Arthroscopy Instrument Set: Knee & Shoulder Scope Tools Guide

Everything about an arthroscopy tray is dictated by one constraint: the portal is about 5 mm across, and the working space behind it is a joint under fluid pressure with no room to manoeuvre. Instruments have to reach 130 mm or more through that hole, work at an angle the surgeon cannot fully see, and come back out without dropping a fragment inside the knee.

That constraint explains every design choice below — the long thin shafts, the pistol-grip handles, the ratcheted jaws that hold without being squeezed, and the obsessive attention to whether a tip can shear off.

The Access Group

Nothing happens until the joint is entered and distended.

• Arthroscope. 4.0 mm diameter with a 30° lens is the standard for knee and shoulder. A 70° scope earns its place in the shoulder for visualising the subscapularis and the posteroinferior recess. A 2.7 mm scope is for small joints — wrist, elbow, ankle.
• Cannula and obturators. A blunt obturator to enter the joint, a sharp trocar for the skin and capsule only. Entering the knee with a sharp trocar is how articular cartilage gets scored on the way in.
• Working cannulas. 5.5 mm, 7.0 mm and 8.25 mm, threaded or smooth. Shoulder work needs the larger diameters for suture management; knee work usually does not need a cannula at all.
• Switching stick. A blunt rod that lets the scope and instruments exchange portals without losing the tract. Simple, and the tray feels wrong without two of them.
• Spinal needle. Not glamorous, but portal placement is localised with an 18-gauge needle under direct vision before the blade goes anywhere.

The Diagnostic Probe

A 3–4 mm hooked probe, usually calibrated in millimetres along the hook, is the most-used instrument in the set. It reads what the camera cannot: whether a meniscal tear is stable, whether cartilage is soft, how far a labral detachment extends, whether an ACL graft is tensioned.

Calibration marks matter. Sizing a chondral defect off a calibrated probe is the difference between an accurate operative note and a guess.

Cutting and Resecting Instruments

The hand instruments that do the actual work in the joint.

Basket Punches

Also called basket forceps. The jaw takes a bite of tissue and cuts it free, and the fenestrated basket lets the fragment fall out rather than jamming the mechanism. Full set geometry:

• Straight — general meniscal trimming
• Up-biting 15° and 30° — posterior horn work
• Left and right curved — the opposite compartment from the portal
• Back-biting — the anterior horn, cutting toward the operator

Jaw widths run 2.5 mm to 4.5 mm. Working length 130 mm for knee, 150–180 mm for shoulder.

Meniscal Scissors and Knives

Straight and curved arthroscopic scissors for controlled soft tissue division. Blade knives come in banana, retrograde, hook and bayonet patterns for meniscal root release, capsular release and labral takedown.

Graspers

Ratcheted, toothed jaws to hold and retrieve. Two patterns cover most needs: a heavy 4 mm toothed grasper for pulling out resected meniscus and loose bodies, and a fine 3 mm for suture and delicate tissue. The ratchet is not optional — an unratcheted grasper means sustained hand pressure at exactly the moment the surgeon needs to look away at the monitor.

Rasps and Curettes

Arthroscopic rasps prepare bony beds for repair — glenoid rim before labral fixation, meniscal wall before a repair, notch preparation in ACL work. A 3 mm ring curette clears the ACL footprint.

Powered Instruments

Shavers and burrs run off a motorised handpiece with suction through the shaft. Common blade diameters: 3.5 mm for small joints and tight compartments, 4.5 mm for general knee work, 5.5 mm for bulk synovectomy or subacromial decompression. Burrs in 4.0 mm and 5.5 mm handle acromioplasty and notchplasty.

Regulatory note for buyers: powered arthroscopy instruments are active devices and do not classify with the hand instruments. In the EU they leave Class Ir entirely, and in the US they are Class II requiring 510(k) clearance. Purchase specifications and documentation requirements are genuinely different — do not assume a supplier’s hand-instrument certificate covers the powered set.

Shoulder-Specific Additions

A shoulder tray adds a suture management group the knee tray never needs:

• Suture passers — penetrating and retrograde (Bird-Beak style), in 45° and 90° angles, left and right curved
• Knot pushers — single and double-hole, for sliding and non-sliding knots
• Suture retrievers and crochet hooks — recovering a limb from the wrong cannula, which happens constantly
• Tissue graspers with a long reach — 180 mm+ for the posteroinferior capsule
• Anchor insertion instruments — drills, taps and inserters matched to the specific anchor system

Reference Specifications

Reprocessing: Where Arthroscopy Sets Fail

These instruments are the hardest routine items in an orthopedic CSSD, for three reasons.

They are long and narrow. A 180 mm shaft with a 2.9 mm lumen needs a matched brush and a lumen-flushing connector in the washer-disinfector; a spray arm alone does not clean it.

They have small hinged jaws that trap synovial tissue and bone paste. Basket punches must go through the ultrasonic in the open position, and the jaw should be cycled under the rinse.

They are easy to damage. A bent basket jaw or a hairline crack at the shaft-jaw junction is a fragment inside a joint waiting to happen. Inspect every hinged instrument under magnification before it goes back in the tray — this is a documented inspection step, not an informal glance.

Standard cycle: enzymatic immersion immediately, lumen brushing, ultrasonic 10 minutes open, deionised rinse, lubricate hinges, steam at 134 °C for 3 minutes. Optics follow the scope manufacturer’s own protocol and generally do not tolerate the same handling. Our guide to ultrasonic cleaning of surgical instruments covers the cannulated-instrument settings in more detail.

Building the Set

A hospital starting arthroscopy typically over-buys punches and under-buys graspers. The realistic core is: scope and cannula group, two probes, six basket punches covering the geometry above, two graspers, one scissors, one rasp, two switching sticks. Shoulder work adds the suture management group as a separate tray rather than bloating the knee set.

Buy duplicates of the probe, the straight punch and the heavy grasper before buying exotic angles. Those three are what stop a list when they are dropped or sent for repair.

Fizza Surgical supplies hand-held arthroscopy instruments within our wider bone surgery instrument range, manufactured to ISO 13485 in Sialkot. For the powered side of an orthopedic theatre, see our comparison of bone drills versus bone saws.