Iatrogenic cartilage injury associated with the use of stainless-steel cannulas and silicone-guarded cannulas for canine stifle arthroscopy

Proximal lateral insertion portal of an intra-articular arthroscopic stifle lever: A cadaveric study

OBJECTIVE

To (1) Describe the proximal lateral insertion portal for the placement of an intra-articular distraction lever. (2) Assess for associated damage with the insertion of the lever and (3) evaluate the impact of duration of lever use on articular cartilage damage.

STUDY DESIGN

Ex vivo canine cadaveric experimental study.

ANIMALS

Paired canine stifles from seven cadavers (14 stifles from dogs weighing >20 kg).

METHODS

A separate 0.5 cm proximal lateral portal was established adjacent to the lateral scope portal. A standard Ventura stifle thrust lever (VSTL) was inserted without removing the arthroscope. In Group A, the VSTL was placed in distraction for 5 min while in Group B the VSTL was placed for 10 min. The stifle joints were disarticulated and evaluated for associated damage to the long digital extensor tendon and iatrogenic articular cartilage injury (IACI) via India ink assay.

RESULTS

No damage to the long digital extensor tendon was noted in any of the specimens during dissection. Superficial IACI was present in all specimens. There were no differences between groups when assessing for overall IACI.

CONCLUSION

A proximal lateral portal and insertion of a standard VSTL can be performed without removing the arthroscope.

CLINICAL SIGNIFICANCE

The use of a proximal lateral lever portal without repositioning the arthroscope was repeatable without damaging the long digital extensor tendon. A duration of up to 10 min in which the thrust lever was engaged did not result in increased visual cartilage damage.

Evaluation of Canine Shoulder Arthroscopy for Anatomical and Safety Considerations

INTRODUCTION

 Arthroscopy is a well-established diagnostic modality for various orthopaedic conditions in veterinary medicine. The aim of this study was to describe the relationship of canine shoulder arthroscopy portals to major muscular, ligamentous, and neurovascular structures for anatomical and safety considerations.

MATERIALS AND METHODS

 Arthroscopic exploration of 20 adult canine cadaver shoulders was performed. Each shoulder region was dissected layer by layer to the level of the joint. Musculotendinous, ligamentous, and cartilaginous lesions were documented. The distance was measured from each portal to neurovascular structures encountered.

RESULTS

 Muscular lesions included the deltoideus, cleidobrachialis, omotransversarius, supraspinatus, infraspinatus, and teres minor muscles. The neurovascular structures identified were the omobrachial vein, the caudal circumflex humeral artery, axillobrachial vein, and branches of the axillary nerve. Lesions to the lateral glenohumeral ligament were noted from the caudal instrument portal and the middle arthroscope portal. Iatrogenic articular cartilage injuries were identified on the caudal humeral head and the glenoid.

CONCLUSION

 This study supports the safety of lateral shoulder arthroscopy in dogs. Most local neurovascular structures are unaffected with traditional scope portal positions. Musculotendinous lesions are unavoidable due to the extensive muscling surrounding the shoulder but are unlikely to cause severe complications postoperatively.

Caudal pole meniscectomy through an arthroscopic caudomedial portal in dogs: A cadaveric study

OBJECTIVE

To describe a caudomedial instrumental portal for caudal pole meniscectomy (CPM).

STUDY DESIGN

Experimental ex-vivo study.

SAMPLE POPULATION

Ten cadaveric hindlimbs of 10 large breed dogs.

METHODS

Each hindlimb was used for establishing the caudomedial portal for CPM. The surgical time was recorded. Specimens were disarticulated afterwards, and the completeness of CPM was documented. Iatrogenic injuries to the articular cartilage and the intra- and periarticular structures were assessed.

RESULTS

The extent of the CPM (mean ± SD, percentage of the resected medial meniscus) was 29.8 ± 12.9% of the area of the medial meniscus. There were no injuries to the medial collateral ligament or caudal cruciate ligament. The mean iatrogenic articular cartilage injury (IACI) was 3.71 ± 1.78% of the area of the medial meniscus.

CONCLUSION

The establishment of a caudomedial portal for CPM in canine cadavers was feasible and allowed to perform a partial caudal pole meniscectomy.

CLINICAL SIGNIFICANCE

A caudomedial portal may be considered for CPM in selected cases when caudal tears cannot be accessed through the standard portals.

Feasibility of feline coxofemoral arthroscopy using a supratrochanteric lateral portal: A cadaveric study

OBJECTIVE

To evaluate the feasibility of feline diagnostic coxofemoral arthroscopy.

STUDY DESIGN

Ex vivo feline cadaveric descriptive study.

ANIMALS

Seven feline cadavers (14 hips).

METHODS

Gross dissection of two feline hips was performed to evaluate anatomic landmarks, guide arthroscopic portal development, and determine optimal limb positioning. A 1.9 mm, 0° arthroscope, inserted through a supratrochanteric lateral portal, was used to assess intraarticular structures in 12 feline cadaver hips. Arthroscopy was followed by gross dissection of periarticular soft tissues. Relative portal locations and damage to periarticular structures were recorded. Hips were disarticulated, and an India ink assay was performed to assess whether there was iatrogenic cartilage injury (ICI).

RESULTS

Scope insertion was achieved in all hips. Articular cartilage of the femoral head and acetabulum, round ligament, joint capsule, transverse acetabular ligament, and dorsal acetabular rim were identified arthroscopically in all hips. Probe insertion and intra-articular structure palpation was achieved in all hips. Scope and instrument portals resulted in minimal periarticular muscle trauma. No sciatic nerve damage was detected. Minor partial thickness ICI was observed in all hips at the site of scope insertion. Focal full thickness ICI was noted in one hip.

CONCLUSION

Arthroscopy of the feline coxofemoral joint allowed visual and probe evaluation of intra-articular structures without evidence of major periarticular neurovascular trauma. Iatrogenic cartilage injury occurred in all hips but severity of lesions was considered mild.

CLINICAL SIGNIFICANCE

Coxofemoral arthroscopy is feasible in cats and can be utilized as a diagnostic tool for minimally invasive joint evaluation.