ARTHROSCOPY INSTRUMENTS-

CARE,HANDLING & STERILIZATION

Dr.SHEKHAR SRIVASTAV
Knee & Shoulder Arthroscopy
Delhi Institute of Trauma And Orthopedics
SANT PARMANAND HOSPITAL,DELHI
BASIC ARTHROSCOPY SET-UP

Dr.SHEKHAR SRIVASTAV
Knee & Shoulder Arthroscopy
Delhi Institute of Trauma And Orthopedics
SANT PARMANAND HOSPITAL,DELHI
 SCORECARD
ENDOSCOPIC OPEN

Small incision x
Less pain x
Less morbidity x
Accuracy x
Early function x
Cosmesis x
 ARTHROSCOPY KNEE
One of the Commonest
surgery
Treatment
Ligamentous and soft
tissue injury of knee
> precise and accurate
than open method
Less morbidity and early
rehab
 Arthroscopic System
Arthroscope
Light source &
Light Cable
Camera system
Video recorder
Monitor
Arthroscopic
Instruments
Arthroscopic Surgical Instruments
Mechanical Instruments- Probes, Punches,
Grasping forceps
Motorised Instruments- Shavers
Electrosurgical Instruments- Electrocautery,
Radiofrequency, Laser
Special Instruments- ACL sets, PCL sets,
Meniscus repair sets, OATS
 Arthroscope
Optical Instrument
-Eye piece
-Attachment for light cable
-Series of lenses
-Optical fibers for transmitting light into joints
 Arthroscope
Optical properties-
Diameter of scope
1.9mm , 2.7mm- wrist
& elbow
4 mm most common-
knee shoulder
Angle of Inclination
Field of view
 Arthroscope
Angle of Inclination- increases field of vision
300 scope 700 scope
 Arthroscope sheath with blunt
Obturation
Always blunt obturator.
Never sharp
Sheath 3 parts
Coupler secure and rapid
fixation
Spigot plane Rotating
Sheath barrel
Smooth transition from
obturator to sheath
Smooth transition from
scope to sheath
 Care & Handling
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 by shaver or
other electronic surgical
devices
Inspect for any scratch,
dents or irregularity
 Aging
Manifested by a hazy, murky image
More an arthroscope is used faster it ages
Accelerated by flash sterilizations
Direct Damage of Scope Tip- By
mechanical or motorized instruments
Laser beam accidentally directed towards
scope
 Light Source & Fibreoptic Cable
300-350 watts reqd.
Tungsten,Halogen & Xenon Source
Life- hrs
Should not be activated till scope is inserted
into the sheath
Light Source & Fiberoptic Cable
Fiberoptic Cables-bundled optical glass
fibers
Fragile,handle Carefully
One end connected to light source and
another to Ascope
Length of cable imp
Fiber breakage due to bending stresses
Loss of light transmission
Sterilisation- autoclavable/gluteraldehyde
Camera System
Advantages
Comfortable position
for surgeon
Avoidance of
contamination
Participation of rest of
the team
Camera System
-camera- 1 chip/3 chip
-camera cable
-control unit
Camera system

Steam autoclaving
can damage camera
casings and seal
Enclose the camera
in sterile, disposable,
clear plastic sleeve
Sterilised Cidex or
Steris solution
 Video Recorder & Monitor
Monitor-
-At least 20 inches
-Placed at cart at
surgeons eye level

Video recorder-
documentation
 Image Quality
All structures should be uniformly
illuminated from center to periphery
Scope should have satisfactory resolution
Dull & Hazy image
- Check scope for scratches, damages
- Check light Cable
- Check light source
 Instruments

Basket forceps /
punches
Grasping forceps
Arthroscopic scissors
Probes
Knives
 Probes
Extension of Ascopist
fingers
Right angled and tip size 3-
4mm
Marking at 5mm
Used to
-Palpate intraarticular
structures
-Determine depth
-To maneuver intraarticular
structures
 Basket forceps(Punches)
Workhorse of arthroscopic
surgeries
Open base where the cut
tissue is dropped which
can be removed later
No need to remove from
joint with each bite
Shaft- straight/curved
Jaws- straight/angled
Also as 150 up & down
biting
 Basket forceps(Punches)
Various Jaw Configuration
-Wide angled- rapid & efficient
cutting
-Narrow or scissor punches
Used for-
-Division of tissue bridges
-R/O deg. Meniscal tissue
-Division of scar tissue
-Detachment of loose
cartilage flap
-Piecemeal removal of soft
tissue bodies
Carefully used in tight joints
as may cause cartilage
scuffing
 Grasping Forceps

Straight or angled
Used for removal of-
-Meniscal fragments
-Loose bodies
-Cartilage flaps
-Osteophytes (partially
detached)
-Retrieving synovial biopsy
Arthroscopic Scissors & Knives
Used in earlier days
Not used now because of high rate of
implant breakage within joint
Chondral Damage
Motorised Instruments ( Shavers)
Control unit
Connecting cable
between handpiece and
control unit
Handpiece
Blades
Suction
Motorised Instruments
( Shavers)
Outer hollow sheath & inner
cutting rotating cannula
Tip Dia- 3-5.5 mm
Sucks tissue inside outer
sheath for cutting
RPM
cutting soft tissues- 1200-2000
as burr - 2000-4000
Handpiece Autoclavable
Shaver blades- Disposable
 Electrosurgical, Laser & RF
Electrocautery- Hemostasis
Lateral retinacular release
Laser- YAG laser, Excimer Laser
Delievers high energy with precision
Uses- Meniscus tear, Articular cartilage
Drawbacks-Expensive , Osteonecrosis
Radiofrequency
Uses- Menisectomy, Coagulation, Capsular
shrinkage
Drawbacks- Articular cartilage damage,
Osteonecrosis
 Basic Arthroscopic Kit
Arthroscope
Light source & cables
Camera system & Moniter
Arthroscopic probe
Arthroscopic Grasper
Arthroscopic Punches (Basket Forceps)-
2.7 & 3.4 mm upcutting, Rt. & Lt. Rotary
Motorized Shaver
Cleaning ,Disinfection & Sterilizability
Remove gross soiling,blood & organic matter
after surgery. Clean the instruments with
sterile water (not saline)
Manual cleaning in enzymatic soak solution
Ultrasonic cleaners- Fine cleaning(hollow &
tubular instrument)
Wiped & dried with clean dry sponge before
storage
Care of the personnel handling instruments-
aerosolization, splashing of infectious material,
injury from sharp objects
Cleaning ,Disinfection & Sterilizability
Instruments should be
properly arranged in
trays
Sharp instrument tips
should be covered
with caps
Instruments with
moving parts should
be lubricated after
cleaning with water
soluble lubricant
Cleaning ,Disinfection & Sterilizability
Ethylene oxide gas- good disinfectant
Mechanical Instruments( probes, punches,
graspers), Shaver handpiece - Steam
Autoclave
Arthroscope, Light cable Cidex,
Steris(Paracetic acid solution) 30 min
Diagnostic Arthroscopy
Supra-patellar pouch
Patellar Articular Surface
Medial Gutter
Medial Compartment- Meniscus
Articular cartilage
Intercondylar Notch- ACL
PCL
Lateral Compartment- Meniscus
Articular Cartilage
Lateral Gutter
Diagnostic Arthroscopy
THANK YOU