Ana Carolina Leal, Vitor Almeida Ribeiro de Miranda, Phelippe Augusto Maia Valente, Alan de Paula Mozella, Douglas Mello Pavão, Rodrigo Salim, Eduardo Branco de Sousa, Marcelo Mandarino, João Antonio Matheus Guimarães, Alfredo Marques Villardi, and José Leonardo Rocha de Faria
Orthopaedic surgeries by video arthroscopy have become increasingly popular, as they allow joint treatment through small incisions and minimal tissue damage. However, their execution requires specific skills from the surgeon, different from open surgery, which can only be achieved through practical training. These skills would be ideally performed on human cadaveric anatomical pieces which, however, can be difficult to access for different reasons. Animal anatomical models for surgical skills training have been used for years in medicine, and we observed that the bovine knee has anatomical characteristics quite similar to that of the human knee. In this study, we explain, step by step, the installation and creation of an arthroscopy laboratory with a bovine model, in an effort to contribute to several training centers in arthroscopic surgery around the world, assisting and guiding such centers to install arthroscopy laboratories and facilitating the improvement of more surgeons., Technique Video Video 1 To set up an arthroscopy laboratory that is easily reproducible in any region of the world, we use the bovine knee. We obtain such an anatomical piece in conventional commercial establishments selling animal meat, like slaughterhouses and butcher shops. We ask the owner of the establishment to separate the entire bovine lower limb, only with dry skin. The preparation of the piece begins by sectioning the thigh muscles about 25 cm proximal to the knee, and then we repeat the same 25 cm distal to the knee at the tibial level. Due to the large volume of the sural triceps of this animal model, we section the distal one third of the gastrocnemius to decrease the weight of the anatomical piece. We then observe knee flexion, still with the femur and tibia intact. We perform a transversal osteotomy of the tibia and femur in the same location as the soft tissues were resected. The room for installing the laboratory must have plugs with 110 and 220 volts, a tap with running water, and appropriate drains. It also must be at least 20 square meters in size. We use pressure pliers fused to a press to fix the anatomical piece, and this must be fixed to a rigid surface. A large bucket must be purchased to function as a container for the water used to perform the arthroscopy. A water tap must be adapted to be able to couple one way of the 4-way equipment in this tap and supply water in a continuous way to perform the arthroscopy. Such adapters as the ones shown may be necessary. We again highlight the pressure pliers fused to the vise. A vacuum cleaner is also necessary. The arthroscopy table must be assembled with arthroscopic forceps, blades and a shaver handpiece, scalpel, and Metzenbaum scissors. The arthroscopy tower must be equipped with a video monitor, a light source, a camera controller, and a shaver console. The bovine knee is then attached to the pressure pliers and the arthroscopy begins. We perform an extensive cleaning of the synovial tissue located posterior to the patellar tendon. We initially observe the trochlea to the patella, being able to observe the patellar track. We are able to observe the anterior and posterior cruciate ligament. After we observe the medial compartment, to facilitate the visualization of this compartment, we perform pie crusting of the medial collateral ligament, easily observing the medial meniscus. We made a radial tear in the medial meniscus body for subsequent meniscal suture training. Then, your arthroscopy laboratory is up and running.