Name: Revolutionizing Ankle Arthroscopy Using the NanoNeedle™ Scope 2.0
Uploaded: 2025-08-25T00:00:00Z
Channel: Arthrex
Description: John G. Kennedy, MD (New York, NY), discusses diagnostic and treatment applications using the NanoNeedle™ scope 2.0 for ankle arthroscopy conditions such as anteromedial and anterolateral ankle impingement.

Imaging and Resection

<p>John G. Kennedy, MD (New York, NY), discusses diagnostic and treatment applications using the NanoNeedle™ scope 2.0 for ankle arthroscopy conditions such as anteromedial and anterolateral ankle impingement.</p>

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VID1-007788-en-US | A | Revolutionizing Ankle Arthroscopy Using the NanoNeedle™ Scope 2.0

John G. Kennedy

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Revolutionizing Ankle Arthroscopy Using the NanoNeedle™ Scope 2.0

Hi, my name is Doctor John Kennedy. I'm an orthopedic professor at NYU Langone in New York. We're going to be talking today and showing the new 2.0 nano needle, and we're going to be looking at it specifically in the ankle joint at the anteromedial impingement and anterolateral impingement. And today we're going to be going how do we diagnose this. And also how do we fix it. And so with no further ado we'll carry on. So we're going to be talking this morning about anterior arthroscopy using a nano needle. And the new 2.0 nano needle. And the first thing we're going to be talking about is how do we set this up. So this is a procedure that you can do in the office. Or indeed you can do it in the operating room. And the way that we do it is exactly the same. We start off always with identifying the superficial peroneal nerve. And you can see that running on the lateral side here, that is the structure that is most at risk. So we always identify that with the third toe for toe flexion sign. And that then makes that more prominent. Our portal will be slightly lateral standard entry lateral portal to that. And then we'll have a medial portal as well. And both of these will be a working portal and a visualization portal. So in the office, once the patient is settled in then we identify these. And the first thing that we do is we give them a local anesthetic with marcaine a lidocaine 1 to 1 ratio. And we inject that into the joint. And we can see here and typically we'll give about 4 or 5 cc's into the medial aspect. And then we come over onto the lateral aspect again always recognizing where that SPN is. And then we inject into the lateral aspect of the joint as well. After that then we leave the patient for about 5 or 10 minutes while we get everything set up. And I think it's important at this point to underscore that in-office needle arthroscopy is truly a team sport. This is not just all about the surgeon and patient. We have our nurse or nurse assistant with us who's versed and skilled in this, and also our local rep. I think that is critical for this because when a patient is awake, they will recognize and certainly see if people are not familiar with what's going on. So I think it's critical that everybody is on the same team. Everybody plays a different position, but collectively we play to win. So that's the setup for anterior arthroscopy using the new needle scope. So for the next portion of this, what we're going to do now is make standard portals on the Andromeda and Anterolateral aspect of the joint. And again we use an 11 blade. And we just simply go through the skin. We don't have to go through the entire length of the blade, just about a 2 to 3 millimeter incision. And because in the end, of course, we're not going to be using sutures and it's just steri-strips. So we go through this into the capsule, gently remove that, and then we have our trocar, which is slightly beveled. Again you want to protect the underlying structures. Put your finger just at the about a centimeter or two from the tip and then advance in. And we're into the joint and you can feel that pop and you have to represent you We have to let the patient know that they will feel a pop. They should feel no pain whatsoever. There's the capsules are completely anesthetized, as is the as is the joint. So they'll feel that mechanical pop and hear it, but they won't feel anything in terms of pain. Then we remove this and then we put in our new 2.0 needle. And you'll see, once we get into the joint, you can see automatically how really clear this is on the top portion of the horizon. There you're seeing the tibia and this is the talus. And if we advance now towards the lateral side you can really see the depth and clarity. And of course that all comes from the the new 720 by 720 sensor that we have, which is an order of magnitude better than what we've been using before. And you can really see how clear this is as we're looking over in the lateral side. Because this as we move over to the lateral side then you can trans illuminate. You can see some of the AI TfL you can see some chondral damage there. The next portion of this we're going to use the needle. And the needle will then identify our lateral portal. So again we've predetermined where that's going to be. And you can see and we just take a picture of that. And of course all the time you're talking to the patient because the patient at this point wants to know. And just for the purposes of this demonstration, we're going to say this patient had a recurrent ankle sprains and this ligament here. The atfl or Bassett's ligament is hypertrophic, and that can often cause snapping and damage the cartilage, as indeed it has done here. So once we've put the needle in, then we would throw the needle. We use our 11 blade once again. And we just make that small incision through there. This is a 3.5 shaver. We use a three and a 3.5. This is a receptor. And you can see we've come through that lateral portal. And this will have the ability to shave everything from the lateral side, right across the joint, right over to the medial side. And at one point when we need to look at the medial side, we'll just simply change portals. One thing to note here on the when you're looking outside the joint is how we hold the actual needle scope. It's important that you stabilize that against the body, and that reduces any emotion or aberrant motion that you might get from if you were choked up here. Any sort of you can certainly get some tremor in your hand if you're up here. But if you're stabilizing against the joint, that tremor is eliminated or reduced. So here we are. We're in the joint, as I said, for the sake of demonstration, we're saying that this is a hypertrophic atfl or an anterior ligament of the of the ankle joint. And this is commonly syncretized or scarred after a recurrent ankle. Sprains. The atfl is underneath here we can dive down here and we can see the atfl will be underneath there, but the atfl is the one that becomes hypertrophic. So we can use the shaver and we can start shaving away on that. And we take you can actually take the entire this ligament away without compromising ankle instability or ankle stability. And, but we're just taking the anterior two thirds of this fascicle away. And you can see the damage that it's done to the control surface here. And I'm just going to introduce, actually to show you that I'm going to use you. This nice new probe that we have is graphite covered. So it reduces glare. And it again the profile of this fits through our portal is very nicely. So again there's going that is going to be the remnant of our TfL or Bassett's ligament underneath here we can dive down and we can see down there is the Atfl and we don't want to touch that on this particular model. And so we're just resecting that. And you can see as the talus snaps over that hypertrophic edge, it can cause damage to the Taylor control surface, and you can see the wear that's occurred here over time. And of course, that will create a lateral osteochondral lesion at some point if that's not addressed. So that's really the lateral aspect. You want to make sure when you're dealing with anterolateral impingement that you always dorsiflex. And you can see now that there's really no impingement there. And there's a nice gliding motion. But if there was impingement and I'll take the shaver again, you can use the shaver, but oftentimes we'll use a bur. So we'll just as we're waiting for the bur to be loaded, we'll just show you in terms of the shaver, we can just shave away some of that bone and we'll just pour it instead of oscillate. We'll just put it on forward to shave away. Again, remember that this is an in-office procedure. You just have to warn the patient. Although they will have no pain at this point, that they will feel the vibratory sense within their joint and not to be alarmed with that. But again, you can see we're getting nice reception if this is a large exostosis or osteophyte, and we'll change that to a three or a four bur, which we'll do now again for the purpose of demonstration. And again, you can see how really critical it is to have your assistant just well versed in knowing what the next steps are going to be. And I think that is, as I was saying earlier, is so important in terms of a team sport. This really is a true team sport, particularly when the patient is awake and is aware of everything that's going on. It has to look like a seamless transition from player to player. And that's particularly so because at some point we need to wash out the joint or lavage the joint. And our company representative will be there and knowing when that occurs so that they're ready on standby. They don't have to struggle to find the the pump. So they're ready to do that or ready to take a picture. Because there are times when you're holding the camera that it is difficult for the operator to address or to take a picture. They'll lose that picture. So the nursing assistant or the rep will take the picture for you. So that's really a demonstration of the anterolateral impingement. So we've taken soft tissue away and we've taken bone away. And of course if that's all we do we can leave half of it undone. It's more common on the medial side, but oftentimes on the lateral side down here, just as you're getting into the neck of the talus, they may have an exostosis here and you don't want to miss that. So always make sure you dorsiflex that joint all the way to make sure that there is nothing there that's going to cause any impingement. So on this model we can see that that's a really nice gliding moment motion. The atfl or that hypertrophic Bassett's ligament is gone largely. We can take a little bit more away if we need to. So again, we can now move our camera over to the medial side to look at anteromedial impingement. So we're introducing now our new 2.0 beta. This is more robust than the previous one. And you can see it's got a really nice cutting profile to it. And again we're simply resecting that anterolateral impingement. So we're able to cut that away. And sometimes you just need to do that to create a surface that the shaver can grip on a little easier. But you can see how nice is a really good tactile feedback on this. You can hear and feel those clicks. And again, it's always useful when a patient is looking at this. It looks like this is an industrial instrument. So it's much better to show the patient that this is really quite tiny. This is the profile. And this is just two two millimeters. So it's very, very small of course. Enormously magnified for the patient to see. So you can see we've taken that away. And then we'll just put our shaver in again after that to clean that up and make that as smooth edge.

Revolutionizing Ankle Arthroscopy Using the NanoNeedle™ Scope 2.0

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