PubMed · 17221175
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A Ewert, T Mittlmeier. 2007. [Techniques for wrist arthroscopy].. https://doi.org/10.1007/s00113-006-1220-4
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After considering the anatomy of the wrist, the technical requirements for wrist arthroscopy are discussed. This method is used as an additional diagnostic procedure and staging procedure as well as a therapeutic technique. Complications, which are rare, most commonly involve nerve irritation, damage to cutaneous nerves and extensor tendons. Lose bodies can be removed arthroscopically, however, arthroscopically assisted fracture treatment or the removal of ganglions are uncommon. Approaches are lateral and oriented on the extensor tendons or other anatomical landmarks. Arthroscopy is especially useful by carpal instability as it offers many possibilities, not only diagnostically but also therapeutically.
THE PROBLEM: Irreversible cartilaginous damage to the femur and tibia due to resection and suture instruments in arthroscopic surgery at the posterior horn of the medial meniscus in narrow knee joints or in the presence of contracted medial capsuloligamentous structures. THE SOLUTION: Enlargement of the medial joint space by repeated percutaneous perforation of the posteromedial capsuloligamentous structures under consistently applied valgus stress. SURGICAL TECHNIQUE: With the knee joint almost in full extension and with simultaneous, uniformly applied valgus stress, repeated percutaneous perforation of the posteromedial capsuloligamentous structures with a sharp-tipped cannula until perceptible enlargement of the medial joint compartment is achieved. POSTOPERATIVE MANAGEMENT AND RESULT: Uneventful healing of the posteromedial capsuloligamentous structures without the need for any special postoperative treatments.
Arthroscopy of the hip joint can be performed in the supine or lateral position. The decision whether to use the supine or lateral position appears to be more a matter of individual training or habit. Both positions have specific pros and cons. The operative experience with arthroscopy of the central and peripheral compartment shows that a combined procedure with and without traction is beneficial. Whereas arthroscopy of the central compartment in normal joints of adults is feasible only with traction, the peripheral compartment can be better scoped without traction. The combination of both techniques however is technically demanding. Particularly for arthroscopy of the central compartment with traction, the success of the operative procedure is strongly correlated with a correct technique of positioning and distraction. Precise positioning and thick padding of the counterpost, secure fixation and thick padding of the foot, and the limitation of magnitude and duration of traction are important features in order to avoid soft tissue and nerve damage. Good relaxation, joint position, and distension of the joint to break the joint vacuum significantly improve distraction of the femoral head from the socket. In combination with fluoroscopy, scope trauma to the acetabular labrum and hyaline cartilage can be minimized. For arthroscopy of the peripheral compartment without traction, the counterpost is removed and the foot taken out of the traction module for free range of motion of the leg and hip joint. This allows dynamic testing of the hip and access to different parts of the peripheral labrum, proximal femur, and soft tissues.