Knee Arthroscopy

Knee Arthroscopy - Scope Basics & Whys

Minimally invasive surgery (MIS) using an arthroscope (camera) and instruments to diagnose/treat intra-articular knee conditions.

• Advantages:
  • Diagnostic: Superior direct visualization.
  • Therapeutic: Reduced pain, faster recovery, smaller incisions, ↓ infection risk vs open surgery.
• General Indications:
  • Meniscal injuries: Tears (repair, partial meniscectomy).
  • Ligamentous injuries: ACL/PCL reconstruction.
  • Chondral defects: Articular cartilage lesions, OCD.
  • Synovial pathology: Synovitis, plica removal, biopsy.
  • Loose bodies: Cartilage/bone fragment removal.
  • Patellar disorders: Maltracking, instability.
  • Intra-articular fractures: Assessment/reduction (e.g., tibial plateau).
• Key Contraindications:
  • Active infection (local/systemic).
  • Severe diffuse Osteoarthritis (limited benefit for pain).
  • Medical instability, uncorrected coagulopathy.

⭐ The most common indication for knee arthroscopy is a meniscal tear.

Knee Arthroscopy - Navigating Entryways

Standard portals provide access while minimizing neurovascular injury. 'Safe zones' are key.

• Portal Placement Strategy:
  • Viewing portal: Usually Anterolateral (AL).
  • Working portal: Typically Anteromedial (AM).
  • Outflow: Superolateral (SL) is common.

⭐ The anterolateral portal is typically the first portal made, established under direct vision after insufflation or by 'feel' relative to anatomical landmarks like the inferior pole of the patella and the lateral edge of the patellar tendon.

Understanding these entryways and their associated risks is crucial for safe and effective knee arthroscopy. Always palpate landmarks and consider patient anatomy variability.

Knee Arthroscopy - Scope & Fixes

• Meniscal Procedures:

  • Meniscectomy: Partial (preferred, preserves rim) or Total (complex, irreparable avascular tears).
  • Meniscal Repair: For young (<40y), active patients; peripheral (vascular zone, e.g. red-red), acute (<6-8 wks) longitudinal/bucket-handle tears. Techniques: all-inside, inside-out, outside-in. | | Meniscectomy (Partial) | Meniscal Repair | |-----------------|-------------------------------|-------------------------------------| | Tear Type | Complex, degenerative, radial | Longitudinal, bucket-handle (vascular)| | Patient | Older, low demand | Younger (<40y), active, acute | | Goal | Rapid symptom relief | Preserve meniscus, ↓OA risk |

• Ligament Reconstruction (ACL/PCL):

  • Graft Choices: Autograft (BPTB, Hamstring); Allograft (cadaveric, revisions).

  ⭐ Bone-patellar tendon-bone (BPTB) autograft is often considered a gold standard for ACL reconstruction in high-demand athletes.

• Cartilage Procedures:

  • Chondroplasty: Smoothing fibrillated cartilage.
  • Microfracture: For defects < 2-4 cm² (younger pts); promotes fibrocartilage.

• Other Common Procedures:

  • Loose Body Removal: Symptomatic fragments (OCD, trauma, chondromatosis).
  • Synovectomy: Inflamed synovium (RA, PVNS).

Knee Arthroscopy - Pitfalls & Bounce-back

Common Complications & Management Hints:

Bounce-back (Rehab Principles):

• RICE: Rest, Ice, Compression, Elevation
• Early ROM (Range of Motion)
• Progressive strengthening

High‑Yield Points - ⚡ Biggest Takeaways

• Meniscal tears, especially bucket-handle tears, are the most common indication for knee arthroscopy.
• It serves as both a diagnostic tool and a therapeutic procedure, allowing direct visualization and treatment.
• Standard portals include anterolateral (AL) and anteromedial (AM); accessory portals are used as needed.
• Key complications include saphenous nerve injury (particularly with the AM portal), infection, DVT, and instrument breakage.
• Major contraindications are active local infection and severe osteoarthritis where arthroplasty is more appropriate.
• It is the standard approach for ACL reconstruction (graft placement) and effective for loose body removal.