A variety of instruments have been made for arthroscopy. For ankle arthroscopy, instruments with a diameter less than 5 mm are ideal, and for smaller foot joints, a diameter less than 3 mm is ideal. The typical nonmotorized hand instruments available are probes, graspers, curettes, knives, osteotomes, gouges, punches, rongeurs, and magnetized rods (Figs. 3–7). Probes are often marked as a measuring device in 1- to 2-mm increments and also allow the size of lesions to be measured.

Fig. 3 Probes can often be used to judge lesion size.

Fig. 4 Arthroscopy osteochondral picks and curved and straight osteotomes.

Fig. 5 Curettes can be cupped (left 2 images) and ring (right 2 images) as well as straight or curved to address lesions.

Fig. 6 A grasper with serrated teeth is useful to remove loose bodies and tissue.

Fig. 7 A gouge has a scoop-like head and sharp leading edge to aid in osteophyte removal.

Motorized instruments (cutters, shavers, and burrs/abraders) are often more efficient especially for debriding synovitis and fibrous bands as well as removing osteophytes. They include an aspiration component when attached to suction, which brings the tissue closer to the cutting edge of the instrument. There are various types of shavers including side cutting, open ended, and full radius. The side-cutting shaver has a small window that does not allow exposure to the blade’s distal tip. These are the least aggressive of the power instruments. The open-ended shaver is the most aggressive and has the distal tip of the blade exposed. Probably the most commonly used is a combination of the 2 types, which is called a full-radius shaver. It has only partial exposure of the tip of the blade and the side-cutting window (Figs. 8 and 9). The full-radius shavers are either smooth (traditional type) or with incisors. The incisor types are either single or double incisor, meaning that both the barrel and the blade have teeth for a double incisor and only the blade has incisors on a single incisor. Typically, the power setting used is between 1500 and 3000 rpm. If the rotation of the blade is too fast, it will not allow the instrument to pull adequate tissue into the device.

Fig. 8 Power shaver with double incisors of both the barrel and blade for grabbing tissue.

Fig. 9 Handpiece for power instrumentation. Shavers and burrs can be disposable or nondisposable.

Other tools available to the arthroscopic surgeon include arthroscopic radiofrequency wands and, to a lesser extent, holmium-YAG laser systems that can vaporize, shrink, coagulate, and even weld tissue. Although arthroscopic laser technology has been available for more than 15 years, it remains controversial because it is expensive, requires special training, and remains unproven regarding its benefits.³ In recent years, radiofrequency wand technology has advanced significantly to effectively manage soft tissue abnormalities, especially in a cleanup role after the bulk of the soft tissue has been removed using a shaver or an ablator. The tips of the instruments vary in size to adapt to small-sized and medium-sized joints. Proper fluid management is important to regulate intra-articular temperature with these devices; this is combined with surgeon-controlled power adjustments to match tissue density and response to thermoablation. Some radiofrequency wands are aspirated to allow for suction application, which assists with fluid flow management, and to draw tissue into the wand tip. These suction types can also help to control intra-articular temperature because of the evacuation of heated fluid.