Authors of section

Authors

Arnold Besselaar, Daniel Green, Andrew Howard

Executive Editor

James Hunter

General Editor

Fergal Monsell

Open all credits

Arthroscopic approach to the knee

1. General considerations

A standard arthroscopic approach with anteromedial and anterolateral portals allows visualization and manipulation of an epiphyseal fracture.

The arthroscopic approach is only recommended in minimally or nondisplaced fractures, and experience in arthroscopic surgery is essential.

Standard arthroscopic approach to the knee with anteromedial and anterolateral portals

2. Anterolateral port

Identify the lateral soft spot adjacent to the patellar tendon.

Lateral soft spot

Make a 5 mm stab incision and insert the trocar and sleeve carefully, avoiding damage to the articular cartilage.

Remove the trocar and insert the arthroscope.

Irrigate the knee joint cavity until clear visibility is achieved.

Continuous positive pressure pump irrigation is useful.

Pitfall: Take care to avoid compartment syndrome if a pump is used in cases where the capsule is ruptured.

Thoroughly examine the knee joint to identify associated meniscal tears, ligament injuries, and osteochondral fractures.

Insertion of the arthroscope

3. Anteromedial port

Identify the medial soft spot adjacent to the patellar tendon and palpate under arthroscopic control.

Medial soft spot

Make a 5 mm stab incision and insert an arthroscopic hook.

Insertion of an arthroscopic hook

4. Wound closure

After careful hemostasis, close the skin and subcutaneous tissues in a routine manner.

Wound closure