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Joint: arthroscopy - overview


Synonym(s): Arthroscopy


  • Arthroscopy is the most useful tool for both diagnosis and treatment of joint, tendon sheath and bursal lesions in the horse.
  • It is a specialist procedure which requires considerable equipment and surgical skills.
  • Has completely superseded arthrotomy and other open surgical procedures in joints.


Diagnostic applications

  • Assessment of soft tissue structures of joints: ligaments, synovium, menisci, plicae and joint capsule.
  • Assessment of joint surface and bone: osteoarthritis, fractures, cartilage and subchondral lesions.
  • Tenosynovioscopy Tenosynovioscopy for examination of the internal structures of tendon sheaths including tendons, ligaments, synovial lining, sheath wall, vincula and mesotendon.
  • Evaluation of lesions within bursae including synovium, capsule, tendons, ligaments, cartilage surfaces and bone Bursoscopy: overview.

Therapeutic applications

  • Arthroscopically guided fracture repair of fractures within the joint or entering it.
  • Removal of osteochondral or osteochondrosis fragment(s).
  • Debridement of articular cartilage defects.
  • Joint lavage.
  • Treatment of synovial sepsis.
  • Debridement of intrasynovial soft tissue lesions such as meniscal or cruciate ligament tears, S/DDFT lesions, and retinacula tears in the intercalcaneal bursa.



  • Diagnostic evaluation of the joint in cases of lameness localized to the elbow joint Elbow: arthroscopy.
  • Surgical treatment of sepsis of the elbow joint, osseous cyst-like lesions, osteochondrosis, intra-articular fractures and osteoarthritis Elbow: osteoarthritis.





Distal and proximal interphalangeal joints

  • Diagnostic and surgical arthroscopy is performed on the dorsal and palmar/plantar compartments of both joints.
  • In the distal joint indications for surgery include:
  • In the proximal joint indications for surgery include:
    • Removal of osteochondral fragments from the dorsal compartment.
    • Removal of fragments of the palmar/plantar margin of P2.

Coxofemoral joint

  • Diagnostic arthroscopy of the coxofemoral joint has been used to evaluate lameness localized to the joint, tearing of the ligament of the head of the femur, osteoarthritis, fracture of the acetabulum and osteochondrosis Coxofemoral joint: disease - overview.
  • Surgical treatment has been described for femoral head cartilage lesions, tearing of the ligament of the head, osteochondrosis, acetabular chip fractures and infectious arthritis.



  • Calcaneal bursae are examined diagnostically and surgically for Calcaneal bursa: bursoscopy:
    • Tearing of the calcaneal insertions of the SDFT and unstable subluxation of the SDFT.
    • Osteolytic lesions and traumatic fragmentation of the calcaneus.
    • Sepsis of the bursae after penetration.
  • Intertubercular (bicipital) bursa is examined diagnostically and surgically for Humerus: bicipital bursa - bursoscopy:
    • Investigation of lameness localized to this site Humerus: bicipital bursa - disease.
    • Treatment of intrathecal fragmentation of the supraglenoid tubercle of the scapula and lateral tubercle of the humerus.
    • Injuries of the bicipital tendon.
    • Contaminated and infected bursa.
  • Podotrochlear (navicular) bursa is examined diagnostically and surgically for Navicular bursa: bursoscopy:
    • Lesions of the DDFT.
    • Lesions of the palmar fibrocartilage and subchondral bone within the bursa.
    • Penetrating injuries of the navicular bursa.


  • Synovial structures can be examined in detail through small stab incisions.
  • New conditions and lesions have been documented that were not known or documented by imaging modalities.
  • Less surgical trauma to the joint and patient, and less post operative pain.
  • Considerable cosmetic and functional advantages over previous open surgeries.
  • Much less post operative care required and less complications mean owners and trainers are more likely to consider surgery in individual patients.
  • Decreased convalescence time, earlier return to work and improved results in some cases has proved very beneficial in the management of equine joint and synovial structure problems.
  • Decreased requirement for palliative therapy.


  • Site of pain or lameness must be localized to specific joint or synovial structure before surgery is undertaken.
  • High degree of surgical training is required.
  • Considerable investment in equipment and facilities is required.
  • Usually performed under general anesthesia Anesthesia: general - overview although limited diagnostic arthroscopy is undertaken in some joints such as the stifle and fetlock.

Obstructed field of view

  • Hemarthrosis:
    • Often not a major problem, particularly with modern fluid supply systems. In the distal limb, dorsal recumbency and the use of an Esmarch bandage and tourniquet are often helpful, particularly where hemorrhage is anticipated.
    • Pre-existing pathology particularly severe synovial inflammation and hyperemia.
    • From debrided bone and particularly soft tissues.
    • Usually not a problem while the joint is distended but may become one when the joint is re-entered, after allowing the joint to collapse. Flush the cavity, and then close the outflow cannula and redistend.
    • Bleeding from subchondral bone is a useful indicator for the depth of debridement, so may need to release fluid pressure during procedure to assess surgery and hemorrhage.
  • Synovial villi:
    • May be a localized or more general problem in individual cases.
    • The latter is usually due to inadequate fluid distension or loss due to an open outflow portal or instrument portal, particularly following removal of a large joint fragment.
    • Capsular fibrosis of the joint may limit distension as will subcutaneous extravasation of fluid.
    • To limit these problems the joint or other synovial structure should be thoroughly examined at the start of surgery and with a closed outflow portal.
    • Small fragments should be removed before creating larger portals for removal of large fragments.
    • Reinsert instrument to block a large portal.
Do not block the outflow portal with a finger as → extravasation of fluid.
  • Villi can be displaced with a probe or removed surgically with hand tools or more effectively with careful limited use of motorized instruments.
  • Extravasation of fluid:
    • More common problem in the antebrachiocarpal (radiocarpal) joint.
    • Once present, limits the extent of joint distension → reduced visualization → may need to delay procedure several days.
    • Associated with the instrument portal shape and positioning/patency, excessive perfusion pressure, and excessive manipulation of instruments → opening up a subcutaneous plane for fluids to leak into.
    • Also due to combination of open inflow cannula and blocked outflow portal at the skin or subcutaneous level, ie when instrument is inserted or subcutaneous insertion of trocar or scope.
    • Problem is reduced by:
      • Reducing inflow pressure while fragments are removed.
      • Turn-off fluid while portals are created.
      • Create skin incision before the blade is advanced into the structure.
    • Most encountered as a problem in the scapulohumeral and stifle joints, plus the tarsal and carpal tendon sheaths.
    • Areas of excessive subcutaneous extravasation of fluid can be manually massaged at the end of surgery before skin closure to decrease the swelling.
    • No long-term consequences have been observed and the swelling usually dissipates within 24-48 hours.

Other intra-operative complications

  • Articular cartilage damage, particularly partial thickness:
    • Iatrogenic injury during surgery with arthroscope, trocar or instruments.
    • Use careful technique.
    • Ensure joint distension is adequate before entering joint.
  • Iatrogenic damage to perisynovial structures during arthroscope or instrument insertion.
    • Surgery of the digital flexor tendon sheath may damage the palmar/plantar neurovascular bundle, particularly in thick skinned cobs and drafts, and the carpal sheaths of the extensor carpi radialis and common digital extensor tendons are at risk. Careful palpation, portal creation and inspection are important to limit problems.
  • Intra-articular broken instruments:
    • Usually due to the use of inappropriate force by surgeon.
    • Use appropriately sized instruments and not disposable instruments.
    • Cracked arthroscope lens - of no consequence to patient but expensive.
    • May be due to contact with instrument or flexion of leg while scope is still in the joint.
    • Other instruments may break in the joint - retrieve any fragments with forceps or magnetic retrievers as soon as possible. Intra-operative radiography may help identify the position of fragments.
  • Intra-articular foreign bodies:
    • Small metal fragments from instruments.
    • Contamination with hair and other debris following needle or instrument insertion.
    • Flushing should remove them.
    • No long-term impact.


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  • Determined by specific pathology of each case.

Further Reading


Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Marshall K M & Adkins A R (2014) Synovial herniation as a complication of arthroscopy in a Thoroughbred yearling. Equine Vet Educ 26 (6), 288-291 VetMedResource.
  • Fowlie J G et al (2011) Comparison of conventional and alternative arthroscopic approaches to the palmar/plantar pouch of the equine distal interphalangeal joint. Equine Vet J 43 (3), 265-269 PubMed.
  • Muurlink T, Walmsley J, Young D & Whitton C (2009) A cranial intercondylar arthroscopic approach to the caudal medial femorotibial joint of the horse. Equine Vet J 41 (1), 5-10 PubMed.
  • Minshall G J & Wright I M (2006) Arthroscopic diagnosis and treatment of intra-articular insertional injuries of the suspensory ligament branches in 18 horses. Equine Vet J 38 (1), 10-14 PubMed.

Other sources of information

  • McIlwraith C W, Nixon A J & Wright I M (2015) Diagnostic and Surgical Arthroscopy in the Horse. 4th edn. Mosby Elsevier, USA.
  • Richardson D (2004) Arthroscopic Surgery in Standing Horses. In: Proc 43rd BEVA Congress. Equine Vet J Ltd, UK. pp 157.

Related Images


Abdomen: laparoscopy

Accessory carpal: fracture

Accessory ligament DDFT: desmotomy

Accessory ligament SDFT: desmotomy

Anesthesia: analgesia - overview

Anesthesia: general - overview

Anesthesia: standing chemical restraint

Annular ligament: transection - palmar / plantar

Bone: osteitis - septic

Bone: osteochondrosis

Bone: scintigraphy

Bone: slab fracture repair - lag screw

Bone: subchondral cysts

Bursoscopy: overview

Calcaneal bursa: bursoscopy

Carpal joint: disease - overview

Carpus: chip removal

Carpus: fracture - chip

Carpus: fracture - comminuted

Carpus: fracture - slab

Carpus: hygroma

Carpus: intercarpal ligament (MPICL) - trauma

Carpus: osteochondroma

Carpus: sheath tenosynovitis

Computed tomography

Coxofemoral joint: disease - overview

Deep digital flexor tendon: tendinitis

Digital sheath: tenosynovitis

DIP joint: disease - overview

Distal phalanx: fracture repair

Distal phalanx: fractures

Elbow: arthroscopy

Elbow: osteoarthritis

Fetlock: arthroscopy

Fluid therapy: overview

Forelimb: joint anesthesia

Forelimb: perineural analgesia

Forelimb: radiography

Hindlimb: radiography

Humerus: bicipital bursa - bursoscopy

Humerus: bicipital bursa - disease

Humerus: fracture

Intercarpal: arthroscopy

Intersesamoidean ligament: disease

Joint: septic arthritis - adult

Joint: septic arthritis - foal

Magnetic resonance imaging

MC / MT 2 and 4: fracture repair

MC / MT 3: condylar fracture

MC / MT 3: condylar fracture repair

MC / MT 3: diaphysis fracture

MCP / MTP joint: chronic proliferative synovitis

MCP / MTP joint: developmental orthopedic diseases

MCP / MTP joint: disease - overview

Middle phalanx: fracture

Musculoskeletal: osteoarthritis (joint disease)

Navicular bursa: bursoscopy

Navicular bursa: puncture

Palmar / plantar annular ligament syndrome

Palmar carpal retinaculum: section

Paranasal sinuses: bacterial sinusitis

Patella: fracture

Patella: fragmentation

Proximal phalanx: fracture

Proximal sesamoid: fracture

Proximal sesamoid: fracture - arthroscopic removal

Radiocarpal: arthroscopy

Scapula: fracture

SDFT: tendinitis

Shoulder joint: disease - overview

Shoulder: arthroscopy

Stifle: arthroscopy

Stifle: femoropatellar osteochondrosis

Stifle: femorotibial subchondral bone cyst

Stifle: trauma - collateral ligament

Stifle: trauma - cruciate ligament

Stifle: trauma - meniscal

Synovial fluid: collection

Tarsus: arthroscopy

Tarsus: fracture

Tarsus: osteochondrosis

Tarsus: tarsal sheath tenosynovitis

Tarsus: trauma - collateral ligament


Therapeutics: anti-inflammatory drugs

Therapeutics: antimicrobials

Tibia: fracture - malleolar

Wound: management - overview

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