In general, arthroscopy is performed under tourniquet control. The tourniquet is
applied with generous padding at the distal arm, above the elbow. The
immobilization to the hand table (if a shoulder crane traction is used) is applied over
the tourniquet. When used, the tourniquet should be inflated to 120mmHg above the
patient’s systolic blood pressure and can be kept inflated safely for 90 minutes.

It has been our experience that the tourniquet does not have to be inflated for the
majority of arthroscopic procedures especially when no bone work needs to be done.
A simple trick to facilitate reduction of bleeding during portal placement is to outline
with a skin marker the superficial veins before applying traction so that they’re not
inadvertently injured during portal placement. The tourniquet can be always inflated
during surgery if significant hemorrhage is encountered, thus reducing the total
tourniquet time.

The usual traction for a medium built patient is 6 kg that can be safely increased to 7
kg for heavier built patients or in extremely tight joints. Slim patients, children and
adolescents usually require 5 kg of traction. The application of nylon mesh finger
traps to all the fingers and the equal distribution of traction to every finger enhances
safety.

Dry arthroscopy has been advocated by many surgeons as an alternative to classic
wet arthroscopy, especially for trauma cases. Although our personal experience is
limited, the the basic principles of dry arthroscopy include:
– the use of a tourniquet
-washing out blood clots in the joint with a 20cc syringe of saline attached to the
inflow of the sheath instead of the tubing of the pump
– using larger portals so that small absorbing pads like the ones used in
neurosurgical procedures can be introduced in the joint to dry the joint and
-keeping airflow to the Joint by keeping the outflow of the sheath open

Dry arthroscopy does have a learning curve and should be considered in the
beginning for simple cases so that the acclamation to the new technique does not
prolong surgery time too much.