AANA Lab Course 913 - Advanced Knee Course-How to Get Where You Need to Be in the Knee Without Damaging Critical Structures Faculty Lecture

How to Get Where You Need to Be in the Knee Without Damaging Critical Structures Faculty Lecture_ Scott C. Faucett, MD

Pdf Summary

Dr. Scott C. Faucett provides a comprehensive guide on safely and effectively gaining arthroscopic access to various knee compartments—medial, lateral, posterior, and patellofemoral—while avoiding damage to critical structures such as articular cartilage, ligaments, and the joint capsule. Key principles emphasize "first do no harm" by careful portal planning and anatomical visualization.<br /><br />Use of higher portals with 30-degree scopes offers enhanced viewing but requires confirmation of trajectory via spinal needles. Surgeons should avoid limiting procedures to only two portals, as complex surgeries may necessitate 3-4 portals for better access. Techniques like the percutaneous medial collateral ligament (MCL) release, performed at least 1 cm proximal to the joint line on the femoral side, are advocated to improve medial compartment access without compromising stability; outcomes show no adverse effects or complications, and valgus stress radiographs confirm normal healing by 3 weeks post-op.<br /><br />The inside-out approach facilitates custom cannula placement, including lateral and trans-tendon portals. Utilizing the Gilchrist view with 70-degree scopes allows comprehensive screening of compartments, with A and B portals identified as safest. Triangulation techniques using needles and switching sticks, alongside cannulas, maintain portal stability.<br /><br />An arthroscopic leg holder eases lateral compartment access by enabling varus loading without hip rotation. Proper knee positioning at 90 degrees of flexion and attention to anatomical landmarks such as the IT band, biceps, and popliteus tendons are crucial.<br /><br />The presentation underlines that complex knee arthroscopy demands precise visualization of landmarks, careful portal choice, and familiarity with advanced access methods like MCL release and posterior portals. These strategies optimize surgical exposure while minimizing risks of iatrogenic cartilage or ligament injury, ensuring procedures are performed accurately and safely.

Keywords

arthroscopic knee surgery

knee compartments

portal planning

medial collateral ligament release

30-degree arthroscope

Gilchrist view

inside-out approach

triangulation technique

arthroscopic leg holder

iatrogenic injury prevention