AANA Lab Course 902 - Foundations in Arthroscopy (Resident/Fellow)-Basics of How to do Knee Arthroscopy and Meniscus Surgery-Dr. Michael Feldman, MD

Basics of How to do Knee Arthroscopy and Meniscus Surgery-Dr. Michael Feldman, MD

Pdf Summary

This presentation by Dr. Michael D. Feldman offers a comprehensive overview of knee arthroscopy and meniscus surgery, emphasizing thorough preoperative planning as crucial for surgical success. Key initial considerations include patient positioning—either "table foot up" or "table foot down"—ensuring leg stability and accessibility to posterior knee compartments, which are vital for effective visualization and intervention.<br /><br />The setup of the operating room, including equipment placement and tourniquet application, is detailed to optimize surgical workflow. Portal placement follows anatomical landmarks, with anterolateral and anteromedial portals commonly used, and posterior portals utilized for accessing difficult posterior compartments. Techniques in portal creation prioritize protection of nerves and articular cartilage, employing blunt obturators and minimal skin incisions.<br /><br />Visualization strategies involve using both 30-degree and 70-degree arthroscopes through various portals to examine all knee compartments thoroughly. The diagnostic arthroscopic exam inspects the suprapatellar pouch, patellofemoral joint, lateral and medial compartments, intercondylar notch, and gutters to identify pathologies such as meniscal tears or ligament damages.<br /><br />Meniscus surgery principles cover the meniscus anatomy including vascular zones and common variations, classifications of meniscal tears, and treatment options ranging from conservative management to surgical interventions like partial meniscectomy, meniscal repair, or transplant. Surgical repairs use inside-out, outside-in, all-inside, or hybrid techniques chosen based on tear location and pattern, with special attention to avoiding nerve injury and ensuring stable constructs.<br /><br />Biologic augmentation methods such as trephination, synovial abrasion, fibrin clot application, and marrow venting can promote healing. The presentation concludes with practical pearls: creating sufficient portals for access, positioning to visualize posterior areas effectively, switching or creating new portals if visualization is inadequate, and mastering different scope types. These insights collectively aim to enhance surgical outcomes in knee arthroscopy and meniscal interventions.

Keywords

knee arthroscopy

meniscus surgery

preoperative planning

patient positioning

operating room setup

portal placement

arthroscopic visualization

meniscal tear classification

meniscal repair techniques

biologic augmentation