Comparison of iatrogenic articular cartilage injury in canine stifle arthroscopy versus medial parapatellar mini‐arthrotomy in a cadaveric model

Abstract

Incidence, number, and area of IACI were greater in the arthroscopy group versus the mini-arthrotomy group. Mini-arthrotomy resulted in a longer incision and incomplete joint visualization. Methods of preventing IACI and clinical significance of IACI warrant further investigation.

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

“…In a clinical case, adding a guard may add a few minutes to the duration of anesthesia. The incidence of IACI in the unguarded arthroscopy (93%) in the current study was similar with that reportedin previous studies . Placing a silicone guard over the arthroscopy cannula reduced the incidence of IACI to 79%.…”

“…Iatrogenic cartilage injury is the most frequently underrecognized complication in human arthroscopy . The sensitivity to detect IACI by a surgeon without india ink staining is 30% in veterinary species . Although studies have provided evidence that IACI may have minimal short‐term consequences, the long‐term implications remain unknown .…”

“…The obturator and cannula caused linear to curvilinear IACI located in the intercondylar region, possibly during placement, evaluation of the cranial joint, or intercondylar notch; along the cranial aspects of the condyles during meniscus evaluation; and along the trochlear ridges or femoral groove during transition from medial/lateral joint compartment to the femoropatellar region. The small gap between the arthroscope and the internal aspect of the cannula can lead to IACI by allowing laceration of cartilage, especially during advancement or lateral movement over cartilage surfaces . A new design for arthroscopy cannulas with tapered ends is now available; this eliminates the space between the arthroscope and the cannula, which may reduce a potential source for IACI.…”

“…Reports of human studies have described the frequency of iatrogenic tissue damage during arthroscopy and reported a surgeon detection rate of iatrogenic damage, including IACI, of up to 31% during clinical cases . The results of a previous veterinary study provided evidence of abysmal sensitivity (30%) for detecting IACI in canine arthroscopy . Placement of the guarded cannula was subjectively more difficult because feedback from penetrating the joint capsule was diminished compared with unguarded cannula.…”

“…A complication of canine stifle arthroscopy is iatrogenic articular cartilage injury (IACI). Previous studies identified IACI as the most common complication of arthroscopy in live animals and cadaver models . Although data from clinical studies of IACI in humans have provided evidence of minimal short‐term consequences, the long‐term clinical effects of IACI on the osteoarthritic canine joint are unknown.…”