If you’re new here, I like to talk about hardware and implants on Fridays. Previous editions have included interesting reduction clamps, OR tables, screw biomechanics, THA revision acetabular constructs, and more.
What I learned today
Today I wanted to cover elbow arthroscopy. But it’s a pretty broad topic. The catalog for Arthrex’s sh-elbow arthroscopy stuff is literally 100 pages long.
So let’s focus on categories of arthroscopy equipment.
By the way, here are some great intro articles for elbow arthroscopy by one of my mentors. Be sure to check out the actual videos linked in Supplementary Data.
Part 2: Positioning and Diagnostic Arthroscopy in the Supine Position
Part 3: Positioning and Diagnostic Arthroscopy in the Lateral Decubitus Position
Now on to the fun stuff.
Scopes
Standard for elbow arthroscopy is a 4.0 mm, 30° arthroscope. This refers to the outer diameter and the direction of view. Other options include 70°, or 2.7 mm and 1.9 mm.
Cannulas
Many flavors and designs of cannulas exist. Essentially, these are the metal or plastic tubes that allow you to maintain a portal. The camera or instruments are passed in and out of the cannulas.
Trocars and obturators
What’s the difference between a trocar and an obturator?
An obturator is a rod-like device, usually with a head/cap. You can have blunt tip obturators or trocar (sharp) tip obturators.
Sometimes “trochar” is used for a trochar (sharp) tip obturator combined (within) a cannula. Sometimes it’s just the sharp obturator alone. And sometimes you see “blunt trochars.” IDK.
Drills, reamers, burrs, shavers
You’ve probably seen these. If not, the names are pretty self-explanatory.
Punches/taps
This name is also very self-explanatory. However, I thought a picture was worth including because we don’t often use these during open procedures (do we?). In arthroscopy, punches and taps are used for prepping the bone before suture anchor placement.
Spears
As shown in (b) in the figure above, these have a removable “trocar” (Arthrex’s words, not mine) and a V-shaped tip. They facilitate suture anchor placement.
Guides
Similarly, these try to guide you to the correct suture anchor position. And I quote, “All offset guides enable surgeons to easily reproduce a 1.5 mm medial offset position relative to the glenoid rim to complete an anatomic reconstruction of the labral tissue.”
On cannulated guides (page 25): “Cannulated guides are designed for inserting anchors during open or arthroscopic Bankart repairs. These guides have a larger wall thickness than the spears, resulting in a very strong instrument with a larger dovetail tip.”
Instruments
Suture passers help to advance the suture past a structure, while suture retrievers allow you to grab the suture on the other side.
Suture passers can be identified by the various angles of the tips, as well as whether they are curved vs straight. Some have a simple loop at the end where you place the suture.
Others will fire the suture through tissue and retrieve it on the other side.
The suture retriever, grasper, and cutter all look like what you would expect, so I'm not going to include images here. You’ll know it when you see it.
Similarly, the knot pusher is easily identifiable. You thread the suture into it and push to tighten the knot down. Probes, curettes, rasps, osteotomes, etc. are also just mini versions of what you use in open procedures.
Suture
I feel a little bit weird being an Arthrex saleswoman and listing all of the suture options. Please see page 27 of the catalog where the suture section begins. It covers all the brand name options such as TigerWire®, FiberTape®, LabralTape™, and so on and so forth.
Suture anchors
LOTS of suture anchor variety out there. Knotted/knot-tying (a.k.a. you tie the knot) or knotless. Biocomposite (β-TCP and PLLA), PEEK, titanium, or Bio materials.
Um yeah, I don’t know if that was helpful. Maybe it was simultaneously too long and too general. Whatever. Sunday is a new day to try again :)
Sources
Arthrex Shoulder and Elbow Next Generation in Repair and Reconstruction | 2020 catalog
Camp CL, Degen RM, Dines JS, Sanchez-Sotelo J, Altchek DW. Basics of Elbow Arthroscopy Part II: Positioning and Diagnostic Arthroscopy in the Supine Position. Arthrosc Tech. 2016 Nov 28;5(6):e1345-e1349. doi: 10.1016/j.eats.2016.08.020. PMID: 28560135; PMCID: PMC5439242.
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