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An atlas of arthroscopic surgery of the knee
Arthroscopy:
The Journal of Arthroscopic
and Related Surgery
Published by Raven Press, Ltd. 0 1989 Arthroscopy
5(2):162-163
Association of North America
Book Review
An Atlas of Arthroscopic Surgery of the Knee. By George J. Schonholtz. Springfield, IL: Charles C. Thomas, 1988. 241 pp., $54.50.
mentions the fact that at the time of writing the book, controversy existed regarding the procedure. He points out that in spite of reports of some serious complications, arthroscopic meniscal repair is becoming popular. He wisely emphasizes the importance of a thorough review of anatomy plus practice of the operation on cadaver or amputation specimens prior to operating on a patient. A good description of the technique is presented, but his discussion of postoperative management is minimal. In general, the author presents a good discussion of the procedures that have been well evaluated. The chapter on complications of arthroscopic surgery is divided into a discussion of intraoperative and postoperative problems. To prevent operating on the wrong knee, the author recommends sterile preparation of the knee with the patient awake, plus a recheck of the chart and x-rays immediately before surgery. In addition, I should like to suggest a visit by the surgeon in the operating room with a reexamination of the area for surgery. This not only prevents disorientation of the surgeon, but reassures the patient. Proper padding, avoiding excessive pressure, and limiting the tourniquet time to 1 or 2 h prevents most problems encountered with the device. Accurate placement of portals of entry is emphasized by the author as a means to obtain a clear visual field and to prevent damage to articular surfaces. This precaution also avoids the use of excess force on the various instruments, thus preventing breakage. Constant visualization of the instruments also prevents damage to the arthroscope. Extravasation of fluid into subcutaneous areas can also be prevented by accurate needle placement and the avoidance of excess pressure. Damage to extraarticular structures is prevented by proper placement of incisions; the avoidance of undue varus or valgus stress to protect medial and lateral ligaments, as well as preventing damage to the popliteal vessels and nerve is achieved by performing all surgery under direct vision. The postoperative problems are also well discussed and the preventive measures are described in detail. The final chapter discusses the postoperative management of the patient. The value of a
As stated by the author in the preface, this book’s purpose is to introduce the orthopaedist to basic arthroscopic procedures in the knee. In his first chapter, Dr. Schonholtz presents an excellent history of the development of arthroscopy. He divides it into the era of the pioneers (1918-1970); the developmental period (1971-1979); and the modern era (1980-1987). The problems with designing a scope of suitable size with a satisfactory lens system led many enthusiasts to lose interest. Only the perserverance of investigators such as Takagi, Watanabe, and their associates led to the ultimate production of an instrument that could be used in the knee and the Needlescope for smaller joints. Photographic records were also possible. The interest and activities of Dr. Robert Jackson, who worked with Watanabe, reintroduced the procedure to the western world. Also, the enthusiasm of Dr. S. W. Casscells caused a spread of acceptance of the procedure by orthopaedists. In his discussion of equipment for arthroscopic surgery of the knee, the author discusses the various types of arthroscopes and emphasizes their assets and problems. He also describes the hand instruments and machine tools, emphasizing the need for caution in their use. He wisely points out the need for gentleness in the use of leg holders. The description of light sources and care of cables is a timely one. The warning of danger of retinal damage by a xenon light source is well made. The importance of an adequate history and physical examination prior to arthroscopy is basic and is well emphasized by the author. The discussion of meniscus tears includes a good general classification of the different types. The importance of an accurate evaluation of the total problem presented by each type of lesion is well discussed. Proper positioning of the involved extremity and of the selection of safe portals, plus the emphasis on gentleness in the use of instruments to prevent complications, are presented. In the discussion of meniscal repair, the author 162
BOOK REVIEW patient information booklet containing instructions for the patient is emphasized. Descriptions of the routine and special types of dressings required are well handled. Control of pain by appropriate medication; the importance of monitoring of circulation and neurologic function is emphasized. The indications for prophylactic use of antibiotics are also described. The routines for the resumption of weight bearing and precautions to be followed in special situations are also discussed. The last sections on the indications for physical therapy and the resumption of activities following surgery provide the reader with a well-planned recovery program.
163
This book presents a well-described conservative discussion of basic arthroscopy. The author avoids some of the procedures that he feels need still further evaluation. It is therefore of particular value to one in the earliest stages of arthroscopy. Although the diagrammatic illustrations of various procedures are helpful, they are rather basic. I would have preferred the realism presented by color photographs, however that would have made the book more expensive.
John J. Joyce III, M.D. Glenside, Pennsylvania, U.S.A.
Arthroscopy,
Vol. 5, No. 2, 1989
The Journal of Arthroscopic
and Related Surgery
Published by Raven Press, Ltd. 0 1989 Arthroscopy
5(2):162-163
Association of North America
Book Review
An Atlas of Arthroscopic Surgery of the Knee. By George J. Schonholtz. Springfield, IL: Charles C. Thomas, 1988. 241 pp., $54.50.
mentions the fact that at the time of writing the book, controversy existed regarding the procedure. He points out that in spite of reports of some serious complications, arthroscopic meniscal repair is becoming popular. He wisely emphasizes the importance of a thorough review of anatomy plus practice of the operation on cadaver or amputation specimens prior to operating on a patient. A good description of the technique is presented, but his discussion of postoperative management is minimal. In general, the author presents a good discussion of the procedures that have been well evaluated. The chapter on complications of arthroscopic surgery is divided into a discussion of intraoperative and postoperative problems. To prevent operating on the wrong knee, the author recommends sterile preparation of the knee with the patient awake, plus a recheck of the chart and x-rays immediately before surgery. In addition, I should like to suggest a visit by the surgeon in the operating room with a reexamination of the area for surgery. This not only prevents disorientation of the surgeon, but reassures the patient. Proper padding, avoiding excessive pressure, and limiting the tourniquet time to 1 or 2 h prevents most problems encountered with the device. Accurate placement of portals of entry is emphasized by the author as a means to obtain a clear visual field and to prevent damage to articular surfaces. This precaution also avoids the use of excess force on the various instruments, thus preventing breakage. Constant visualization of the instruments also prevents damage to the arthroscope. Extravasation of fluid into subcutaneous areas can also be prevented by accurate needle placement and the avoidance of excess pressure. Damage to extraarticular structures is prevented by proper placement of incisions; the avoidance of undue varus or valgus stress to protect medial and lateral ligaments, as well as preventing damage to the popliteal vessels and nerve is achieved by performing all surgery under direct vision. The postoperative problems are also well discussed and the preventive measures are described in detail. The final chapter discusses the postoperative management of the patient. The value of a
As stated by the author in the preface, this book’s purpose is to introduce the orthopaedist to basic arthroscopic procedures in the knee. In his first chapter, Dr. Schonholtz presents an excellent history of the development of arthroscopy. He divides it into the era of the pioneers (1918-1970); the developmental period (1971-1979); and the modern era (1980-1987). The problems with designing a scope of suitable size with a satisfactory lens system led many enthusiasts to lose interest. Only the perserverance of investigators such as Takagi, Watanabe, and their associates led to the ultimate production of an instrument that could be used in the knee and the Needlescope for smaller joints. Photographic records were also possible. The interest and activities of Dr. Robert Jackson, who worked with Watanabe, reintroduced the procedure to the western world. Also, the enthusiasm of Dr. S. W. Casscells caused a spread of acceptance of the procedure by orthopaedists. In his discussion of equipment for arthroscopic surgery of the knee, the author discusses the various types of arthroscopes and emphasizes their assets and problems. He also describes the hand instruments and machine tools, emphasizing the need for caution in their use. He wisely points out the need for gentleness in the use of leg holders. The description of light sources and care of cables is a timely one. The warning of danger of retinal damage by a xenon light source is well made. The importance of an adequate history and physical examination prior to arthroscopy is basic and is well emphasized by the author. The discussion of meniscus tears includes a good general classification of the different types. The importance of an accurate evaluation of the total problem presented by each type of lesion is well discussed. Proper positioning of the involved extremity and of the selection of safe portals, plus the emphasis on gentleness in the use of instruments to prevent complications, are presented. In the discussion of meniscal repair, the author 162
BOOK REVIEW patient information booklet containing instructions for the patient is emphasized. Descriptions of the routine and special types of dressings required are well handled. Control of pain by appropriate medication; the importance of monitoring of circulation and neurologic function is emphasized. The indications for prophylactic use of antibiotics are also described. The routines for the resumption of weight bearing and precautions to be followed in special situations are also discussed. The last sections on the indications for physical therapy and the resumption of activities following surgery provide the reader with a well-planned recovery program.
163
This book presents a well-described conservative discussion of basic arthroscopy. The author avoids some of the procedures that he feels need still further evaluation. It is therefore of particular value to one in the earliest stages of arthroscopy. Although the diagrammatic illustrations of various procedures are helpful, they are rather basic. I would have preferred the realism presented by color photographs, however that would have made the book more expensive.
John J. Joyce III, M.D. Glenside, Pennsylvania, U.S.A.
Arthroscopy,
Vol. 5, No. 2, 1989