Name: NanoScope™ Operative Arthroscopy System Cases
Uploaded: 2020-02-19T00:00:00Z
Channel: Arthrex
Description: John G. Kennedy, MD, FRCS (New York, NY), presents cases using the NanoScope™ operative arthroscopy system for foot and ankle applications.

Imaging and Resection

Foot and Ankle

<p>John G. Kennedy, MD, FRCS (New York, NY), presents cases using the NanoScope™ operative arthroscopy system for foot and ankle applications.</p>

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VID1-000718-en-US | A | NanoScope™ Operative Arthroscopy System Cases

John G. Kennedy

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Surgeons presenting one or more clinical cases

Chirurg:innen präsentieren einen oder mehrere klinische Fälle

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NanoScope™ Operative Arthroscopy System Cases

I'm going to talk today about this new, exciting new needle scope or NanoScope. The first case is a 65 year old female, and she had pain in the anterior aspect of her ankle joint, and any time she dorsiflexed, it exacerbated the pain. She'd had previous physical therapy for several months, and she had a small injection as a diagnostic modality into the front of her ankle joint and felt better. But for a temporizing period of time, there's an MRI, T2, and T1 imaging showing that there's a lot of scar tissue at the front of her joint. And we suggested that that we could get rid of this with a NanoScope. This is actually what we saw inside. The patient was brought just to our office and given a local anesthetic. And then we put the NanoScope, which is just the size of a very small needle, less than two millimeters. And not only did we see a lot of scar tissue there, which we saw on the MRI, but we also saw this loose body and all the inflammation around there that was clearly causing problems when she was dorsiflexing. And you can see very clearly with this technology, we can just with a very tiny portal, not only take away all the scar tissue, but also in fact take out a loose body. And that patient walked out of that room very, very happy indeed. The next case is a 40 year old male, and he had an OATS procedure or an osteochondral autograft transplant. And five years ago, and he had started recently to develop pain at the anterior aspect of his ankle joint. Well, we took a standard X-ray. We can see the chevron osteotomy was fixed very well and certainly no problems there. There's a little bit of anteromedial spurring which you can see on that lateral film. We gave the patient an injection. And again he had some pain relief from that. So we proceeded with a NanoScope. And you can see here we're using a two millimeter followed by a three millimeter cinevator or receptor. And it's getting rid of a lot of that scar tissue. Sometimes we need to use a biter, particularly on the lateral side when he had some significant scar tissue there. And now we're advancing into the joint itself. And we're able to see. Asking the patient to Dorsey and plantar flex where the graft is. And you can see the graft is really quite perfect, not just in terms of visualization but also on probing. So again, using nanotechnology, we can get in to do this in the office setting. The patient jumps off the table, walks home. Very happy. Third case 33 year old male multiple lateral ankle sprains. He's pain over subtalar joint and the peroneal tendons. Mri shows just an amorphous mass of cicatriz tissue on that lateral side. We're a little bit worried that he may have some posterior facet arthrosis really not 100% sure of what's going on. Doesn't seem to be a tear in the perineal sheath or in the perineal tendon, but certainly some pathology going on over there. Patient is not anxious for a big surgery. So we say, well, why don't we bring you to our treatment room and we can put a little needle in there, and we should be able to see what's going on and take care of it. And that's what we did. Again under local anesthetic. You can see the patient there quite happy looking at the television monitor. And this is what we see on the left lower quadrant. You can see that there is a that's the tendon, the peroneal brevis tendon running along there. And it's running by all this scar tissue right over his CFL. So we're able to debride that. And this is something that you just simply couldn't have seen with such ease, either with ultrasound or with any other diagnostic modality. And again, the patient gets off the table and feels immediate benefit. Now, this was an interesting case of a 23 year old female. She had pain for many years in the posteromedial aspect of the ankle joint. She was a gymnast and she'd had a previous fracture which was a Salter-harris two, so she had some overgrowth of her growth plate orifices. Since that time, she'd been unable to participate in any sporting activities, because any time she started to put any pressure through her posterior tibial tendon, it started to become painful and swollen. And there was really no evidence as to as to why that was the case on MRI. When we looked under ultrasound, we can see there was a very slight bony overgrowth in that area of the just on the on the edge of the fissus there. So we suggested that we bring her just to the treatment room. And we'll do this under local. And this is what we saw. We saw that the bony overgrowth was pushing against the posterior tibial tendon. Not only were we able to see that, but we're able to do something about it. So we again, we put in A30 shaver and a small jacketed burr in there, and we get rid of that bony overgrowth. And over time, of course, her tendon will heal. And so again, something that you just simply couldn't have seen or done with traditional technology. Underscoring the use of these needle scopes 34 year old male non insertion Achilles tendinopathy and who had failed shockwave and conservative therapy. Again he was not anxious for a big open surgery or even a traditional arthroscopic surgery. He wanted to have this done wherever possible in the office, so he could have an early return to his normal activities. This is what we saw on MRI. Typical Achilles tendinopathy, where you see a fusiform swelling and no great tear in there, but certainly some inflammation in the tendon sheath. We brought him to the treatment room, and in the prone position we were able to insert not just the NanoScope but also A30 resection. And you can see we're taking away all the scar tissue, all this inflammation between the tendon and the tendon sheath or the Parthenon. And then we identify the plantaris which is stuck down to the to the Parthenon. And that's the plantaris on the right. And we're able to go in there and with A20 receptor be able to debride that. So it is now free and running normally. Our final case 63 year old female. She'd had one of these polyvinyl alcohol hydrogel implants for rigidus. And she'd never done that well. And she'd persist in pain in the first MMP MP joint. Both X-ray and MRI were really non-conclusive. And so we put the camera in and we found that there was a lot of cicatrization or scar tissue in there. We were able to use A20 shaver. You can see that here. And we're able to clean that up. So we'd have better visualization of the joint itself. And as we get into the joint, you can see that there's been massive loss of cartilage and progressive arthritic change. And we're just beginning to see the polyvinyl insert. And it's actually subsided. And you can see the linear wear on this failed implant. And I think it's not only useful diagnostically, but it's very useful for the patient to be able to see this. Whereas traditionally on MRI or any other imaging modality, it's difficult for patients to appreciate it. So again, needle arthroscopy or nano arthroscopy allows us not only the ability to see and do, but also for the patient to interact and know what's going on truly within themselves.

NanoScope™ Operative Arthroscopy System Cases

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