portals

Knee Arthroscopy

Portals

 

1.  Anterolateral

 

Viewing portal

- 1cm lateral to patella tendon

- 1cm above joint line

- 1 cm below inferior pole patella

 

Problems

- too medial, in fat pad

- too high, limitation by patella, difficult to see posterior horns

- too low, damage anterior horn meniscus

 

Limitations

- PCL

- anterior horn LM

Arthroscopy

Indications

 

TFCC tears

SL instability

Dorsal wrist ganglion

Scaphoid fracture with percutaneous pinning

Distal radius fracture

 

Setup

 

Tourniquet

 

Finger Traps Index & middle

 

Overhead traction device

 

Wrist Scope set up

 

2.7 mm scope / small joint instrumentation

Arthroscopy

Position

 

1.  Lateral decubitus

- stabilise patient with beanbag or lateral rests

- apply skin traction to forearm

- place traction pole at foot of table opposite surgeon

- suspend arm with 10 lb weight

- abduction 60°

- forward flexion of 20°

- tilt top shoulder posteriorly 30° so that glenoid is parallel wwith bed

- mark bony landmark

- prep & free drape