about nine months of therapy because I was ready
where the question was asked before surgery the discus- and she did not have to spend that time breaking down
sion with the client was, I would like to try this with my resistance. We went from there. I am a much happier
minimally invasive technique, I have never done this person, I have eliminated my anger issues, and I am
before or this has never been done before, if I cannot do much more resilient to the stresses in life.
this with minimally invasive technique I will do it the Early in this saga, I made the statement in my lec-
traditional old way, and the cost will by the same how tures: “Endoscopy is a quantum leap forward in our
matter how it gets done. I never had a client say no to diagnostic and therapeutic armamentarium.” This was
this plan. Sure, I had to eat some of the cost on many and still is true. Now I say “A patient comes into every
early cases, but this is the easiest, most effective, cheap- veterinary practice every day who would benefit from a
est continuing education I have ever gotten and has minimally invasive procedure” This is also true or when
benefitted the patients, clients, my practice, my happi- I get pushy: “Every patient who comes into every veteri-
ness, plus my pocketbook thousands of times over the nary practice every day would benefit from a minimally
cost. Sixty endoscopes and over 7000 procedures later I invasive procedure” and this is almost true.
am writing the second edition of this book. Enjoy your endoscopes. They are the best burnout
I know that I am different and do not follow the book. protection that you can buy.
I am so dyslexic that I cannot read about what I am not
supposed to be able to do. I also never learned to come
in out of the rain because my mother took me out in the
rain. In the first grade, when we had art class all the
class got coloring books, but the teacher did not give me
one. Being a typical first grader, I was devastated and
did not understand why I did not get a coloring book.
The teacher then brought me a large blank piece of
paper and told me that my mother did not want me to
have a coloring book but wanted me to make my own
drawings. So, I never learned to color between the lines.
In fact, I never learned that there were lines. When
someone says something about thinking outside the box
my question is, what is a box?
As I said at the beginning, my career has been an
incredible journey. But it has not all been easy or fun.
There have been times of miserable struggle. I belong to
the face book group; “Not one more vet,” because I am a
suicide survivor. Twice in my life I have been at the edge.
Fortunately, I never acted on my thoughts of suicide and
am here to tell about the experience. If I can get through
this so can you. I looked for and got help from my friends
and great help from some great Psychologists. I also have
to admit that I am really stubborn and wasn’t going to let
the b’s win. If you are in trouble, get help! Working with
a psychologist has changed my life. It does not mean that
if you see a Psychologist that there is something wrong
with you. Get over this mental block. Unburden yourself
to them, that is what they are there for. At my first visit
xiii
Acknowledgments
This work would not have been accomplished without a great number of people and animals who collectively made
this possible. I simply put it to paper.
First to my parents for bringing me into this world and for their unending support, encouragement, and love.
To Dr. Don and Betty Bailey for introducing me to Veterinary Medicine, for getting me into Veterinary School, and
for their continued support throughout my career.
To all my teachers and professors, from my first-grade teacher Mrs. Mathews, through high school and college for
their efforts to educate and stimulate me but especially to Drs Jim Creed, Glenn Severin, Pat Chase, Harry Gorman,
and Henry Swan.
To my colleagues who referred the cases that provided me with the material for learning these techniques. And to
the clients who entrusted me with their beloved pets.
To Dr. Karl Storz, his daughter Ms. Sible Storz, and his grandson Mr. Karl-Christian Storz for their interest in
Veterinary Medicine and support of our profession. To all the staff of the Veterinary Division of the Karl Storz
Endoscope Company for their educational endeavors and instrumentation development for our profession. Especially
to Dr. Christopher Chamness for his support, encouragement, and friendship.
To all the younger veterinarians who have picked up the reins and are driving all aspects of endoscopy forward at
an ever-increasing rate. I am thrilled that I now only see smoke and taillights. This is a thrill to watch.
And most importantly, to my wife and son for their patience and for allowing me the time to complete this
project.
xiv
About the Companion Website
This book is accompanied by a companion website:

www.wiley.com/go/mccarthy/arthroscopy
The website includes:
OO Videos
Note: The videos are clearly signposted throughout the book. Look out for .
1
Introduction and Instrumentation
1.1 Introduction advantage of arthroscopy. Most dogs recover to their

preoperative status of lameness and pain within a few
Arthroscopy is the most significant advance in small hours after arthroscopy. Many dogs are better than
animal orthopedics that has occurred during my 50 years their preoperative level of function by the time they are
of professional lifetime. released from the hospital on the day after arthroscopy.
Arthroscopy provides more information about intra- Arthroscopy is commonly performed as an outpatient
articular pathology than any other diagnostic tech- procedure with a release on the same day as surgery.
nique. The most important advantages of arthroscopy Activity restriction is not needed for portal site healing.
are visual access to more joint area, magnification pro- The time required for healing of intra-articular struc-
duced by the telescopes and video systems, excellent tures after arthroscopy for conditions such as OCD and
illumination, and a clear visual field when continuous medial coronoid process disease (MCPD) has not been
irrigation is employed. Arthroscopy is also minimally studied or effectively compared with healing after open
invasive, reduces trauma, shortens operative times, and surgery.
decreases recovery times. The small sizes of telescopes There are few disadvantages of arthroscopy. The most
available today allow placement into the deepest parts significant disadvantage is that arthroscopy is the most
of joints and combined with angulation of the field of difficult of all endoscopies to learn. Arthroscopy’s tech-
view, 30° for most arthroscopes, provide visual access nical difficulty with its long slow learning process for
to more area of joints than can be achieved with open both diagnostic applications and for performing correc-
surgery. Arthroscopes magnify intra-articular struc- tive surgical procedures makes it a challenge to gain
tures allowing visualization of anatomical details and proficiency. Arthroscopy requires considerable practice,
pathologic changes that are beyond the resolution of patience, and persistence to master. Reasons for arthros-
radiographs, CT, MRI, or what can be seen with open copy’s difficulty are related to the small space involved,
surgery (Video 1.1). Submacroscopic lesions that elude confinement by rigid bony structures, and the anatomic
us with open surgical exploration can be easily seen complexity of some joints such as the stifle. Even with
with arthroscopy. High-intensity lighting is passed its difficulties, developing proficiency with arthroscopy
directly through the arthroscope providing perfect illu- is within the grasp of most who are willing to make the
mination of everything in the field of view of the tele- effort and put in the time to learn. Expense of instru-
scope. Irrigation employed with arthroscopy maintains mentation is a relative disadvantage as the cost of the
a clear field of view by continuously flushing blood and equipment and instrumentation for arthroscopy is sig-
debris away from the end of the telescope. This is all nificant but is no more than other sophisticated instru-
done with minimally invasive technique and far less mentation used in small animal practice today. The
tissue trauma than with an arthrotomy. Speed is not the limitation of small patient size is shrinking as instru-
most important criteria or the most important advan- ment size decreases and as our skill level and experience
tage of arthroscopy over open arthrotomy, but for the increase.
experienced arthroscopic surgeon, anesthesia and pro- Arthroscopy is indicated whenever there is a history,
cedure times are significantly shorter than with con- physical findings, imaging changes, or laboratory
ventional open surgery. Postoperative recovery after result suggestive of joint disease. A history of lame-
arthroscopy is also much faster than following an open ness, stiffness, difficulty or reluctance to get up, reluc-
arthrotomy. This time comparison is an important tance to go up or downstairs, reluctance to get up and
Veterinary Arthroscopy for the Small Animal Practitioner, First Edition. Timothy C. McCarthy.
© 2021 John Wiley & Sons, Inc. Published 2021 by John Wiley & Sons, Inc.
Companion website: www.wiley.com/go/mccarthy/arthroscopy
2 1 Introduction and Instrumentation
down off the couch or the favorite chair, and inability Table 1.1 Diagnoses with arthroscopy.
to get in and out of the car or truck; combined with
All joints Degenerative joint disease
joint pain, swelling or thickening, crepitus, reduced
Chondromalacia
range of joint motion, or joint instability on physical
Neoplasia
examination are definite reasons to perform arthros-
Synovitis/villus synovial proliferation
copy. Radiographic, CT, MRI, or ultrasound abnormal-
Intra-articular Fractures
ities of increased joint fluid or joint capsule thickening,
Immune-mediated polyarthropathies
periarticular osteophytes, periarticular sclerosis, OCD
Septic arthritis
lesions, ununited anconeal processes, ununited caudal
Shoulder OCD of the humeral head
glenoid ossification center, intra-articular fractures or joint Bicipital tendon ruptures – partial and
chips, periarticular bone lysis, tendon and ligament complete
abnormalities, or any other changes involving a joint Medial glenohumeral ligament and
are also indications for arthroscopy. Normal radio- subscapularis tendon injuries
graphic, CT, MRI, or ultrasound findings do not pre- Lateral glenoid labrum separations
clude arthroscopy as a diagnostic technique if history Ununited caudal glenoid ossification center
and physical findings point to joint involvement. Ununited supraglenoid tubercle
Arthroscopy is indicated whenever we need more Supraspinatus tendon injuries
information about a joint than can be obtained with Glenoid cartilage defects
any less invasive technique. Elbow joint Medial coronoid process pathology/
Arthroscopy is most commonly performed in the fragmentation
shoulder, elbow, and stifle in dogs. Arthroscopy is less Lateral coronoid process pathology/
fragmentation
commonly performed on the radiocarpal, hip, and tibio-
OCD of the humeral condyle
tarsal joints. Arthroscopy is easier to perform in large
Ununited anconeal process
dogs but has been done effectively in dogs as small as
Joint incongruity/growth deformity
seven pounds. Arthroscopy has also been performed in Incomplete humeral condyle ossification
the shoulder, elbow, and stifle of cats but its use is
Radiocarpal Radial carpal bone fractures
largely unexplored in this species. The same position- joint Chip fractures of the dorsal margin of the
ing, procedures, techniques, and portals that are used in distal radius
dogs are used for cats. Ligament and joint capsule tears
Conditions that have been diagnosed with arthros- Hip joint Hip dysplasia
copy (Table 1.1) include osteochondritis dissecans Dorsal joint capsule tears
(OCD) of the shoulder, stifle, elbow, and tibiotarsal Aseptic necrosis of the femoral head
joints (Van Bree and Van Ryssen 1998); partial and Stifle joint Cranial cruciate ligament ruptures – partial
complete cranial and caudal cruciate ligament rup- and complete
tures; meniscal injuries; medial coronoid processes dis- Caudal cruciate ligament ruptures – partial
ease (MCPD); ununited caudal glenoid ossification and complete
center (UCGOC), ununited anconeal process (UAP), Meniscal injuries
ununited supraglenoid tubercle, degenerative joint dis- OCD of the femoral condyle
ease (DJD); intra-articular fractures; immune-mediated Medial patellar luxation/lateral patellar
ligament rupture
arthritis; synovitis; partial or complete bicipital tendon
Long digital extensor tendon injuries
rupture; injury to other intra-articular soft tissues of
Popliteal tendon avulsion
the shoulder, soft tissue injury of intra-articular struc-
Cruciate stabilization failure
tures of the elbow, radiocarpal, stifle, and hip joints;
Hock joint OCD of the talus
septic arthritis; and neoplasia. Arthroscopic assess-
ment of femoral head and acetabular articular cartilage
condition in young dysplastic dogs have been used for
case selection and to predict results with pelvic osteot- Operative procedures currently being performed with
omy surgery. Cartilage injury or chondromalacia sec- arthroscopy (Table 1.2) include removal of OCD cartilage
ondary to instability, deformity, or inflammatory flaps and debridement of the cartilage defects in the
processes is more easily identified and the extent of shoulder, elbow, stifle, and tibiotarsal joints (Bertrand
damage scored more accurately than with open et al. 1997; Bilmont et al. 2018; Cook et al. 2001; Gielen
surgery. et al. 2002; McCarthy 1999; Miller and Beale 2008; Olivieri
1.2 Instrumentation and Equipmen 3
Table 1.2 Operative procedures performed of avulsed ligament attachments, medial patellar luxation
with arthroscopy. management (Bevan and Taylor 2004), assisted repair of
intraarticular fractures (Beale and Cole 2012; Bright and
Shoulder OCD cartilage flap removal and lesion
joint debridement May 2011; Cole and Beale 2020; Cusack and Johnson 2013;
Bicipital tendon transection Deneuche and Viguier 2002; Perry et al. 2010), intra-artic-
Ununited caudal glenoid ossification center ular management of shoulder instability (Franklin
fragment removal et al. 2013; Mitchell and Innes 2000; Ridge et al. 2014),
Ununited supraglenoid tubercle fragment neoplasia management (Arias et al. 2009; Scherrer
removal et al. 2005), septic arthritis management (Fearnside and
Intra-articular soft tissue injury stabilization Preston 2002; Luther et al. 2005), and more. The majority
Intra-articular or assisted fracture repair
of procedures and publications relate to application of
Elbow joint Medial coronoid process fragment arthroscopy in dogs, but this technique has also been per-
removal/process revision formed in cats (Bardet 1998; Beale and Cole 2012;
OCD cartilage flap removal and lesion Bright 2010; Cole and Beale 2020; Cusack and
debridement
Johnson 2013; Mindner et al. 2016; Ridge 2009; Serck and
Anconeal process removal
Wouters 2019; Staiger and Beale 2005).
Osteophyte resection
Radiocarpal Carpal chip removal
joint Intra-articular or assisted fracture repair
1.2 Instrumentation
Stifle joint Cruciate ligament debridement/removal
and Equipment
Meniscectomy – partial/total
OCD cartilage flap removal and lesion 1.2.1 Arthroscopes
debridement
Rigid telescopes used for arthroscopy range in size from
Meniscal release
1.9 to 5.0 mm diameter. Telescopes in use today are
designed using what is termed a Hopkins rod lens sys-
Hock joint OCD cartilage flap removal and lesion
tem (Figure 1.1) for image transmission that has dra-
debridement
matically improved image quality over previous lens
Free joint body and tarsal chip fracture
fragment removal systems. Telescopes commonly used for small animal
Intra-articular or assisted fracture repair arthroscopy (Table 1.3) include a long 2.7 mm arthro-
scope also called the 2.7 mm multipurpose rigid tele-
scope (MPRT), a 4.0 mm arthroscope, a short 2.7 mm
et al. 2007; Person 1989; Rochat 2001; Van Bree and Van arthroscope, a 2.4 mm arthroscope, and a 1.9 mm arthro-
Ryssen 1998); coronoid process fragment removal scope (Figure 1.2). These telescopes all have a 30° visual
(McCarthy 1999; Rochat 2001) and coronoid process revi- angle, but other angles are available (Figure 1.3). Each
sion or subtotal coronoidectomy (McCarthy 1999), free has advantages, disadvantages, and specific best
joint body (arthrolith) removal (Smith et al. 2012), bicipi- applications.
tal tendon transection (Bergenhuyzen et al. 2010; Cook The 2.7 mm MPRT was for years promoted as the tel-
et al. 2005; Rochat 2001), carpal chip removal escope of choice for arthroscopy in small animals
(McCarthy 2005), partial and total meniscectomy (Ertelt because it had the best optics of all the small telescopes
and Fehr 2009; Ridge 2006; Ritzo et al. 2014; Rochat 2001), and its length allows it to be used for multiple endo-
cruciate ligament debridement (Rochat 2001), meniscal scopic techniques. This recommendation has changed
release (Austin et al. 2007; Kim et al. 2016; McCarthy 1999), with improvement of the optics of the 2.4 mm arthro-
ununited caudal glenoid ossification center removal scope, which now equals or exceeds those of the 2.7 mm
(McCarthy 2005), ununited supraglenoid tubercle MPRT. The 2.4 scope is shorter, 11 cm vs 18 cm, smaller,
removal (McCarthy 2005; Serck and Wouters 2019), unu- with a better blunt obturator design making it much
nited anconeal process removal (McCarthy 2005), screw easier to insert and use in the small joints of our patients.
fixation of ununited anconeal process fragments, osteo- This size and design allow procedures to be performed
phyte removal in chronic degenerative joint disease of the with less joint damage.
elbow and tarsus (McCarthy 2005), intra-articular repair One of the previous arguments for recommendation
of ruptured cranial cruciate ligaments (Bolia and of the 2.7 mm MPRT was that it can be used for many
Böttcher 2015; Person 1987; Winkels et al. 2010), fixation endoscopic techniques commonly performed in small
Figure 1.1 A diagram of the Hopkins rod lens system shown in the telescope at the bottom and a conventional lens system in
the telescope at the top. Hopkins rod lenses are the standard design for arthroscopes in current use today. Source: Photo
courtesy of KARL STORZ: © KARL STORZ SE & Co KG, Germany.
Table 1.3 Telescopes used for small animal arthroscopy.
Arthroscope diameter Telescope length (cm) Telescope angle (°) Telescope part number (Karl Storz)
4.0 mm 18 30 64230 BWA

a
12 30 67728 BWA
Endocameleon 8 15 T0 90 (Variable) 28731 AE
a
2.7 x Long (MPRT) 18 30 64029 BA
a
2.7 mm Short 11 30 67208 BA
a
2.4 mm 11 30 64300 BA
a
1.9 mm 10 30 64301 BA
6.5 30 28305 BA
a
Shown in Figure A I 2.
0°
12°
30°
Figure 1.2 Arthroscopes commonly used in small animal
practice from bottom to top: the long 2.7 mm multipurpose
rigid telescope (MPRT), 4.0 mm arthroscope, short 2.7 mm Figure 1.3 A diagram showing the angle of view of
arthroscope, 2.4 mm arthroscope, and 1.9 mm arthroscope. telescopes used for arthroscopy. Thirty degrees is the angle
These telescopes all have a viewing angle of 30°. The 2.7 mm of view of all commonly used telescopes for arthroscopy. Zero
multipurpose telescope has a working length of 18 cm; the degree and seventy degrees arthroscopes are available but
4.0 mm, short 2.7 mm, and 2.4 mm arthroscopes have a are rarely used. Source: Photo courtesy of KARL STORZ:
working length of 11 cm; and the 1.9 mm arthroscope with © KARL STORZ SE & Co KG, Germany.
6.5 cm working length. These telescopes are all autoclavable.
Source: Photo courtesy of KARL STORZ: © KARL STORZ SE &
Co KG, Germany.
animal practice and is why this endoscope is termed the out of the joint. This is particularly important for
MPRT. The larger size of this telescope and the design of beginners.
the blunt obturator increase the difficulty of establish- A significant advance in telescope technology is that
ing a telescope portal for arthroscopy. The other major most telescopes are now autoclavable. The autoclavable
disadvantage of this telescope is its length, which makes telescopes are labeled as autoclavable. This greatly facil-
manipulations more difficult for arthroscopy with the itates instrument turnaround and practice efficiency.
finite movements needed for maneuvering the visual
field within small joints combined with the long ful-
1.2.2 Sheaths and Cannulas
crum produced by a video camera on the end of the tel-
escope. The demands of arthroscopy for effective 1.2.2.1 Telescope Sheaths
application in small animals today combined with the Arthroscopes are used with a cannula or sheath to pro-
need for continued improvement in technique and tect the telescope and provide a channel for fluid inflow
results no longer allow us to substitute a multipurpose (Figure 1.4 and Table 1.4). A specifically matched sheath
telescope, when a better single application instrument is is required for each specific telescope size. Telescope
available. The 2.4 mm arthroscope is currently the tele- sheaths come with a sharp trocar and a blunt obturator.
scope of choice for small animal practice. The blunt obturator is preferred because it causes less
A 2.7 mm arthroscope is available with a working damage to joint cartilage when establishing the tele-
length of 11 cm. Its shorter length is an advantage over scope portal. Sheaths for the smaller telescopes used in
the 2.7 mm MPRT for arthroscopy making handling the small animal practice typically have a single fixed stop-
telescope in small joints much easier. The only other cock with a Luer lock connector used for fluid inflow.
advantage of this telescope over the 2.4 mm arthro- Cannulas are also available with two stopcocks and
scope is that it is more robust with less chance of break- stopcocks that rotate on the cannula. All sheaths have a
age, especially when used by a beginner. Disadvantages locking mechanism that fixes the cannula to the tele-
are that the optics are not as good as either the 2.4 mm scope. This locking mechanism is very important as it
arthroscope or the 2.7 mm MPRT and the blunt obtura- protects the telescope from being damaged. When
tor design makes portal placement more difficult. locked in place, the distal tip of the telescope is aligned
The 1.9 mm arthroscopes are available in 10 mm and with the distal tip of the sheath and this protects the
6.5 mm lengths. The smaller size of these telescopes is distal lens of the telescope. More importantly, when the
an advantage for use in smaller joints such as the radio- telescope is locked in place, the sheath protects against
carpal joint, tibiotarsal joint, and for use in small dogs or excessive bending stresses along the telescope shaft.
cats. Their disadvantages are that they are fragile break- This locking mechanism also creates a watertight seal at
ing more easily, the field of view is significantly smaller the proximal end of the sheath so that irrigating fluid
increasing the difficulty of joint visualization, and the flows into the joint. It is very important that the tele-
optics are not as good making them less effective for scope is properly locked in place for fluid flow, to pre-
documentation purposes. vent interference of the tip of the cannula with the
Four-millimeter diameter telescopes are also available visual field, and most importantly, to prevent telescope
for use in small animals but are too large for most joints damage.
in most patients. A 4 mm arthroscope has been used in The locking mechanism of telescope cannulas has
the stifle joint of larger dogs and in the shoulder joint in evolved over time from a rotating ring to a sliding box
giant breeds. Four-millimeter telescopes are available in and, more recently, to a snap-in design with spring-
lengths of 18 cm and a shorter 12 mm version. A 4.0 loaded locks (Figure 1.5). The rotating ring is the tradi-
Endocameleon arthroscope is a new addition to the tional coupling mechanism being the oldest and simplest
armamentarium for large joint arthroscopy with a vari- configuration for locking the telescope to the cannula.
able direction of view from 15° to 90°. This design works well, has withstood the test of time for
The shorter length arthroscopes have another advan- dependability, and is easy to use. The sliding box or auto-
tage in that they can be held in a pistol grip fashion with matic lock design is slightly easier to use, is more secure
the surgeon’s index finger on the skin at the portal site than the traditional coupling mechanism, but can
to accurately and easily maintain a constant depth of become hard to slide over time eventually sticking and
telescope insertion. This greatly reduces the number of becoming inoperable. The snap-in coupling is the most
times the field of view is lost because the telescope is recent locking mechanism, is the easiest to use, and pro-
inserted too deep or the telescope is inadvertently pulled vides secure attachment of the telescope to the cannula.
Figure 1.4 Arthroscope sheaths with blunt obturators from left to right: blunt obturator for the 2.7 mm long arthroscope or
MPRT, sheath for the 2.7 mm long arthroscope or MPRT telescope with a single rotatable stopcock and with a blunt obturator
inserted, blunt obturator for the 2.4 mm telescope, sheath for the 2.4 mm arthroscope with a single fixed stopcock, blunt
obturator for the short 2.7 mm arthroscope, sheath for the short 2.7 mm arthroscope with a single rotatable stopcock, an
operating cannula with a blunt obturator in place, sheath for the1.9 mm arthroscope with a single fixed stopcock and with a
blunt obturator inserted, and an egress cannula with a blunt obturator in place. The telescope cannulas in this image all have
the snap-in coupling design. Source: Photo courtesy of KARL STORZ: © KARL STORZ SE & Co KG, Germany.
Table 1.4 Telescope sheaths used for small animal arthroscopy.
Arthroscope Sheaths part number (Karl Storz) Obturators part number (Karl Storz)
4.0 mm/18 cm/30° (64 230 BWA) 64124AR 65127BS/BT

4.0 mm/12 cm/30° (64 728 BWA) 64126KR 64129BT
4.0 mm Endocameleon/18 cm (28 731 AE) 28 136 EC 28126 BC/BT
a
2.7 mm/18 cm/30° (64 029 BA) 64128 AR 63122 AS/AB
Snap in 28132S 28132BC/BT
a
2.7 mm/11 cm/30° (67 208 BA) 64147 BN 64147 BS/BT
Snap in 26133DS 28133BC
a
2.4 mm 10 cm/30° (64 300 BA) 64303 BN 64303 BU/BV
Snap in 28303BN 28302BU/BV
1.9 mm/11 cm/30° (64 301 BA) 64 302 BN 64302 BS/BT
a
1.9 mm/6.5 cm/30° (28 305 BA) 28306 BN 64306 BS/BT
Snap in 64306BN 64306BS/BT
a
1.2.2.2 Operative Cannulas best, but both are effective with each having its indica-
Operative portals are established with a cannula tions, advantages, and disadvantages. When a cannula
(Figure 1.6 and Table 1.5) or using a free passage tech- is used, access for instrumentation is established and
nique where instruments are placed through the soft maintained by placing the cannula into the joint at
tissues overlying the joint without using a cannula. the operative portal site. This technique has the
Conflicting opinions exist about which technique is advantage of facilitating reinsertion of instruments.
Figure 1.5 Locking mechanism designs for attaching sheaths to telescopes. From left to right: A snap-in coupling mechanism
with spring-loaded locks, a traditional rotating ring locking mechanism, and an automatic lock. Source: Photo courtesy of KARL
STORZ: © KARL STORZ SE & Co KG, Germany.
ifficult to keep in place tending to come out with

d
instrument and tissue removal.
For free passage of instruments without a portal can-
nula, joint access is created with a sharp incision into
the joint using a no. 11 blade followed by blunt dissec-
tion through tissues overlying the joint using a curved
mosquito hemostat. Instruments are passed into the
joint directly through the tissues. This technique has the
advantages of allowing passage of larger instruments,
removal of larger pieces of tissue, eliminating interfer-
ence of the cannula during operative instrument manip-
ulation, and eliminating the problem of the cannula
being displaced by removal of instruments and tissues.
The primary disadvantage of this technique is increased
Figure 1.6 Operating cannulas for arthroscopy from left to
difficulty of instrument reinsertion through the opera-
right: a 5.5 mm operating cannula with its blunt obturator in
place, a 4.5 mm operating cannula with a blunt obturator, a tive portal. A combination of the two techniques has
2.5 mm operating cannula with a sharp trocar in place, and a been employed using the one that best fits the current
3.5 mm operating cannula with a blunt obturator. Rubber procedure or stage of the procedure.
gaskets for these cannulas are used when indicated. Source:
Operative cannulas that have been used for small ani-
Photo courtesy of KARL STORZ: © KARL STORZ SE & Co KG,
Germany. mal arthroscopy are 2.5 mm diameter for 2.0 mm instru-
ments, 3.5 mm diameter for 2.8 mm instruments, 4.5 mm
The disadvantages of operative cannulas are that they diameter for 3.5 mm instruments, and 5.5 mm diameter
limit the size of instruments that can be placed into for 4.8 mm instruments. Cannulas come with sharp tro-
the joint and the size of tissue fragments that can be cars or blunt obturators for insertion and are supplied
removed. Operative cannulas can interfere with with rubber gaskets to prevent fluid leakage when
instrument manipulation because of small joint size instruments are in place. If increased pressure in the
with very short distances between the joint capsule joint is needed for a specific procedure, the gaskets are
and operative sites. Operative cannulas are also used. There are no valves or stopcocks in these cannulas,
Table 1.5 Operating cannulas used for small animal arthroscopy.
Cannula diameter ( mm) Instrument size ( mm) Cannula part number (Karl Storz) Obturator part number (Karl Storz)
a
5.5 4.8 64146 X 64146 XS/XT
a
4.5 3.5 64169 X 64169 XS/XT
a
3.5 2.8 64183 X 64183 XS/XT
a
2.5 2.0 64302 X 64302 XS/XT
a
so they do not hold fluid in the joint when an instru- Table 1.6 Egress cannulas used for small animal
ment is not in place. Gaskets increase the resistance of arthroscopy.
instrument insertion or removal and increase the ten-
dency for cannulas to be removed when instruments are Cannula Cannula part Obturator part number
diameter ( mm) number (Karl Storz) (Karl Storz)
withdrawn.
Operative cannulas are positioned under observation 4.5 a
64146 TT 28146 TO/TS
with the arthroscope to prevent intra-articular damage. a
3.2 64146 T 64146 QO/28146QB
a
2.2 64146 R 64146RO
1.2.2.3 Egress Cannulas
a
A site for outflow of fluid from joints is required. Fluid Shown in Figure A I 7.
flow is necessary to maintain a clear visual field during
arthroscopy, to provide joint distension, and for removal Placement of an egress cannula is difficult in some
of debris created with operative procedures. Low out- smaller joints because of inadequate space within the
flow resistance achieved with an egress cannula will joint or inadequate room for portal placement sites. In
maintain adequate fluid flow without excessive pres- these cases, and for simple diagnostic procedures in
sure. Egress cannulas for small animal arthroscopy are larger joints, a 20-gauge hypodermic needle is used for
2.2, 3.2, and 4.5 mm in diameter (Figure 1.7 and an egress site. Egress through operative portals is used
Table 1.6). The larger two sizes have multiple side holes in many joints for many operative procedures. This has
in the distal 1–2 cm of the cannula. This allows free the advantage of simplifying the procedure by eliminat-
access of fluid to the cannula and minimizes the possi- ing the step of egress cannula placement. Another
bility of occlusion. A Luer connector at the proximal or advantage of using operative portals for egress is that
outside end of the cannula allows connection of an when egress is close to the operative site debris from the
outflow line to direct fluid away from the operative field. procedure flows directly out of the joint rather than
The two larger sizes have a stopcock to control the rate through the joint to a distant egress portal. This
of fluid egress. The two larger egress cannulas come decreases the potential for leaving operative debris in
with either a sharp trocar or a blunt obturator for insert- the joint.
ing the cannula into the joint. Intra-articular tissue
damage is minimized by observing cannula placement
1.2.3 Operative Hand Instruments
with the arthroscope.
The number and variety of hand instruments available
for arthroscopy are extensive, but fortunately very few
hand instruments are needed to perform operative
arthroscopy for most of the common conditions seen in
small animals. A basic set of arthroscopic hand instru-
mentation (Table 1.7 and Figure 1.8a) includes 2.0, 2.5,
3.5, 4.0, and 5.0 mm arthroscopic rongeurs (Figure 1.8b);
2.3 and 3.5 mm arthroscopic grasping forceps
(Figure 1.8c); 0°, 30°, and 70° microfracture chisels
(Figure 1.8d); 0, 2–0, 3–0 and 4–0 straight curettes
(Figure 1.8e); 3–0, 4–0, and 5–0 curved/angled curettes;
1 and 2 mm hook probes (Figure 1.8f); and changing
rods or switching sticks (Figure 1.8g). Standard surgical
instrumentation and supplies used for arthroscopy
(Table 1.8) include curved mosquito hemostats with
and without teeth; 20 gauge 1″ and 1.5″ hypodermic
needles; 20 gauge 2.5″ or 3.5″spinal needles; no. 11 scal-
Figure 1.7 Egress cannulas for small animal arthroscopy
from bottom to top: a 2.2 mm egress cannula without a pel blades; 3 and 12 cc syringes; a 3-way stopcock; liter
stopcock, a 3.2 mm egress cannula with a stopcock, and a containers of saline or Ringers solution; IV administra-
4.5 mm egress cannula with a stopcock. The 3.2 mm tion sets; IV extension sets; pressure cuffs for fluid bags,
cannula is shown with a blunt obturator, and the 4.5 and a set of standard orthopedic operative instruments.
cannula is shown with a sharp trocar. Source: Photo
courtesy of KARL STORZ: © KARL STORZ SE & Co KG, This set of instruments is adequate for performing
Germany. OCD surgery in all joints, for coronoid process revision,
(a)
(b)
Figure 1.8 Operative hand instruments for small animal arthroscopy: (a) A set of small animal arthroscopy hand instruments
that are sufficient for the majority of operative procedures being performed today. On the top row from left to right: 2.0 mm
grasping forceps, 2.8 mm SilGrasp cartilage grasping forceps with straight spoon-shaped jaws, 2.8 mm SilGrasp straight Alligator
grasping forceps, 3 mm SilGrasp straight Alligator grasping forceps, 3.5 mm Blakesley rongeurs, and 4.0 mm Blakesley rongeurs.
On the bottom row from left to right: 30°, 0°, and 70° microfracture chisels; 0, 2–0, 3–0, and 4–0 curettes; 1.0 mm and 2.0 mm
graduated probes; a 5–0 delicate curette, and two switching sticks or changing rods. Instrument details are presented in
individual groups. (b) Rongeurs and grasping forceps from left to right, Blakesley 4.0 mm rongeurs, Blakesley 3.5 mm rongeurs,
2.8 mm SilGrasp cartilage grasping forceps with straight spoon-shaped jaws, and 2.0 mm grasping forceps with spoon-shaped
jaws. (c) Grasping forceps from left to right: 2.8 mm SilGrasp alligator grasping forceps and 3.5 mm SilGrasp alligator grasping
forceps. (d) Microfracture chisels from top to bottom: 0°, 30°, and 70°. (e) Straight curettes from left to right: 0, 2–0, 3–0, 4–0,
and 2.3 mm straight curettes. (f) Graduated probes: a 2.0 mm graduated hook probe at the top and 1.0 mm graduated hook
probe at the bottom. (g) Changing rods or switching sticks: a 2.8 mm diameter × 23 cm long changing rod on top and a 3.5 mm
diameter × 23 cm long changing rod on the bottom. A 2.0 mm diameter × 15 cm changing rod is also available. Source: Photo
courtesy of KARL STORZ: © KARL STORZ SE & Co KG, Germany.
(c) (d)
(e)
(f) (g)
Figure 1.8 (continued)

Table 1.7 Hand instruments used for small animal Table 1.8 Additional supplies used for small animal
arthroscopy. arthroscopy
Instruments Part number (Karl Storz)

No. 11 scalpel blades
20 gauge 1″ and 1.5″ hypodermic needles
Hook probes 20 gauge 2.5″ or 3.0″ spinal needles
1.0 mm 28145SN 3 cc syringes
2.0 mm 64145S 12 cc syringes
Arthroscopic rongeurs 3-way stopcock
2.0 mm 64302 L Liter containers of saline or Ringers solution
2.5 mm 634824 IV administration sets (Hespera life shield 12672-28)
4.0 mm 456502 IV extension sets (Hespera life shield 12656-28)
5.0 mm 64149 RL Pressure cuffs for fluid containers
SilGrasp alligator grasping forceps (Figure A I 8C) Curved mosquito hemostats without teeth
2.8 mm 28572AG Curved mosquito hemostats with teeth
3.5 mm 28571AG A basic set of orthopedic surgery instruments
Straight curettes
2-0 64620
3-0 64630
4-0 64640 tion to open the joint space providing more room for
5-0 Miltex 19-700 instrument placement and tissue manipulation. The
Curved curettes Leipzig stifle distractor (Figure 1.9 and Table 1.7) was
3-0 Miltex 26-1737 designed specifically for this purpose. It is typically not
needed for diagnostic examination of the stifle. Some
4-0 Miltex 26-1738
minor surgical procedures in loose joints can be per-
5-0 Miltex 26-1739
formed without the distractor, but its application is indi-
Exchange rods or switching sticks
cated for most operative procedures. It is attached to the
2.0 mm × 15 cm 64302 W distal femur and proximal tibia with fixation screws
2.8 mm × 23 cm 64124 BZ supplied with the distractor or bone pins can be used.
Micro fracture chisels This instrument provides for distal distraction of the
0° 64728 CF tibia from the femur to open the joint space and cranial
30° 64728 CG displacement of the tibial plateau to increase exposure
70° 64728 CH
of the menisci.
Leipzig stifle retractor 64820 LSD
bicipital tendon transection, anconeal process removal,

meniscal release, and bone chip removal. Additional
hand instruments that are helpful include larger ron-
geurs and grasping forceps, open curettes, a selection of
arthroscopic knives, and curved meniscal resection for-
ceps. When starting arthroscopy where minimally inva-
sive completion of procedures may not always occur, a
set of standard operative instruments is needed includ-
ing all those needed for completion of the surgical pro-
cedure should conversion to open arthrotomy be
indicated.
Figure 1.9 The Leipzig stifle distractor.
Operative procedures in the stifle joint, especially Source: Photo courtesy of KARL STORZ: © KARL STORZ SE &
meniscectomy, are greatly facilitated with stifle distrac- Co KG, Germany.
1.2.4 Power Instruments Table 1.9 Power instruments used for small animal
arthroscopy.
1.2.4.1 Power Shavers
Power-operated shavers are a great asset to operative Part number
arthroscopy and are used to remove cartilage, bone, Instrumentation (Karl Storz)
and soft tissues (Figure 1.10 and Table 1.9). These units
greatly speed operative procedures, produce a better Power shaver
result with a smoother surface after tissue removal, Unidrive SL III Arthro(Console) 287230 2
and decrease the amount of debris left in joints. Drillcut-X Arthro(Handpiece) 28200 DX
Shavers are not absolutely necessary for some of the Multifunction Handpiece 287210 36
basic operative procedures in small animals which can Shaver blades(70 mm Length)
be performed effectively with hand instruments. Using Aggressive cutter 3.5 mm 28206 ABS
a powered shaver when first learning to perform
Aggressive cutter 2.5 mm 28206 AAS
arthroscopy is not recommended because the potential
Full radius resector 3.5 mm 28206 CBS
for severe joint and instrument damage is greatly
increased by putting power tools in the hands of the Full radius resector 2.5 mm 28206 CAS
inexperienced operator. Extensive damage can be Aggressive full radius resector 3.5 mm 28206 DBS
caused by a single rotation of the shaver when the Aggressive full radius resector 2.5 mm 28206 DAS
blade is inappropriately placed. Any surgeon getting Small round burr 3.5 mm 28206 FBS
into arthroscopy needs to consider purchasing a power Small Round Burr 2.5 mm 28206 FAS
shaver at the time of acquiring initial instrumentation Two pedal foot switch 200168 31
or as a planned addition. Complex procedures per-
Three pedal foot switch 200128 32
formed by experienced surgeons are greatly facilitated
Bipolar radiofrequency
with a shaver and an appropriate selection of blades.
MITEK VAPR/VAPR VUE
Fluid pumps
Endomat select UP210
Vet software (must be specified UP609
or device does not function)
Irrigation tubing set 031523-10
An example of damage caused by an inexperienced

arthroscopic surgeon was in a training session with
surgery residents at an academic institution. This was
their first exposure to arthroscopy and the instrumenta-
tion was new. During this training session, the end of
the telescope was ground off with the shaver destroying
the instrument before it was ever placed in a patient.
Caution is required in the use of power tools by all of us
but particularly for beginners.
A series of small shavers originally designed for max-
illofacial surgery was initially applied for small animal
arthroscopy. These shaver handles were much smaller
than available human “small joint” shavers and their
size was much more suitable for small animal arthros-
copy. Small joint shaver handles have evolved into more
suitable instruments for our use. These small hand-
Figure 1.10 The Unidrive S III SCB Console with the pieces have less torque than the standard larger hand-
multifunction orthopedic handpiece for orthopedic surgery pieces which has been a complaint from some surgeons,
and the Drillcut-X Arthro handpiece for arthroscopy. Both of
these handpieces are appropriate for use in small animal
but this lower torque is actually an advantage in the
practice. Source: Photo courtesy of KARL STORZ: © KARL small spaces where we work. The newest small hand-
STORZ SE & Co KG, Germany. piece, the Drillcut-DX ARTHRO shaver handpiece
(a)
Figure 1.11 The Drillcut-X ARTHRO shaver handpiece.

Source: Photo courtesy of KARL STORZ: © KARL STORZ SE &
Co KG, Germany. (b)
(Figure 1.11) is smaller and lighter with improved ergo-

nomics, with a maximum speed of 8000 rpm, more
torque, and an easier to clean design. Larger handpieces
(c)
have greater maximum speeds of up to 15 000 rpm and
are more difficult to use in our small joints. They also
have significantly more torque which is a disadvantage
as the blade can catch sending the shaver across the
joint potentially causing damage to the joint or (d)
telescope.
A wide variety of blade types and sizes are available
for the Drillcut-DX ARTHRO shaver handpiece for
different applications. Shaver blades include burrs
(2.5–6.5 mm diameter and 70–180 mm long) for Figure 1.12 Single-use shaver blade types commonly used
removing bone and cartilage, aggressive cutters, and in small animal arthroscopy: The blades shown here are
those available in 70 mm length, 2.5 mm and 3.5 mm
full radius aggressive cutters (2.5–5.5 mm diameter diameters, which are ideal for use in the small joints of our
and 70–180 mm long) for removing soft tissue and patients. (a) A full radius resector with smooth blades on
cartilage, and full radius resectors with smooth cut- both cutting surfaces. (b) An aggressive full radius resector
ting edges (2.5–5.5 mm diameter and 70–180 mm with a serrated blade on the inner cutting surface and a
smooth blade on the outer cutting surface. (c) An aggressive
long) for removing soft tissue. These shaver blades cutter with both blades serrated. (d) A round burr. Source:
come in reusable and disposable versions. Reusable Photo courtesy of KARL STORZ: © KARL STORZ SE & Co KG,
versions are not recommended as they become dull Germany.
too fast, break too easily, and are far more expensive
than disposable blades. Disposable versions are rec-
ommended because they are less expensive, are still A selection of blade sizes and types is recommended
reusable several times, and can be autoclaved. to maximize shaver function.
Lengths of 70, 120, and 180 mm are available with The shaver control unit has the capability to drive all
some types in curved versions. A limited selection of the arthroscopy shaver units, from 6000 to 15 000 rpm,
70 mm long shaver blades is available in 2.5 and and also to power a multifunction handpiece for open
3.5 mm diameters (Figure 1.12). These short small orthopedic surgery applications. The console has a large
diameter blades are ideal for the small size of the multicolor touchscreen providing easy determination of
joints encountered in our patients. The longer blades instrument settings, intuitive instrument management
can be used with the Drillcut-DX ARTHRO hand- for changing speeds or rotation direction, and allows
piece with much wider selection types but are more changing settings from hand switch to foot switch
cumbersome to use. Shaver blades are cannulated so control.
that debris from the cutting process is aspirated out With the small size of the joints that we operate, foot
through the blade as shaving is performed. Suction is switch control is recommended. Using a foot switch
used with shavers to facilitate debris removal and to rather than hand controls on the handpiece allows the
pull soft tissues into the blade to enhance the soft tis- shaver to be started and stopped without changing grip
sue cutting process. Larger sized blades speed soft tis- position on the handpiece. Having to change hand or
sue removal in procedures such as cruciate ligament finger position is difficult to do without moving the
debridement but are more difficult to use in small handpiece or especially the tip of the shaver blade.
joints. Smaller blades are easier to use, are needed to Inadvertent movement of the shaver tip by only a few
access small joint spaces such as for meniscus millimeters or a few degrees rotation can cause damage
debridement, but remove tissue more slowly, and are to the tissues or to the arthroscope. Foot switches are
more susceptible to occlusion with tissue debris. available in three-pedal (Figure 1.13a) and two-pedal
(a) gravity, pressure cuffs on fluid bags, or with a mechan-

ical arthroscopy pump. Outflow is controlled with the
level of suction applied to the system and with a lever
on the shaver handpiece. The shaver blades are hol-
low and are designed to have suction applied so that
fluid is aspirated through the blade and handpiece to
remove bony debris from the joint. With soft tissues in
the joint suction through the shaver, in addition to
removing debris, also functions to pull tissue into the
shaver blade facilitating cutting and removal. Too lit-
tle flow allows shaver produced bone fragments to
accumulate in the joint (Video 1.2) interfering with
the visual field and increasing debris that can be left
in the joint. Too much suction pulls air into the joint
(b) that can interfere with the visual field (Video 1.3).
When inflow and suction are balanced neither occurs
and shaver function is optimized (Video 1.4). Many
cases proceed with little problem, but others require
constant adjustment.
1.2.4.2 Radiofrequency/Electrocautery
Instrumentation
Monopolar or bipolar radio-frequency instrumentation
is used to cut tissue, cauterize bleeding vessels, and for
removal of tissue by vaporization. The most common
use of radio-frequency is for ablation of the fat pad and
villus synovial reaction to improve visualization in the
cruciate compromised stifle joint, for cranial cruciate
ligament debridement or removal, for medial meniscal
Figure 1.13 Foot switches for use with the shaver
system. (a) The three pedal shaver foot switch. The left release by transection of the caudal meniscotibial liga-
pedal is for unidirectional rotation to the left ment, and for partial or complete meniscectomy.
(counterclockwise), the right pedal is for unidirectional Radiofrequency was used in the shoulder joint for ther-
rotation to the right (clockwise), and the center pedal is
mal modification of medial soft tissue structures, but
for oscillating rotation. (b) The two pedal shaver foot
switch. The left pedal is for unidirectional rotation to the this application has fallen into disfavor and is no longer
left (counterclockwise), and the right pedal is for recommended. Radiofrequency is also used for transec-
unidirectional rotation to the right (clockwise). To achieve tion of the bicipital tendon when indicated. Ablation of
oscillating rotation, both pedals are depressed. Source:
villus synovial proliferation with radiofrequency is ben-
Photo courtesy of KARL STORZ: © KARL STORZ SE & Co
KG, Germany. eficial in any joint to improve the visual field by removal
of excessive synovial tissue.
Specific instrumentation designed for arthroscopy is
versions (Figure 1.13b). The three-pedal system is larger available in bipolar configuration (Figure 1.14 and
but is easier to use because each pedal has one function Table 1.9). Multiple handpiece tip configurations and
with the left pedal running the shaver in one direction, sizes are available to facilitate access to structures within
the right pedal running the shaver in the other direc- joints and for different tissue effects (Figure 1.15). The
tion, and the center pedal activating the oscillating rota- power settings of these units are automatically set for
tion function. With the two pedals system, each direction the handpiece employed but are also manually adjusta-
of rotation is controlled by depressing one of the foot ble for different applications. The original arthroscopy
pedals but to achieve oscillating rotation both pedals specific bipolar radio-frequency unit is still in use but is
need to be depressed at the same time making control of no longer supported. Evolution of this system through
this function more difficult. several generations has occurred with significant
Another issue with power shavers is balancing liq- improvements including better heat management and
uid inflow and outflow. Inflow is controlled with integrated suction (Figure 1.16).
Standard monopolar radio-frequency surgery units

can be modified for intra-articular use by purchasing
specific arthroscopy tips. This approach is effective for
cutting and for cauterizing but is not effective for abla-
tion of large quantities of tissue.
1.2.5 Irrigation Fluid and Management

Systems
The optical field for arthroscopy is established and main-
tained by irrigating the joint with fluid. Three different
techniques are used for maintaining fluid flow; gravity
flow using liter containers of fluid placed above the
Figure 1.14 A Mitek VAPR II bipolar arthroscopic patient with an IV set connected to the fluid portal on the
radiofrequency control unit used in the author’s practice. telescope cannula; pressure assisted flow with a manual
Source: Timothy C. McCarthy. © John Wiley & Sons Inc.
pressure cuff added to the gravity flow system; or an auto-
matic mechanical arthroscopic infusion pump. Ingress
fluid flow through the telescope cannula assists in keep-
ing a clear view by washing blood and debris away from
the lens of the telescope out of the visual field. Continuous
drainage provided by an egress needle, egress cannula, or
through the operative portal allows for continuous fluid
flow. A high flow low pressure system is effective in
maintaining a clear visual field while decreasing the
potential for periarticular fluid accumulation. This is
achieved by decreasing outflow resistance rather than by
increasing inflow pressure. Overzealous infusion of flu-
ids results in collection of fluid in the periarticular and
subcutaneous tissues that can interfere with joint exami-
Figure 1.15 A selection of handpieces for use with the
Mitek VAPR II bipolar radiofrequency unit. Multiple handpiece nation by compressing the joint capsule. Excessive fluid
configurations are available. Shown here from top to bottom pressure can cause rupture of the joint capsule.
are a 3.5 mm side effect electrode (center in insert), a
3.5 mm hook electrode (left in insert), and a 2.3 mm short
side effect electrode (right in insert). Additional electrode 1.2.5.1 Irrigation Fluids
configurations termed end effect in 3.5 mm and 2.3 mm sizes, Lactated Ringer’s solution, Ringer’s solution, and physi-
a 2.3 mm wedge electrode, and a 3.5 mm thermocouple ologic saline solution are the most commonly used flu-
temperature-controlled electrode are also available.
ids for arthroscopy. There is no clear agreement on
which is the preferred solution and research has given
conflicting results. This debate had been well studied
prior to publication of the Arthroscopy chapter of
first edition of Veterinary Endoscopy for the Small
Animal Practitioner (McCarthy 2005; Andrews and
Timmerman 1997). Some of the studies done at that
time showed no difference in effect on cartilage metabo-
lism of physiologic saline, lactated Ringer’s solution,
and sterile water (Arciero et al. 1986). Other studies
showed that sterile water has more adverse effect than
lactated Ringer’s solution and that lactated Ringer’s
solution has more adverse effect than saline (Bert
et al. 1990; Reagan and McInerny 1983). Whereas other
studies have shown that Ringer’s solution is more detri-
Figure 1.16 A Mitek VAPR VUE bipolar arthroscopic mental than sterile water (Gradinger and Träger 1995;
radiofrequency unit with handpiece and two pedal foot
switch. Source: Photo courtesy of DePuy Mitek Sports Jurvelin and Jurvelin 1994). An evaluation of ionic (lac-
Medicine division of Johnson & Johnson. tated Ringer’s and sterile water) and nonionic solutions
(Sorbitol, Mannitol, and Dextran 40) showed the least

effect on mechanical properties and least proteogly-
can loss with nonionic solutions (Gradinger and
Träger 1995). A review of this debate at that time con-
cluded that: “The author is unaware of any deleterious
effects of normal saline solution. At the author’s institu-
tion, normal saline is the most economical solution
available.” (Andrews and Timmerman 1997). A recent
systematic review of the literature from 1946 to 2018
looking at this question did not provide any additional
conclusive answers and suggested that additional
human studies are needed (Sardana et al. 2019).
There is currently no clear scientific answer to the
question as to which solution is best for arthroscopy. In
a practical sense, there are no proven clinical disadvan- Figure 1.17 An intravenous fluid administration extension
tages or adverse effects of using lactated Ringer’s solu- set with a filter cap that allows the escape of air but not
tion, Ringer’s solution, or normal saline. Any crystalloid liquid facilitating bleeding irrigation lines for arthroscopy.
solution suitable for IV use can be used for arthroscopy
although solutions containing glucose are not recom-
mended because of the sticky residue. Since normal trolled by inflow pressure and by egress resistance. A
saline and lactated Ringer’s solutions are readily availa- high flow low pressure system is effective in maintain-
ble, inexpensive, and there are no valid clinical argu- ing a clear visual field while decreasing the potential for
ments against their use, they are the solutions currently periarticular fluid accumulation. This is achieved by
used for arthroscopy. decreasing outflow resistance rather than by increasing
One, three, and five-liter bags of sterile IV solutions inflow pressure.
are available and are suitable for arthroscopy. Larger
bags have the advantage of requiring less frequent con- 1.2.5.3 Pressure Assisted Flow
tainer changes during procedures than smaller bags. Gravity flow is adequate in most cases for diagnostic
With experience, most procedures are completed with and beginning operative arthroscopy. A pressure cuff on
one liter or less of fluid making the need for larger bags the fluid bag can be added to the system to increase
uncommon. Larger bags are more cumbersome to han- pressure and flow when needed. A manually inflatable
dle than one-liter bags. One-liter containers are also less pressure cuff is placed on the fluid bag and inflated to
expensive per liter than their larger counterparts. create adequate pressure. This system is inexpensive
and is easy to set up and use. Disadvantages are that
1.2.5.2 Gravity Flow pressure needs to be repeatedly added to the bag during
This is the simplest, easiest, and least cumbersome tech- the procedure, changing bags can be cumbersome, and
nique for maintaining irrigation and works well for the potential for periarticular fluid accumulation is
most diagnostic arthroscopy and many of the basic increased if too much pressure is applied to the cuff.
operative procedures. The technique uses IV fluid bags Using two fluid bags with two pressure cuffs facilitates
connected to an intravenous fluid administration set changing bags because when one bag is empty, the fluid
that is then connected to the inflow port in the arthro- line is quickly and easily changed to the second bag. The
scope cannula. Air is bled from the IV line prior to use to pressure cuff from the empty bag is then transferred to a
minimize air bubbles that will interfere with the visual new full bag so that it is ready for the next exchange.
field. Intravenous administration sets are available with Many operative procedures do not require more than
a filter in the cap on the patient end of the line one liter of fluid but preparation of the second bag with
(Figure 1.17) that allows air to escape and prevents liq- the pressure cuff in place minimizes the time for bag
uid leakage. The fluid bag is hung above the patient, and replacement when it is needed.
the intravenous administration set flow controls are
opened fully. The stopcock on the telescope cannula is 1.2.5.4 Mechanical Arthroscopy Fluid Pumps
then used to start and stop fluid flow. Fluid pressure and Mechanical pumps that automatically manage intra-
joint distension are controlled by the level the bag is articular fluid pressure and flow are an asset to opera-
placed above the joint. The rate of fluid flow is con- tive arthroscopy (Figure 1.18 and Table 1.9). They are
and care of the tubing is critical for proper pump func-

tion. All air must be removed from the system as the
presence of air interferes with pressure sensing causing
the pump to cycle unnecessarily. The tubing is designed
to allow attachment of two fluid bags simultaneously
facilitating uninterrupted fluid availability.
1.2.6 Video System Tower

A video endoscopy system is absolutely essential for
arthroscopy. The system is assembled in a video tower
which is a movable cart or cabinet on wheels contain-
Figure 1.18 ENDOMAT SELECT UP 210, Automatic ing the components of the video system needed for
mechanical arthroscopic fluid pump. Source: Photo courtesy
of KARL STORZ: © KARL STORZ SE & Co KG, Germany. performing arthroscopy or other video endoscopic
procedures (Figure 1.20 and Table 1.10). The necessary
also an added expense and increase the complexity of
operating room setup. Although not necessary for diag-
nostic arthroscopy or for basic operative arthroscopy,
they become more important as complexity of proce-
dures increases with their benefits increasing and
advantages of having a fluid pump becomes more sig-
nificant. These pumps have adjustable pressure and
flow settings that are used to balance pressure and flow
for each specific joint and case. Pressures of 50 cm of
water or less are recommended for small animal arthros-
copy. Once set the pressure is maintained automatically
by the pump varying fluid flow. Special inflow tubing is
required for use with these pumps (Figure 1.19). Setup
Figure 1.20 A video tower that is appropriate for small

animal arthroscopy and other endoscopy applications in
small animal private practice. Shown from top to bottom:
17” flat screen high definition monitor, a keyboard, on the
next shelf on the right a laparoflator, a 300-W Xenon light
source, and a high definition camera control box with a
built-in capture system. On the left side of this shelf is a
30-W diode surgical laser. The next shelf down has an
Figure 1.19 ENDOMAT irrigation tubing setup for use for arthroscopic shaver control box on the left side with the foot
arthroscopy with the ENDOMAT SELECT UP 210. The tubing switch for the laser on the right side. On the bottom shelf, a
is designed to allow attachment of two fluid bags LigaSure is stacked on top of a VAPR II arthroscopic
simultaneously facilitating uninterrupted fluid availability. radio-frequency unit. Carbon dioxide tanks are fastened to
Source: Photo courtesy of KARL STORZ: © KARL STORZ SE & the left side of the cart with a pole for hanging fluid bags.
Co KG, Germany. Source: Timothy C. McCarthy. © John Wiley & Sons Inc.
Table 1.10 Video system components used for small animal

arthroscopy.
Video component Part number (Karl Storz)
Video cameras
Image I S H3-link rigid TC 300
endoscopy full HD link module
Image I connect console TC 200
Image I S three chip full HD TH 100
camera head
Light sources
Xenon Nova(175 W) 691315 01
Xenon Nova 300(300 W) 201340 01
LED Nova 150(150 W) 201612 01
Power LED 175(175 W) 201614 01-1
Power LED 300(300 W) TL 300
Fiber optic light cables
Many lengths and diameters 495/69495
Monitors
Any high quality flat-screen monitor
Documentation
AIDA with Smartscreeen WD 350
Compact one piece portable system
Tele PAC VET X LED RP 100
Tele cam one-chip camera head 20 212 030/20212130
Figure 1.21 An elaborate endoscopy tower with two

components of a video system are a video camera, flat-screen monitors on arms and more shelf space for
video monitor, light source, and a cart or cabinet on additional instrumentation modules. Source: Photo courtesy
of KARL STORZ: © KARL STORZ SE & Co KG, Germany.
wheels. An arthroscopic power shaver, mechanical
fluid pump, and radio-frequency unit are included in
the tower so that setup for procedures is quick and
easy. Additional optional components include video
recording or capture devices and, for soft tissue appli-
cations, a diode or holmium laser, an insufflator for
laparoscopy, plus a vessel sealing device are needed.
Larger more elaborate carts are available that hold
more instrumentation and that have positioning arms
for the monitor, but the tower shown has functioned
well (Figure 1.21).
Figure 1.22 An IMAGE 1 FULL HD Three Chip Camera Head
1.2.6.1 Video Camera H3-Z. Source: Photo courtesy of KARL STORZ: © KARL STORZ
Specifically designed cameras for arthroscopy and SE & Co KG, Germany.
minimally invasive surgery are essential for arthros-
copy (Figure 1.22). The camera head attaches directly
to the arthroscope eyepiece to create a one-piece oper- tower (Figure 1.24). An alternative camera system for
ating system (Figure 1.23). Endoscopic camera heads limited space situations and for mobile applications is
are very small and lightweight because the majority of a Tele Pack. This self-contained system includes a light
electronic circuitry for the system is in a control unit source, camera control box, monitor, and a capture sys-
box that is out of the operative field in the video system tem in a single small suitcase-sized unit (Figure 1.25).
Figure 1.25 A Tele Pack Vet X LED self-contained endoscopy

video system with a camera control box, LED light source,
monitor, and capture system in a single small suitcase-sized
box. Source: Photo courtesy of KARL STORZ: © KARL STORZ
SE & Co KG, Germany.
provide an excellent image. Three chip cameras and

high definition cameras have higher resolution and
better color separation but are only necessary for
obtaining publication-quality images. A significant
recent advance in camera technology is that they are
available as autoclavable versions greatly speeding
instrument turnaround.
Figure 1.23 The IMAGE 1 HD camera head coupled to an
arthroscope while performing elbow arthroscopy. Source: 1.2.6.2 Video Monitor
Timothy C. McCarthy. © John Wiley & Sons Inc. The medical-grade video monitors previously recom-
mended and considered to be necessary for effective
video endoscopy are no longer needed and have been
replaced by flat-screen monitors (Figures 1.20 and 1.21).
The added expense of a medical-grade monitor is no
longer required. The decreased cost for monitors with
flat-screen technology also allows use of more than one
monitor in the operating room. The currently recom-
mended operating room setup uses two monitors, one
on the tower, and one mounted on a wall at an appropri-
ate location for the operating room. A wireless transmis-
sion system connects the remote monitor to the tower
system eliminating the need for wired connections. This
arrangement eliminates the problem of monitor place-
ment for complex procedures where more than one
monitor position is needed.
Figure 1.24 An IMAGE I FULL HD camera box and head
with an Image 1 connect capture module. Source: Photo
courtesy of KARL STORZ: © KARL STORZ SE & Co KG, 1.2.6.3 Light Source
Germany. A good quality light source and fiberoptic light guide
cable are required for arthroscopy. Halogen was the ini-
This system uses a standard definition single-chip tial light source used when fiberoptic light transmission
camera with image quality that is more than adequate was developed for endoscopic use. Xenon light sources
for small animal arthroscopy. These cameras are light- (Figure 1.26) have replaced halogen and have been the
weight, compact, connect directly to the telescope, and preferred technology for arthroscopy for many years.
Figure 1.27 A 300-W LED light source. Source: Photo

courtesy of KARL STORZ: © KARL STORZ SE & Co KG,
Germany.
Figure 1.26 A Xenon Nova 300-W light source. Source:

Photo courtesy of KARL STORZ: © KARL STORZ SE & Co KG,
Germany.
They are available in 175 and 300-W sizes. Xenon light

sources are much brighter and provide a light wave-
length closer to natural light giving tissues truer color.
The major disadvantage of Xenon is the cost of bulb
replacement and its short bulb life expectancy com-
pared to other light sources. Newer diode light sources
(Figure 1.27) are available that produce light compara-
ble in wavelength to Xenon with less energy use and a
Figure 1.28 Light guide cable for connecting the light
bulb life expectancy in the 30 000 hours range. They are
source to the light post on rigid endoscopes. Source: Photo
currently more expensive than Xenon light sources. courtesy of KARL STORZ: © KARL STORZ SE & Co KG,
Flexible fiberoptic light guide cables are used to con- Germany.
nect the light source to the telescope (Figure 1.28).
These light guide cables are available in diameters from (Figure 1.20). Video printers and video cassette record-
2.5 to 4.8 mm and lengths from 180 to 320 cm. Smaller ers used in the early days of video arthroscopy have
light guide cables are recommended for smaller tele- been replaced with digital capture devices. Video and
scopes and larger light guide cables for larger telescope still images are captured directly off the camera during
diameters. Multiple adaptors are available to allow con- procedures. These captured images are transferred to a
nection to endoscopes and light sources from many computer for editing, stored on disks or thumb drives,
manufacturers. used for computer presentations, or printed for distribu-
tion to clients and referring veterinarians. The highest
1.2.6.4 Documentation Equipment quality still images are obtained with digital capture sys-
Diagnostic and operative arthroscopy can be performed tems. Capture of video during procedures is an optional
without a capture device. When a capture device is used, method of documentation, but short video clips are rec-
they are incorporated into the video system tower, so ommended as opposed to recording whole procedures
they are ready whenever the system is used. Camera as this requires extensive editing to provide an accepta-
control units are also available with capture systems ble product. Most capture devices can be set to a prede-
built into the control unit box as an ICM module termined video recording time.
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Ridge, PA. & Cook, JL. et al. (2014) Arthroscopically Winkels, P. & Werner, H. et al. (2010) Development and in
assisted treatment of injury to the lateral glenohumeral situ application of an adjustable aiming device to guide
ligament in dogs. Vet. Surg. 43(5):558–62. extra- to intraarticular tibial tunnel drilling for the
Ritzo, ME. & Ritzo, BA. et al. (2014) Incidence and type of insertion of the cranial cruciate ligament in dogs. Vet.
meniscal injury and associated long-term clinical Surg. 39, 324–33.
23
General Technique
2.1 Anesthesia, Patient Support, patients, although more comfortable the day of arthros-
and Pain Management copy, have been more painful the day after surgery when
local anesthetics were used. Another concern with
A surgical plane of general anesthesia is required for intra-articular placement of local anesthetics is systemic
arthroscopy with the same considerations that would be toxicity (Di Salvo and Bufalari 2015). Intra-articular sys-
temic pain medications may be beneficial in managing
employed for any orthopedic surgery. Beyond this basic
postarthroscopy pain (El Baz and Farahat 2019; Moeen
criterion selection of preanesthetic medications, induc-
and Ramadan 2017; Salman and Olgunkeleş 2019).
tion agents, maintenance anesthesia, and pain manage-
Intra-articular corticosteroids have been used occasion-
ment are more patient driven than they are procedure
ally in severely inflamed joints, but their use is contro-
driven. Anesthetic and support needs of the young dog
versial (Céleste et al. 2005; Doyle et al. 2005; Gogia
undergoing shoulder arthroscopy for OCD are com-
et al. 1993; Murphy et al. 2000; Todhunter et al. 1996).
pletely different than the needs of the geriatric dog
Supportive treatment typically includes intravenous
undergoing multiportal elbow arthroscopy for debrid-
crystalloid fluid therapy based on patient needs.
ing degenerative joint disease. Pain management needs
Perioperative antibiotic administration is left to the dis-
also vary greatly depending on patient needs and on the
cretion of the surgeon. Padded leg wraps are applied at
specific arthroscopic procedure that is performed; how-
the end of the procedure for distal joints including the
ever, pain medication needs are usually significantly
elbow, carpus, stifle, and hock. The wraps are removed
less than those for an open arthrotomy or other open prior to release on the day following arthroscopy.
orthopedic procedure. Postoperative icing of joints undergoing extensive
An example of a typical patient management protocol arthroscopy has been used when indicated.
includes preanesthetic evaluation with CBC, blood
chemistry profile, thoracic radiographs, EKG, and uri-
nalysis. Preanesthetic, induction, and maintenance pro- 2.2 Postoperative Care
tocols that are appropriate for the patient are used based
on those established for individual practices. Most patients are kept in the hospital until the day after
Perioperative NSAIDs are given based on standards arthroscopy was performed although many can be
employed by the practice. Additional opiate pain medi- released on the day of surgery. Medications starting
cations are indicated for sensitive patients and for more after the procedure include oral NSAIDs with Tramadol
extensive arthroscopic procedures such as multiportal or other appropriate opiates. Patients are released with
elbow debridement or arthroscopic stifle debridement these medications for 7–14 days. Activity is restricted for
in conjunction with surgical management of cruciate a minimum of 2 weeks. In-house activity is limited to
ligament injuries. Intra-articular local anesthetics are walking with no running, jumping, roughhousing,
typically not used as they damage joint cartilage (Çevik going up or downstairs, jumping up or down off the fur-
and Gergin 2018; Jayaram et al. 2019; Lo and Sciore 2009) niture, or jumping in or out of the car. Outside activity is
although single intra-articular injections of some limited to leash walking sufficient for urination and def-
diluted local anesthetics have not been proven to be det- ecation. A recheck examination is performed at two
rimental (Breu and Rosenmeier 2013; Dragoo et al. 2012; weeks after arthroscopy, and the activity level is adjusted
Kreuz et al. 2018). Personal experience has found that based on the procedure that was performed and on
Veterinary Arthroscopy for the Small Animal Practitioner, First Edition. Timothy C. McCarthy.
© 2021 John Wiley & Sons, Inc. Published 2021 by John Wiley & Sons, Inc.
Companion website: www.wiley.com/go/mccarthy/arthroscopy
24 2 General Technique
patient progress. Additional pain medication is pre-

scribed as indicated.
2.3 Patient Preparation,
Positioning, and Operating
Room Setup
Patients are most commonly prepared and draped in a

manner similar to what would be employed for an open
arthrotomy of the joint being examined. The limb or
limbs are clipped, scrubbed, and draped for aseptic sur-
gery as would be done for any open orthopedic proce-
dure. Effective arthroscopy requires that the joint be
freely movable and draping must allow a full range of
flexion, extension, and rotation of the joint of interest.
Endoscopes and accessory instrumentation are steri-
lized with cold sterilization, ethylene oxide, or by auto-
claving. Many instruments that previously required cold
or gas sterilization are now autoclavable greatly increas-
ing efficiency of case management. It is very important
that the specific instrument manufacturer’s recommen-
dations for sterilization are followed. Figure 2.1 Triangulation in the stifle joint with the
telescope (on the right) and the operative instrument (on the
The leg is positioned and stabilized by an assistant or
left) converging in the area of interest in the intercondylar
it can be immobilized in a holding device. The authors notch for an operative procedure. Source: Freeman (1999).
experience has been using an assistant. Various immo- © 1999, Elsevier.
bilizing and distraction devices have been designed and
tested (Böttcher et al. 2009; Devesa et al. 2014, 2015; Patient positioning and operating room setup are spe-
Gemmill and Farrell 2009; Götzens et al. 2019; Kim cific for each joint, for specific procedures within each
et al. 2016, 2017, 2019; Park et al. 2018; Rovesti joint, and for unilateral vs bilateral procedures. Having
et al. 2015, 2018; Schulz et al. 2004; Winkels et al. 2016). two monitors in the operating room greatly facilitates
Their use is at the surgeon’s preference. Basic principles setup and performing arthroscopy especially when mul-
of endoscopic operating room setup are followed tiple joints are examined, or multiple procedures are
(Freeman 1999). The patient and video monitor or mon- done in a single joint.
itors are arranged so that the telescope is pointed as
close to directly toward the monitor as possible. This
2.3.1 Shoulder Joint
concept is essential to effective arthroscopy. Arthroscopy
techniques are difficult enough to learn and master Bilateral shoulder arthroscopy is more commonly per-
without the added disorientation of improper monitor formed than unilateral procedures as most of the com-
placement. Portals are placed to achieve triangulation mon shoulder abnormalities requiring arthroscopy
optimizing function for arthroscopic surgery with the occur bilaterally. When bilateral arthroscopy is being
telescope visual field and operative instruments posi- performed under the same anesthesia, the patient is
tioned to converge on the intra-articular operative site positioned in dorsal recumbency with both legs sus-
in the same visual plane as seen by the surgeon pended (Figure 2.2a) and clipping is done to allow ster-
(Figure 2.1). The angle between the telescope and the ile preparation to the midscapula (Figure 2.2b). Draping
operative instrument is kept between 30 and 60°. Too is done so that the patient can be rolled to each side pro-
narrow an angle increases interference of the telescope viding access to both joints. Bilateral shoulder OCD and
with instrumentation or what is termed sword fighting. bilateral UCGOC procedures are performed with the
Working at an angle of more than 90° distorts transla- patient placed in dorsal recumbency with a monitor
tion of hand movements to movement on the video placed at the caudal end of the patient (Figure 2.3).
monitor. When the legs have been draped, the patient is rolled
2.3 Patient Preparation, Positioning, and Operating Room Setu 25
(a) (b)
Figure 2.2 A patient positioned in dorsal recumbency with the front legs hung in preparation for bilateral shoulder and/or
elbow arthroscopy. (a) An AP view and (b) a lateral view. Source: Timothy C. McCarthy. © John Wiley & Sons Inc.
Anesthesia Sterile table

machine setup
Video cart
Surgeon Assistant
Figure 2.3 Operating room setup for bilateral shoulder arthroscopy for OCD or UCGOC with the patient in dorsal recumbency.
The surgeon and assistant stand on what will be the ventral side of the patient after it is rotated on the side away from the
shoulder to be operated. The monitor is placed at the caudal end of the patient. This arrangement is also used for bilateral
elbow arthroscopy for UAP. Source: Drawing by Cindy Cox.
toward the side to be operated first and the surgeon be performed with monitor position as for bilateral pro-
stands ventral to the patient with an assistant standing cedures or with the monitor on the dorsal side of the
on the same side caudal to the surgeon, between the patient directly across from the surgeon. For the cranio-
surgeon and the monitor. After the first side has been medial telescope portal, the patient is prepared and
completed, both surgeon and assistant move to the draped in dorsal recumbency, but the legs are left
other side of the patient and the patient is rolled to attached to the suspension system. This is an uncom-
expose the second shoulder. For bilateral bicipital ten- monly employed technique. An easier procedure is to
don surgery and procedures involving medial joint use an Endocameleon Arthro or a 70° arthroscope to
structures, patient positioning and transfer from side to evaluate the lateral joint structures from the lateral
side is the same as for OCD and UCGOC surgery but the portals.
monitor is placed at the head of the patient and the
assistant stands cranial to the surgeon, again between
2.3.2 Elbow Joint
the surgeon and the monitor (Figure 2.4). Bilateral pro-
cedures involving manipulations in both the cranial and Elbow arthroscopy is typically performed bilaterally at
caudal joint compartments require two monitors: one the same anesthesia, and dorsal recumbency is
placed at the head of the patient and one placed and the employed to allow access to both elbows using the same
foot of the patient (Figure 2.5). Unilateral procedures in preparation as for the shoulder joint (Figure 2.2). The
either the cranial or caudal areas of the joint are per- patient is prepared with both legs suspended, and drap-
formed with the patient positioned in lateral recum- ing is done so that the legs are freely movable and can be
bency with the joint to be examined on the upside and abducted for access to the medial aspect of both joints.
with the surgeon and assistant standing on the ventral Bilateral procedures for medial coronoid process pathol-
side of the patient (Figure 2.6). Unilateral procedures ogy, for medial condylar ridge OCD lesions, and for gen-
performed with the patient in lateral recumbency can eral exploration of the elbow joints using the medial
Anesthesia machine
Sterile
Video
table
cart
setup
Surgeon
Assistant
Figure 2.4 Operating room setup for bilateral shoulder arthroscopy for bicipital tendon transection and for other cranial or
medial joint procedures with the patient in dorsal recumbency. The surgeon and assistant stand on what will be the ventral
side of the patient after it is rotated on the side away from the shoulder to be operated. The monitor is placed at the cranial
end of the patient. This arrangement is also used for bilateral elbow arthroscopy for medial coronoid process disease and OCD
of the elbow joint. Source: Drawing by Cindy Cox.
Anesthesia machine
Sterile
table
Video setup
cart
Video
cart
Surgeon Assistant
Figure 2.5 Operating room setup for bilateral elbow arthroscopy with monitors at both the head and foot of the table. This
operating room configuration can also be used for bilateral shoulder arthroscopy. Source: Drawing by Cindy Cox.
Video cart
Anesthesia
machine
Sterile
table
setup
Assistant Surgeon
Figure 2.6 Operating room setup for unilateral shoulder arthroscopy with the surgeon and assistant standing on the ventral
side of the patient and the monitor placed on the dorsal side of the patient. Source: Drawing by Cindy Cox.
(a) (b)
Figure 2.7 (a) The front leg of a dog viewed in a caudal to cranial direction that has been draped and positioned for elbow
joint arthroscopy. The leg is abducted over a one-pound cotton roll that is being used as a bolster, and the antebrachium is
rotated internally. (b) A medial to lateral view of the front leg of a dog that has been draped and positioned for elbow joint
arthroscopy. The leg is abducted over a one-pound cotton roll that is being used as a bolster, and the antebrachium is rotated
internally. These two movements open the medial aspect of the joint. Source: Timothy C. McCarthy. © John Wiley & Sons Inc.
telescope portal and craniomedial operative portal are the problem of working away from the monitor for coro-
performed with the patient in dorsal recumbency with noid process revision or fragment removal if required. If
the monitor placed at the head of the patient (Figure 2.4). a second monitor is not available, alternatives are to per-
The patient is held in dorsal recumbency with position- form a unilateral procedure with the patient in dorsal or
ing supports, sandbags, or a “V” trough, the leg to be lateral recumbency with the monitor placed across from
operated is abducted, and the surgeon stands on the the surgeon on the opposite side of the patient. Then to
same side as the joint being operated. The assistant perform the second side, the monitor is moved when
stands beside the surgeon on the patient’s cranial side the surgeon and assistant change sides. An additional
between the surgeon and the monitor. A bolster is alternative is to use caudal portals for access to the anco-
placed under the elbow joint to create a fulcrum for val- neal process with the patient in dorsal recumbency and
gus stress with internal rotation to open the medial side the monitor at the head of the table. Multiportal elbow
of the joint. A one-pound roll of cotton covered with a arthroscopy for debridement of degenerative joint dis-
waterproof sterile drape is commonly used for the bol- ease is typically performed as a unilateral procedure
ster (Figure 2.7a and b. When the first joint arthroscopy with the patient in dorsal recumbency so that the patient
has been completed, both surgeon and assistant move to can be rolled from side to side for access to both medial
the other side of the patient and the other leg is abducted and lateral aspects of the joint and with the monitor at
for the second procedure. Arthroscopy for bilateral unu- the head of the patient.
nited anconeal process removal is also performed with
the patient in dorsal recumbency but with the monitor
2.3.3 Radiocarpal Joint
at the caudal end of the table, and the legs are abducted
to provide access to the medial aspect of the joint for Portals for radiocarpal joint arthroscopy are all on the
placement of a standard medial telescope portal, caudo- dorsal aspect of the joint, and procedures are typically
medial operative portal, and a craniomedial operative unilateral. Dorsal recumbency with the leg pulled cau-
portal (Figure 2.4). Ununited anconeal processes are dally or lateral recumbency with the limb rotated out-
commonly associated with medial coronoid process ward is employed for unilateral arthroscopy. For the
pathology, and this positioning with this portal selection occasional bilateral procedure, the patient is placed in
allows evaluation of the medial coronoid process at the dorsal recumbency with the monitor placed at the head
same time as anconeal process fragment removal. This of the table (Figure 2.4) and the assistant stands cranial
positioning requires two monitors, one at each end of to the surgeon. For lateral recumbency, the monitor is
the patient (Figure 2.5). With only one monitor, there is placed across the table from the surgeon (Figure 2.6).
2.3.4 Hip Joint cruciate ligament injury diagnosis is confirmed. Both

dorsal recumbency with the leg extended caudally
Lateral recumbency is used for arthroscopy of the hip
(Figure 2.9) and lateral recumbency with the leg to be
joint, and procedures are performed unilaterally
examined uppermost and rotated outward (Figure 2.10)
(Figure 2.8). The most common indication for hip joint
can be used for diagnostic stifle arthroscopy. Dorsal
arthroscopy is in young dogs with hip dysplasia prior to
recumbency with the leg extended caudally provides
performing pelvic osteotomy surgery so the patient is
easier manipulation of the joint and more complete
positioned, prepared, and draped for that surgery. The
access for operative procedures. When the patient is
monitor is placed at the head of the table or obliquely on
placed in dorsal recumbency, the monitor is placed at
either side of the patient and far enough cranially to be
the head of the table or obliquely on the side of the leg
out of the way for the surgical procedure. The surgeon
being examined far enough cranially to allow appropri-
stands at the caudal end of the patient. The assistant
ate telescope orientation and to be out of the way of the
stands ventral to the patient in a position to apply trac-
sterile operative field for the surgical procedure. The
tion to the leg and countertraction to the ventral
surgeon stands at the foot of the table, and the assistant
midline.
stands lateral to the patient on the same side as the joint
that is being operated. For stifle arthroscopy in the lat-
eral position, the monitor is placed dorsal to the patient,
2.3.5 Stifle Joint
the surgeon stands ventral to the patient, and the assis-
The most common diagnosis with stifle arthroscopy is tant stands at the foot of the table. Dorsal recumbency is
an injury to the cranial cruciate ligament. Unless there employed for bilateral arthroscopy of the stifles with the
is another definitive diagnosis prior to arthroscopy, the monitor at the head of the table, the surgeon at the foot
patient is placed in position with draping for the correc- of the table, and the assistant moving to be on the lateral
tive surgical procedure that will be performed after the side of the joint being operated.
Anesthesia
machine
Sterile
table
setup
Surgeon
Video
cart
Assistant
Figure 2.8 Operating room setup for hip arthroscopy with the patient in lateral recumbency and prepared for pelvic
osteotomy surgery following arthroscopy. The monitor is placed at the head of the patient or obliquely on the dorsal side of the
patient cranially out of the way of the aseptic field. The surgeon stands at the foot of the table or on the dorsal side at the level
of the pelvis. The assistant stands on the ventral side of the patient at the level of the hind legs. Source: Drawing by Cindy Cox.
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The Project Gutenberg eBook of Isabel of
Castile and the making of the Spanish nation,
1451-1504
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Title: Isabel of Castile and the making of the Spanish nation,

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*** START OF THE PROJECT GUTENBERG EBOOK ISABEL OF

CASTILE AND THE MAKING OF THE SPANISH NATION, 1451-
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granted to the public domain.
ISABEL OF CASTILE
AFTER A PAINTING IN THE PRADO

GALLERY ATTRIBUTED TO MIGUEL
ZITTOZ
FROM “TORQUEMADA AND THE

SPANISH INQUISITION” BY RAFAEL
SABATINI
ISABEL OF CASTILE
AND
THE MAKING OF THE SPANISH NATION
1451–1504
BY
IERNE L. PLUNKET
Author of “The Fall of the Old Order, 1763–1815”
Illustrated
G. P. PUTNAM’S SONS
NEW YORK AND LONDON
The Knickerbocker Press
1915
Copyright, 1915
BY
G. P. PUTNAM’S SONS
The Knickerbocker Press, New York

FOREWORD
Isabel of Castile is one of the most remarkable, and also one of the
most attractive, figures in Spanish history. Her marriage with
Ferdinand the Wise of Aragon brought about the union of the
Spanish nationality, which had so long been distracted and divided
by provincial prejudices and dynastic feuds. She is the ancestress of
the Spanish Hapsburg line. But she is also important in Spanish
history as a wise and energetic ruler, who rendered invaluable
assistance to her husband and to some extent moulded his policy.
Under their government Spain was reduced from anarchy to order
and took her place among the great Powers of Europe. Isabel is
perhaps best known as the patroness of Christopher Columbus and
the unflinching ally of the Spanish Inquisition. But her career
presents many other features of interest. In particular it reveals the
problems which had to be faced by European governments in the
critical period of transition from mediæval to modern forms of
national organization.
H. W. C. D.
Balliol College, Oxford,

Dec. 17, 1914.
CONTENTS
PAGE
CHAPTER I
CASTILE IN THE FIFTEENTH CENTURY 1
CHAPTER II
THE REIGN OF HENRY IV.: MISGOVERNMENT. 1454–1463 22
CHAPTER III
THE REIGN OF HENRY IV.: CIVIL WAR AND ANARCHY. 1464–

1474 51
CHAPTER IV
ACCESSION OF ISABEL: THE PORTUGUESE WAR. 1475–1479 88
CHAPTER V
ORGANIZATION AND REFORM 121
CHAPTER VI
THE MOORISH WAR. 1481–1483 158
CHAPTER VII
THE FALL OF GRANADA: THE MOORISH WAR. 1484–1492 185

CHAPTER VIII
THE INQUISITION 231
CHAPTER IX
THE EXPULSION OF THE JEWS AND MUDEJARES 263
CHAPTER X
CHRISTOPHER COLUMBUS 285
CHAPTER XI
ISABEL AND HER CHILDREN 319
CHAPTER XII
THE ITALIAN WARS. 1494–1504 346
CHAPTER XIII
CASTILIAN LITERATURE 387
APPENDIX I. HOUSE OF TRASTAMARA IN CASTILE AND

ARAGON 424
APPENDIX II. PRINCIPAL AUTHORITIES FOR THE LIFE AND

TIMES OF ISABEL OF CASTILE 425
Index 427
ILLUSTRATIONS
PAGE
ISABEL OF CASTILE Frontispiece
After a painting in the Prado Gallery attributed to Miguel
Zittoz.
From Torquemada and the Spanish Inquisition, by Rafael
Sabatini.
HENRY IV 22
From Boletin de la Real Academia de la Historia, vol. lxii.
From a photograph by Hauser and Menet.
ALFONSO V. OF ARAGON 24
From Iconografia Española, by Valentin Carderera y
Solano.
JUAN PACHECO, MARQUIS OF VILLENA 28

Solano.
ALFONSO, BROTHER OF ISABEL OF CASTILE 66

Solano.
FERDINAND OF ARAGON 90
Solano.
TOLEDO, LA PUERTA DEL SOL 106

From a photograph by Anderson, Rome.
TOLEDO, CHURCH OF SAN JUAN DE LOS REYES 110

SEGOVIA, THE ALCAZAR 114

From a photograph by Lacoste, Madrid.
PRINCE JOHN, SON OF FERDINAND AND ISABEL 116

(FUNERAL EFFIGY)
Solano.
JOANNA “LA BELTRANEJA” 118

From Sitges’ Enrique IV. y la Excelente Señora.
SPANISH HALBERDIER, FIFTEENTH CENTURY 162

From Spanish Arms and Armour.
Reproduced by courtesy of the author, Mr. A. F. Calvert.
SPANISH CROSSBOWMAN, FIFTEENTH CENTURY 166

ARMS BELONGING TO BOABDIL 172

From Lafuente’s Historia General De España, vol. vii.
ALHAMBRA, COURT OF LIONS 178

DOUBLE BREECH-LOADING CANNON, IN BRONZE 192

RONDA, THE TAJO OR CHASM 200

MALAGA TO-DAY 214

BOABDIL, LAST KING OF GRANADA 222

From Altamira’s Historia de España.
ALHAMBRA, PATIO DE L’ALBERCA 226

Á
THE CARDINAL OF SPAIN, DON PEDRO GONSÁLEZ DE 234
MENDOZA
From Historia de la Villa y Corte de Madrid, by Amador de
los Rios.
XIMINES DE CISNEROS 242

Solano.
TORQUEMADA 258
After a painting attributed to Miguel Zittoz.
From Torquemada and the Spanish Inquisition.
Reproduced by kind permission of the author, Mr. Rafael
Sabatini.
TOMB OF FRANCISCO RAMIREZ (“EL ARTILLERO”) 282

los Rios.
CHRISTOPHER COLUMBUS 286

From Christopher Columbus, by Washington Irving.
A CARAVEL UNDER SAIL 298

From Christopher Columbus, by Washington Irving.
ISABEL OF CASTILE 322

Carved wooden statue from the Cathedral at Granada.
From A Queen of Queens, by Christopher Hare, published
by Messrs. Harper.
TOMB OF FERDINAND AND ISABEL 330

From Nervo’s Isabelle La Catholique.
Reproduced by permission of Messrs. Smith, Elder & Co.,
publishers of translated edition.
AVILA, TOMB OF PRINCE JOHN, SON OF FERDINAND AND

ISABEL 334
AVILA, THE CATHEDRAL 336
From a photograph by Hauser and Menet.
ISABEL, QUEEN OF PORTUGAL, ELDEST DAUGHTER OF

FERDINAND AND ISABEL 338
Solano.
AVILA FROM BEYOND THE CITY WALLS 344

A KING-AT-ARMS 364
SPANISH MAN-AT-ARMS, FIFTEENTH CENTURY 368

TILTING ARMOUR OF PHILIP THE FAIR 376

JOANNA “THE MAD,” DAUGHTER OF QUEEN ISABEL 380

los Rios.
CODICIL TO ISABEL’s WILL, WITH HER SIGNATURE 384

FERDINAND OF ARAGON 388

Carved wooden statue from the Cathedral at Malaga.
GRANADA CATHEDRAL, ROYAL CHAPEL, TOMB OF

FERDINAND AND ISABEL 392
BURGOS CATHEDRAL 396

COINS, CATHOLIC KINGS 402



COINS, FERDINAND 408

FAÇADE OF SAN PABLO AT VALLADOLID 420

MAP AT END
ISABEL OF CASTILE
CHAPTER I
CASTILE IN THE FIFTEENTH CENTURY
There are some characters in history, whose reputation for heroism

is beyond reproach in the eyes of the general public. There are
others, however, whose claims to glory are ardently contested by
posterity, and none more than Isabel of Castile, in whose case
ordinary differences of opinion have been fanned by that most
uncompromising of all foes to a fair estimate, religious prejudice.
Thus the Catholic, while deploring the extreme severity of the
methods employed for the suppression of heresy, would yet look on
her championship of the Catholic Faith as her chief claim to the
admiration of mankind. The Protestant on the other hand, while
acknowledging the glories of the Conquest of Granada and the
Discovery of the New World, would weigh them light in the balance
against the fires and tortures of the Inquisition and the ruthless
expulsion of the Jews.
One solution of the problem has been to make the unfortunate
Ferdinand the scapegoat of his Queen’s misdeeds. Whatever tends to
the glory of Spain, in that, if not the originator, she is at least the
partner and moving spirit. When acts of fanaticism hold the field,
they are the result of Ferdinand’s material ambitions or the religious
fervour of her confessors; Isabel’s ordinarily independent and clear-
sighted mind being reduced for the sake of her reputation to a
condition of credulous servility.
Such a view has missed the consistency of real life. It is probably
responsible for the exactly opposite summary of another critic, who
denies Isabel’s superiority to her husband in anything but hypocrisy
and the ability to make her lies more convincing. He even fails to
admit that, this being granted, her capacities in one direction at least
must have been phenomenal, since Ferdinand was the acknowledged
liar of his day par excellence.
Faced by the witness of the Queen’s undoubted popularity, he
sweeps it away with a tribute to Spanish manhood: “The praise
bestowed on the character of Isabel is, to no small amount, due to the
chivalrous character of the Spaniards, who never forgot that the
Queen was a lady.”
Such an assumption must be banished, along with Isabel’s weak-
mindedness on religious matters, to the realms of historical fiction.
The very Castilians who extol her glory and merit do not hesitate to
draw attention in bald terms to her sister-in-law’s frailties. Indeed a
slight perusal of Cervantes’ famous novel, embodying so much of the
habits and outlook of Spain at a slightly later date will show it was
rather the fashion to praise a woman for her beauty than to credit her
with mental or moral qualities of any strength.
The Catholic Queen, like other individuals of either sex, must
stand or fall by the witness of her own actions and speech; and these
seen in the light of contemporary history will only confirm the
tradition of her heroism, which the intervening centuries have
tended to blur. The odium that sometimes attaches to her name is
largely due to the translation of Spanish ideals and conditions of life
in the Middle Ages into the terms that rule the conduct of the
twentieth century.
“Quien dice España dice todo,” says the old proverb,—“He who
says Spain has said everything.”
This arrogance is typical of the self-centred, highly strung race,
that had been bred by eight centuries of war against the Infidel. The
other nations of Western Europe might have their occasional
religious difficulties; but, in the days before Luther and Calvin were
born, none to the same extent as Spain were faced by the problem of
life in daily contact with the unpardonable crime of heresy, in this
case the more insidious that it was often masked by outward
observance of rule and ritual.
The greater part of the modern world would dismiss the matter
with a shrug of its shoulders and the comfortable theory that truth,
being eternal, can take care of itself; but this freedom of outlook was
yet to be won on the battlefields of the Renaissance and in the
religious wars of the sixteenth century. It would be an anachronism
to look for it in Spain at a time when the influence of the new birth of
thought and culture had extended no further than an imitation of
Italian poets.

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Veterinary Arthroscopy for the Small

Animal Practitioner Timothy C.

Timothy C. McCarthy, DVM, PhD

Diplomate, American College of Veterinary Surgeons

Limit of Liability/Disclaimer of Warranty

Library of Congress Cataloging-in-Publication Data

Names: McCarthy, Timothy C., author.

Cover Design: Wiley

Set in 9.5/12.5pt STIXTwoText by SPi Global, Pondicherry, India

1 Introduction and Instrumentation 1

4 Arthroscopy of the Elbow Joint 108

5 Radiocarpal Joint 187

6 Hip Joint 192

7 Stifle Joint 207

8 Tibiotarsal Joint 276

8.5.4 Immune-Mediated Erosive Arthritis 287

9 Problems and Complications 292

­About the Companion Website

This book is accompanied by a companion website:

Introduction and Instrumentation

1.1 ­Introduction advantage of arthroscopy. Most dogs recover to their

Table 1.3 Telescopes used for small animal arthroscopy.

4.0 mm 18 30 64230 BWA

Table 1.4 Telescope sheaths used for small animal arthroscopy.

4.0 mm/18 cm/30° (64 230 BWA) 64124AR 65127BS/BT

­ ifficult to keep in place tending to come out with

Table 1.5 Operating cannulas used for small animal arthroscopy.

Figure 1.8 (continued)

Instruments Part number (Karl Storz)

bicipital tendon transection, anconeal process removal,

An example of damage caused by an inexperienced

Figure 1.11 The Drillcut-X ARTHRO shaver handpiece.

(Figure 1.11) is smaller and lighter with improved ergo-

(a) gravity, pressure cuffs on fluid bags, or with a mechan-

Standard monopolar radio-frequency surgery units

1.2.5 Irrigation Fluid and Management

(Sorbitol, Mannitol, and Dextran 40) showed the least

and care of the tubing is critical for proper pump func-

1.2.6 Video System Tower

Figure 1.20 A video tower that is appropriate for small

Table 1.10 Video system components used for small animal

Video component Part number (Karl Storz)

Figure 1.21 An elaborate endoscopy tower with two

Figure 1.25 A Tele Pack Vet X LED self-contained endoscopy

provide an excellent image. Three chip cameras and

Figure 1.27 A 300-W LED light source. Source: Photo

Figure 1.26 A Xenon Nova 300-W light source. Source:

They are available in 175 and 300-W sizes. Xenon light

patient progress. Additional pain medication is pre-

Patients are most commonly prepared and draped in a

Anesthesia Sterile table

2.3.4 Hip Joint cruciate ligament injury diagnosis is confirmed. Both

Title: Isabel of Castile and the making of the Spanish nation,

Author: Ierne L. Plunket

Release date: October 22, 2023 [eBook #71930]

Original publication: New York: G. P. Putnam's Sons, 1915

Credits: Richard Tonsing, Clarity, and the Online Distributed

*** START OF THE PROJECT GUTENBERG EBOOK ISABEL OF

AFTER A PAINTING IN THE PRADO

FROM “TORQUEMADA AND THE

THE MAKING OF THE SPANISH NATION

The Knickerbocker Press, New York

Balliol College, Oxford,

About the Companion Website

1.1 Introduction advantage of arthroscopy. Most dogs recover to their

ifficult to keep in place tending to come out with