ARTROSCOPY
Rouchal M., Ryba L., Vališ P.,
Nýdrle M., Filipovič M.
Ortopedická klinika
FN Brno-Bohunice
• endoscopic method
– Incisions - PORTS for
• OPTIC (light+camera)
• INSTRUMENTS
• KNEE
• SHOULDER
• ANKLE
• ELBOW
• WRIST
• HIP
• SMALL JOINTS
• RETRO-TENDINOUS SPACE (ACHILLES TENDON)
MONITOR
PC
light source
camera processor
pump
shaver
30 degree optic
ARTHROSCOPIC
INSTRUMENTS
IMPLANTS - anchors
• TOURNIQUET (extremity ischemization,
for bloodless surgery)
– cca 250 Torr (syst. Blood Pres+100)
– maximum 90 min
– knee, ankle
Preparation
surgeon
anesth
UPPER EXTREMITY
SHOULDER
• DEGENERATIVE DISORDERS
• TRAUMA, POSTRAUMATIC
DISORDERS
• INFLAMMATION
• TUMOUR
SURGERY
• ARTHROSCOPY
– RECCURENT DISLOCATION
– DEGENERATIVE AFFECTION OF ROTATOR
CUFF
– SUBACROMIAL PROBLEMS (IMPINGEMENT)
– DEGENERATIVE ARTHRITIS
SURGERY TECHNIQUE
SURGERY TECHNIQUE
SURGERY TECHNIQUE
Treatment of instability - anchors
ANCHORS (TIGHTENING OF JOINT CAPSULE FOR INSTABILITY)
POSTOPERATIVE TREATMENT
Desault orthosis
OPEN SURGERY
• MINIMALLY INVASIVE
– SUTURE OF ROTATOR CUFF
– LATERAL CLAVICULA RESECTION (Stewart)
SURGERY TECHNIQUE
POSTOPERATIVE
TREATMENT
Abduction orthosis
•ARTROSCOPY OF THE WRIST
•WRIST and FINGERS ARTHRODESIS
•LIMITED WRIST ARTHRODESIS
•PARTIAL EXCISION OF CARPUS
•OSTEOTOMY OF DISTAL RADIUS/ULNA
•CARPAL TUNEL DECOMPRESSION
WRIST ARTROSCOPY
•wrist instability
•synovectomy
•TFCC surgery (wrist meniscus)
•navicular pseudoarthrosis
•smaller optics, instruments
•without pump
LOWER EXTREMITY
HIP
• ARTROSCOPY
– posttraumatic disorders
– degenerative arthritis
– coxitis
– DEBRIDEMENT
– LOOSE BODIES REMOVING
– LABRUM SURGERY
– RINSE (LAVAGE)
KNEE
• ARTROSCOPY
– „acute injuries“
– instability
– degenerative arthritis
– gonitis
(surgery of meniscus, plicae,
loose bodies removing,
lateral patellar retinaculum
release, etc.)
Method with graft sec.Brückner
-BTB graft (BONE-TENDON-BONE)
(source – ligamentum patellae)
so called „golden standard“
Treatment of
ACL – Ant. Cruciate Ligament
Instability
CHONDRAL DEFECT
• MOSAICPLASTY
• AUTOLOGOUS
CHONDROCYTES
TRANSPLANTATION
MOSAICPLASTY
(Puzzle technique)
Mosaicplasty
AUTOLOGOUS
CHONDROCYTES
TRANSPLANTION
• 2 SURGERIES
– arthroscopic chondral sample taking
– chondrocytes cultivation on bone bank for
4-8 weeks
– open implant of cartilaginous tissue graft
(using fibrin glue)
CHONDROCYTES
transplantation
ADVANTAGE
„ultimate“ chondral defects healing
DISADVANTAGE
2 surgeries
price
ANKLE
• ARTHROSCOPY
– injury
– degenerative arthritis
– chondral defects
• mosaicplasty
• Chondrograft –
chondrocytes
transplantation
5.4.2016V.R.
5.4.2016
Surgery – defect filling with chondrograft
Medial malleolus osteotomy
5.4.2016
Surgery – defect filling with chondrograft
5.4.2016
Surgery – defect filling with chondrograft
5.4.2016V.R.
Surgery – defect filling with chondrograft
5.4.2016
Surgery – screw fixation of osteotomy