The Use Of Arthroscopes For Arthroscopy

The miniaturization of the arthroscope has simplified its operation to outpatient and local anesthesia, but we still use the common knee arthroscope and perform it in the operating room. The procedure is outlined below.
Under continuous epidural anesthesia, the affected limb was placed on the operating table, the epidural puncture needle was used to perform joint puncture on the suprapatellar capsule, the exudate was extracted, and normal saline was injected into the joint to expand the joint cavity (the suspension height of the salt bottle was generally about 1m higher than the knee joint). Puncture points were selected at the center of the triangle formed by the lateral margin of patellar tendon, anterior border of lateral femoral malleolus, and superior border of tibia. First, a small incision of about 0.5cm was made in the skin, and then a trocar matching the diameter of the arthroscope was used for puncture. The sharp occlusive device was removed and replaced with a blunt occlusive device. The arthroscope was inserted into the joint cavity, and the order of observation was as follows: Plicae suprapilipatella - patellofemoral joint - medial recess (medial inner wall, medial patellofemoral synovial fold, recess surface of medial malleolus) - medial tibiofemoral joint (medial meniscus, below anterior femoral malleolus of femur, and opposite articular surface of tibialis) - to suprapilipatella bursae - lateral tibiofemoral joint (lateral meniscus, below anterior femoral malleolus of femur, and opposite articular surface of tibialis) - lateral recess (lateral inner wall, femoral The recess surface of the lateral condyle of the bone, muscle strength). This can be photographed. Finally, a biopsy can be performed to wash the full liquid in the back, pull out the trocar, and close the skin incision. There are different views on whether hemostatic belt should be used in arthroscopy. The authors believe that it is better to not use tourniquet at the beginning of arthroscopy, so that the internal tissue structure of the joint can maintain a normal appearance, and it is easy to identify normal or abnormal tissue. An hour or so of arthroscopic surgery (including clear membrane biopsy) is sufficient for diagnosis. If the therapeutic procedure is to continue, a tourniquet should be applied.
Synovial pathology is an important step in the diagnosis of joint disease. Synovial biopsy is usually performed at the same time after the arthroscopic examination. There are three methods for synovial biopsy: ① Blind examination: that is, after the arthroscopy is completed, the mirror is withdrawn from the cannula, the biopsy forceps are inserted, and the head of the biopsy forceps is felt through the skin with the other hand, and the biopsy is performed. ② If special lesions have been seen under the microscope, the original lens can be withdrawn from the cannula and replaced with a small arthroscope with biopsy forceps to perform surgery under direct vision. ③ If the surgeon wants to keep the observed lesion in the visual field, a biopsy can be performed through the second puncture port.