Instrument breakage as a complication of elbow arthroscopy in a dog

Review of minimally invasive surgical procedures for assessment and treatment of medial coronoid process disease

OBJECTIVE

To summarize the current peer-reviewed publications on minimally invasive surgery (MIS) for medial coronoid process disease (MCPD) in dogs.

STUDY DESIGN

Invited review.

METHODS

Pubmed, CAB Abstracts and Scopus databases were utilized for literature review (1990-2023).

RESULTS

More than 60 papers have been published that involve MIS evaluation or treatment of MCPD. Six prospective trials incorporated quantitative gait analysis evaluating outcome following MCPD debridement, of which three included a control group. Whilst case numbers were limited, all studies employing a control group failed to demonstrate superiority of surgery over nonsurgical management. Of three studies employing gait analysis and no control group, all documented some improvement in function compared to pretreatment lameness. Multiple studies document progression of osteoarthritis in dogs following MCPD debridement although this may not be synonymous with worsened function. Subtotal coronoid osteotomy (SCO) is described as an alternative to MCP fragment removal, although the long-term biomechanical consequences are currently unclear and quantitative data on the efficacy of this treatment in isolation for MCPD is awaited.

CONCLUSION

Arthroscopy of the canine elbow joint is a safe means by which to evaluate MCP pathology. Quantitative longitudinal analysis of outcome following minimally invasive surgery for MCPD is required. Correlation with clearly defined subclassification inclusion criteria such as age, incongruity and the precise arthroscopic findings in each case are required to more accurately differentiate any superiority of surgery over nonsurgical management for this disease.

Combined Fluoroscopic and Arthroscopic Detection and Removal of a Foreign Body Lost During Elective Shoulder Arthroscopy: A Case Report

Introduction:

We report a case of a lost metal platelet from a radiofrequency ablation probe (VAPR VUE Radiofrequency System, Cool Pulse 90, DePuy, Synthes, Switzerland) in the shoulder joint during elective arthroscopic cuff repair. To the best of our knowledge, this kind of an incident during elective arthroscopy has not been described in the literature so far. In addition, we present an algorithm on how to deal with such an incident.

Case Report:

A 69-year-old woman underwent an arthroscopic subacromial decompression and rotator cuff repair for a torn supraspinatus tendon. While performing the subacromial decompression and after swapping the portals from lateral to posterior, the metal platelet of the electrocautery device got detached from the instrument and lost in the operation field. Several attempts to visualize the lost platelet with the camera failed. Finally, intraoperative fluoroscopic imaging was used to detect the platelet. To confirm the definitive whereabouts of the platelet, two spinal needles were positioned perpendicular to another under x-ray control, both pointing at the missing platelet. After determining the exact location, the platelet could finally be visualized with the camera and removed. Due to this incident, the operation time was extended extensively, and the patient as well as the theatre team was exposed to an unnecessary amount of radiation.

Conclusion:

This report indicates that an extraordinary incident such as the detachment of a component of the arthroscopic equipment during surgery is possible and should be kept in mind by the surgeon. Therefore, we believe that it is essential to perform a test of integrity at least at the end of every operation. In addition, we are presenting an algorithm on how to deal with the situation of a lost foreign body during arthroscopy, which can be applied to any joint.