|
http://upload.orthobullets.com/topic/3031/images/portals.jpg
http://upload.orthobullets.com/topic/3031/images/pf joint.jpg
http://upload.orthobullets.com/topic/3031/images/popliteus insertion.jpg
http://upload.orthobullets.com/topic/3031/images/medial.jpg
http://upload.orthobullets.com/topic/3031/images/notch.jpg
http://upload.orthobullets.com/topic/3031/images/lateral.jpg
Indications
  • Arthroscopy is a surgical technique that can be applied to perform the following types of procedures:
    • Diagnostic surgery
    • Meniscal repair or resection 
    • Removal of loose bodies
    • ACL and PCL reconstruction
    • Synovial biopsy or synovectomy
    • Chondral defect repair, including microfracture
    • Osteochondritis dissecans treatment
    • Knee debridement for osteoarthritis
      • controversial whether or not it provides symptomatic relief
Positioning and Scope Insertion
  • Patient placed supine with ability to flex the knee
    • leg holder or post 
      • has benefit of allowing valgus stress
      • but makes figure-four position more difficult
  • Place tourniquet (important for safety, but often not inflated)
  • Make anterolateral incision over soft spot of knee
    • vertical incisions
      • have advantage of increased superior-inferior mobility of instruments
    • horizontal incisions
      • have advantage of increased medial-lateral mobility of instruments
  • Insert trochar into capsule
    • advance blade into capsule then follow with trochar
    • do with knee flexed
  • Advance trochar into suprapatellar pouch
    • with knee straightened
Primary Portals 
  • Anterolateral 
    • function
      • standard portal 
      • used as the primary viewing portal
    • location & technique
      • make with knee in flexion, adjacent to patellar tendon over soft spot on joint line
  • Anteromedial
    • function
      • standard portal
      • used as the primary instrumentation portal
    • location & technique
      • make with knee in flexion, adjacent to patellar tendon over soft spot on joint line
  • Superomedial
    • function
      • accessory portal
      • most commonly used for water in/out flow
    • location & technique
      • make with knee in extension
  • Superolateral
    • function
      • accessory portal 
      • most commonly used for water in/out flow
    • location & technique
      • make with knee in extension
      • most common site for aspiration or injection 
Secondary Portals
  • Posteromedial portal 
    • function
      • helps visualize posterior horn and PCL
    • location & technique
      • 1 cm above joint line behind the MCL
  • Posterolateral portal
    • function
      • helps visualize posterior horn and PCL
    • location & technique
      • 1 cm above joint line between LCL and biceps tendon
  • Transpatellar portal
    • function
      • used for central viewing or grabbing
    • location & technique
      • 1 cm distal to patella and splits the patellar tendon
      • do not use if performing a bone-patella-bone graft harvest
  • Proximal superomedial portal
    • function
      • used for anterior compartment visualization
    • location & technique
      • 4 cm proximal to patella
  • Far medial and far lateral portals
    • function
      • used for accessory instrument placement
      • often helpful for loose body removal
    • location & technique
      • place where can be best utilized for need
Diagnostic Scope 
  • Should systematically check the following locations and structures 
    1. with knee fully extended start in suprapatellar pouch
      • loose bodies
    2. patellofemoral joint 
      • patellofemoral cartilage
      • patellofemoral tracking
    3. trochlear groove
    4. lateral gutter 
      • insertion of popliteus
    5. lateral compartment
      • anterior horn of lateral meniscus
    6. medial gutter
    7. with knee flexed to 90 move to medial compartment 
      • medial meniscus
      • medial femoral condyle cartilage
      • medial tibial plateau cartilage
    8. intercondylar notch 
      • ACL
      • PCL
      • posteromedial corner 
        • best seen with 70 degree scope placed through notch (Modified Gillquist view)
    9. with knee in figure-four position finish in lateral compartment 
      • lateral meniscus
      • popliteal hiatus
      • lateral femoral condyle cartilage
      • lateral tibial plateau cartilage
Complications
  • Iatrogenic articular cartilage damage
    • is most common complication
  • Hemarthrosis
  • Neurovascular injury
    • posteromedial portal
      • saphenous nerve
    • posterolateral portal
      • common peroneal nerve

 

Please rate topic.

Average 4.8 of 13 Ratings

Questions (2)
EVIDENCE & REFERENCES (5)
CASES (1)
GROUPS (1)
Topic COMMENTS (2)
Private Note