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

Abstract

Objective To determine the ability to reduce iatrogenic cartilage injury (IACI) during canine stifle arthroscopy by using a silicone arthroscope cannula guard. Study design Ex vivo canine cadaver experimental study. Animals Paired canine stifles from 14 cadavers (≥20 kg). Methods Stifles (N = 28) were assigned to unguarded traditional or silicone‐guarded arthroscopy. Stifle arthroscopy and full joint exploration with meniscal probing was performed by a second‐year surgery resident (I.C.) in fourteen canine cadavers, alternating between left and right stifles for guarded vs unguarded arthroscopy. After arthroscopy, stifles were disarticulated, and india ink assay was performed to identify IACI. Total IACI number, lesion length and area, duration of procedure, and procedure difficulty score were recorded for each stifle. Results Unguarded arthroscopy resulted in more total IACI per joint (unguarded 5.2 ± 3.0, guarded 2.4 ± 1.4; P = .02), larger IACI area (unguarded 5.2 ± 4.2 mm2, guarded 2.3 ± 1.5 mm2; P = .02), and IACI length (unguarded 13.6 ± 6.9 mm, guarded 8.6 ± 5.9 mm; P = .03). No difference was identified in duration of procedure (unguarded 11.8 ± 5.2 minutes, guarded 13.8 ± 4.3 minutes; P = .79) or procedure difficulty score (unguarded 1.7 ± 0.6, guarded 1.6 ± 0.6 P = .73). Conclusion Silicone‐guarded arthroscope cannulas decreased IACI number and size during canine cadaveric stifle arthroscopy without increasing duration of procedure or surgical difficulty. Clinical significance Silicone‐guarded arthroscope cannulas may be safer than traditional cannulas for novice veterinary surgeons performing stifle arthroscopy.

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

“…In this study, ICI occurred in all hips but the severity of lesions was considered minor in most hips. This is similar to reported ICI postarthroscopy in other joints in dogs 8,26 . Previous studies evaluating canine stifle articular cartilage ICI post arthroscopy reported a 93% incidence mostly consisting of partial thickness lesions 8,26 .…”

“…This is similar to reported ICI postarthroscopy in other joints in dogs. 8,26 Previous studies evaluating canine stifle articular cartilage ICI post arthroscopy reported a 93% incidence mostly consisting of partial thickness lesions. 8,26 Arthroscopic ICI lesions can be created during portal establishment, by arthroscope cannula insertion or manipulation, by the egress needle, or while inserting or manipulating hand instruments inside the joint.…”

“…8,26 Previous studies evaluating canine stifle articular cartilage ICI post arthroscopy reported a 93% incidence mostly consisting of partial thickness lesions. 8,26 Arthroscopic ICI lesions can be created during portal establishment, by arthroscope cannula insertion or manipulation, by the egress needle, or while inserting or manipulating hand instruments inside the joint. In the present study, the majority of ICI lesions were located at the middle region of the femoral head in the area of arthroscope cannula insertion and manipulation.…”

“…After gross dissection of the periarticular region, all hips were disarticulated, and an India-ink assay was performed to assess for femoral head and acetabular ICI (Figure 6). 8,26,27 The femoral head and acetabulum were divided into cranial, middle, and caudal regions for the purposes of localizing ICI. Cartilage lesions were categorized by severity and location.…”

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

“…22 Because of the extremely limited healing capacity of articular cartilage, 23,24 further studies to investigate methods to limit IACI are still warranted. 25 The current study had several limitations, including the use of cadavers, because the freeze-thaw cycle and post-mortem changes negatively affect the integrity of the articular cartilage, making IACI more likely in cadavers than in live patients. 6 On the other hand, many dogs undergoing arthroscopic surgery have some degree of intra-articular osteoarthritic cartilage, which would therefore be predisposed to injury because of softening.…”