Proximal approaches to arthroscopic surgery of the knee

Abstract

Arthroscopic surgery of the knee has become more popular recently because of better optics and instru mentation. The currently available techniques and ap proaches for doing surgery as well as their drawbacks are summarized. The author's new technique is de scribed. The anterior and lateral compartments and popliteal tunnel could not be adequately visualized with the existing techniques. Distortion of image, magnifica tion, crowding, and collision were found in the distal approaches during surgery. Injuries to the anterior compartment of the knee as the instruments come blindly in and out can also cause damage to the fat pad and the menisci. By inserting the arthroscope proximally (midpatellar lateral, mid patellar medial) and using inferomedial and inferola teral portals for instruments, the surgery and the above problems have been minimized. The drawbacks of this technique are initial confusion in orientation and proper placement of the arthro scope. The posterior cruciate ligament cannot be seen using this technique. The posterolateral portion of the lateral meniscus and to some extent the posteromedial portion of the medial meniscus are, in inexperienced hands, somewhat difficult to see. The technique of menisectomy is described.