The standard technique is to turn off the water, remove the camera from the cannula, and place the blunt obturator. The techniques for addressing the 2 posterior compartments of the knee are more advanced but necessary to learn to perform a complete arthroscopy. In a tight knee it may be necessary to go back to the suprapatellar pouch to enter the lateral gutter. Next, the arthroscope is brought directly into the lateral gutter to check for loose bodies. The popliteal hiatus and popliteal tendon are also evaluated. The lateral meniscus and articular cartilage are examined similarly to the medially compartment ( Fig 4). Care is taken to keep the arthroscope in the triangle as the leg is manipulated. A varus force is applied to the knee either using the figure-of-4 position or directly using the circumferential leg holder. The light cord is turned to look laterally, and the arthroscope is advanced into the triangle. To enter the lateral compartment, a triangle between the lateral meniscus, the lateral femur, and the anterior cruciate ligament is identified. The ligaments can be probed to check for integrity. The knee is then bent to 90°, and the arthroscope is brought into the intercondylar notch to examine the anterior cruciate ligament and posterior cruciate ligament and to check for loose bodies ( Fig 3). The knee flexion angle can be changed to inspect the entire weight-bearing portion of the medial femoral condyle. The cartilage on the tibial plateau and the medial femoral condyle are evaluated ( Fig 2). The medial meniscus is inspected and probed for tears. At this point, the anteromedial compartment is made, which will be covered in part 4 of this series. The arthroscope is brought into the medial compartment. Next, the medial compartment is opened by straightening the knee and placing a valgus force on the leg. The arthroscope is then moved medially into the medial gutter, and the hand is raised to follow the floor down to the tibia, checking for loose bodies. The light cord is rotated downward to look up at the patella, and then the light cord is raised to look down at the trochlear groove to evaluate for cartilage injury ( Fig 1). The arthroscope is placed into the suprapatellar pouch through the anterolateral portal. In this article basic diagnostic knee arthroscopy is reviewed in a step-by-step manner ( Table 1). Mastery of basic diagnostic arthroscopy is a critical tool for orthopaedic surgeons treating disorders of the knee. Diagnostic arthroscopy is a crucial skill for diagnosing intra-articular disorders of the knee including meniscal, synovial, ligamentous, and articular cartilage pathology. A complete diagnostic arthroscopy includes visualization of the suprapatellar pouch, medial gutter, lateral gutter, medial compartment, lateral compartment, intercondylar notch, and posterior medial and posterior lateral compartments. A standardized and step-by-step approach is presented in this article and Video 1. 1,2ĭiagnostic arthroscopy involves visualization of all the intra-articular structures of the knee. In this series of articles, we present a comprehensive review of the step-by-step surgical technique for basic knee arthroscopy. Indications include diagnostic arthroscopy, meniscectomy, loose body removal, chondroplasty, microfracture, irrigation and debridement, and ligament reconstruction. Knee arthroscopy is the most commonly performed orthopaedic procedure.
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