title: Arthroscopic Removal of Shotgun Pellet From Within the Medial Meniscus.
abstract: Arthroscopic techniques are effective for the removal of intra-articular bullet and metal fragments after gunshot wounds to the shoulder, hip, knee, and sacroiliac joints. Surgical removal of bullets retained within the synovial joints is indicated; lead is dissolved by synovial fluid over time, leading to proliferative synovitis, lead arthropathy, elevated serum lead levels, and lead toxicity. We present an arthroscopic technique for removal of a shotgun pellet retained within the medial meniscus. In this technique, diagnostic knee arthroscopy is initially performed, which allows for localization of the pellet within the medial meniscus. An up-biter is used to resect the inner rim of meniscus surrounding the pellet, and the pellet is removed with a grasper. This arthroscopic approach is advantageous because it allows for efficient visualization of the pellet within the meniscus, thorough visualization of all compartments of the knee, a reduction in blood loss, and a decrease in surgical morbidity to the surrounding cartilaginous, neurovascular, and soft-tissue structures. This technique may therefore be one option to address bullet fragments or shotgun pellets that are retained within the medial meniscus.
authors.affiliation: Detroit Receiving Hospital, Detroit Medical Center, Detroit, Michigan, U.S.A.
authors.forename: Kyle
authors.initials: K
authors.lastname: Lacy
authors.affiliation: Detroit Receiving Hospital, Detroit Medical Center, Detroit, Michigan, U.S.A.
authors.forename: Chris
authors.initials: C
authors.lastname: Cooke
authors.affiliation: Detroit Receiving Hospital, Detroit Medical Center, Detroit, Michigan, U.S.A.
authors.forename: Pat
authors.initials: P
authors.lastname: Cooke
authors.affiliation: Detroit Receiving Hospital, Detroit Medical Center, Detroit, Michigan, U.S.A.
authors.forename: Frederick
authors.initials: F
authors.lastname: Tonnos