Basic Arthroscopic

Instruments
IOSSMA Pre Fellowship Course
Ferdiansis MD
 Arthroscopic System
Arthroscope (the Scope)

Light source + Cable

Camera system

Video recorder console

Monitor

Arthroscopic instruments

Irrigation systems

Implants
 The Scope
Optical instruments
Eye piece, light attachment, lenses, optical fibers

Types
Diameter : 1.9mm, 2.7mm, 4mm
Angle of inclination : 30deg, 45deg, 70deg

Obturator + Sheath
To introduce and penetrate the scope to the joint
Coupler, spigot, sheath
 The Scope
Important
Should always be inserted into the joint
through sheath
Sudden movement should be avoided as it
may cause cartilage scuffing
Care taken to avoid damage ny shaver or
electronics
Inspect for any scratch dents or irregularity
The Scope
 Light source & cables
300 -350 watts required

Tungsten, Halogen, or Xenon

Have life hours

Should not be activated till scope is inserted into the

sheath

Fiberoptics : fragiles, no bend stress/flipped

 Light source & cables
300 -350 watts required

Tungsten, Halogen, or Xenon

Have life hours

Should not be activated till scope is inserted into the

sheath

Fiberoptics : fragiles, no bend stress/flipped

Light source & cables
 Camera System
Advantages
Comfortable position
Avoidance of contamination
Easy to see by everyone

Components
Camera, camera cable, control unit/console

Important
Steam autoclave can damage camera casings and seals
Enclose the camera in sterile disposable clear plastic sleeve
Sterilized by cidex or steris solution
Camera System
Monitor & Video recorder
Placed in a cart/ tower at surgeons eye level

Can record a video or take a picture (snapshot)

Monitor & Video recorder
 Artrhoscopic Instruments
Mechanical instruments
Probes, Punches, Forceps, etc.

Motorized instruments
Shavers

Electrosurgical instruments
Radiofrequency, ablators, electrocauters

Special instruments
ACL sets, PCL sets, Meniscus sets, etc
 Mechanical Instruments
Basket forceps/punches

Grasping forceps

Scissors

Probes

Knife

Canules
 Mechanical Instruments
Probes :
Extension of surgeons fingers
Right angled and tip size : 3-4mm
Marking at 5mm
To palpate intra articular structures
To determine depth
To maneuver intra articular structures
Mechanical Instruments
 Mechanical Instruments
Punches / Basket forceps
Workhorse
Open base where the cut tissue is dropped which can
be removed later
No need to remove from joint with each bite
Type :
Shaft straight/ curved
Jaws straight/ curved
15deg up/ down biting
Wide angled
Narrow angled (scissor punches)
Mechanical Instruments
 Mechanical Instruments
Grasping forceps
Extension of surgeons pinch
To remove or grasp
Meniscal fragments, loose bodies, cartilage flaps,
osteophytes, tissue biopsies

Type :
Straight
Angled
Mechanical Instruments
 Mechanical Instruments
Scissors & knives
Rarely used nowadays due to high rate of implant
breakage within joint
Can damage nearby structures due to sharp edges
Mechanical Instruments
 Motorized Instruments
Components
Control unit/console
Connecting cable
Handpiece
Blades
Suction

• Outer hollow sheath and inner cutting rotating canula

• Tip diameter : 3-5mm

• RPM : 1200 – 2000 (shave), 2000 – 4000 (burr)

• Handpiece are autoclavable

• Shaver blades disposable

Motorized Instruments
Electrosurgial Instruments
Electrocautery
As a haemostasis and adhesion release

Laser
YAG – Excimer laser
Expensive, risk osteonecrosis

Radiofrequency
Coagulation, capsular shrinkage, menisectomy
Articular cartilage damage, osteonecrosis
Electrosurgial Instruments
 Irrigation systems
Function : Irrigation and distension

Components : Inflow, Outflow, Suction

Continuous irrigation

Optimal pressure :
Knee : 60-80mmhg
Shoulder : 30mmHg below systolic BP
Elbow & Ankle : 40 – 60 mmHg

Pressure elevation : 1 foot elevation = 22mmHg

Outflow site should be closed during suction

Irrigation systems
 Implants
Suture anchors
Meniscal repair devices
Tendon / ligament fixation (button,
interference screws, etc)
Suture materials
Grafts
Articular cartilage repair (augmentation,
scaffolds, etc)
Implants
 Handle with care
Remove gross soiling, blood & organic matter

Clean with sterile water (not saline)

Manual cleaning in enzymatic soak solution

Fine cleaning with ultrasonic cleaners (hollow &

Tubular)

Wiped & dried with clean dry sponge before storage

Care of the personal handling

Instruments should be properly arranged in trays

 Handle with care
Sharp instruments tips should be covered with caps

Instruments with moving parts should be lubricated

after cleaning with water soluble lubricant

Ethylene oxide gas – good disinfectant

Mechanical instruments : steam autoclave

Scope, cables, tubes : cidex (acitvated gluteraldehyde)

/ Steris solution
 Reference
Ao Yingfang, editors. Operative arthroscopy of knee, Beijing:Peking
university medical press;2004.

McGinty, John B, Stephen S. Burkhart. Operative arthroscopy.

NY:LWW;2003.

Singh S, Tavakkolizadeh A, Arya A. Arthroscopic powered instruments:

a review of shavers and burrs. Orthopaedics and Trauma,
2009;23(5):357-361.

Tingstad EM, Spindler KP. Basic arthroscopic instruments. Oper Techn

Sport Med, 2004;12(3):200-3.

Zhihua C, Wang C, Jiang W, et al: Review on surgical instruments of

knee arthroscopic debridemant and total hip arthroplasty. Procedia CRIP
65. 2017 p291 – p298
Thank you