knee arthroscopic surgery in delhi by dr. shekhar srivastav

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Diagnostic Knee Arthroscopy

Dr Shekhar Srivastav Sr Consultant- Knee & Shoulder

Sant Parmanand hospital,Delhi

Arthroscopic Portal

Provides access to knee joint to LOOK and FEEL

Portal Placement Two portals

Arthroscopy or Viewing Portal

Instrument or Working Portal

Portals should be optimally positioned to permit

-satisfactory inspection

-adequate access to lesion

Arthroscopic Portal Common portals

Anterolateral Portal- Viewing Portal

Anteromedial Portal- Working Portal

Other Portals

Posteromedial ,Posterolateral

Superolateral , Superomedial

Central (Gillquist) Portal

Viewing Portal

ANTEROLATERAL PORTAL

Position of Knee

Draping

Viewing Portal Portal site-

-level of patellar apex just lat. to patellar tendon

-hollow spot just above lat. Tibial condyl

Infiltration with LA

Viewing Portal

Skin Incision- 700 Knee Flexion

Viewing Portal

Insertion of Sheath

Skin and capsule inserted at 700 knee fexion

After capsule has been inserted extend the knee completely and direct sheath towards suprapatellar pouch

Instrument Portal

Access for Probes and Surgical Instrument

Optimally Positioned-

Access to the lesion

Without damaging cartilage

Minimal instrument

Always after arthroscopic inspection has been done

Location varies according to the site of lesion

Instrument Portal

ANTEROMEDIAL PORTAL

Needle Technique-

Needle inserted at transilluminated site

Needle advanced under visual guidance to target structure

If access less than satisfactory- reposition the needle

Instrument Portal

Infiltrate LA

Skin Incision

-Transverse incision

-Avoid damage to veins

-Avoid damage to peripheral rim meniscus

Instrument Portal

Suprameniscal Portal - post third med.men.

High Medial Portal -Lat.men.

-Post horn med. Men.

-PCL recnstn.

Lateral Suprapatellar Portal

Synovectomy

Loose body removal

Patellar Tracking

Lateral Portal

Removal Loose Body

Posteromedial Portal

Pass scope postero-medially thro’ intercondylar notch in slight flexion.

Then flex the knee to 900

Ext. digital palpation. Pass needle

INDICATION

-Post horn med. Men.

-Loose body removal

-Synovectomy

-PCL reconstruction

Posteromedial Portal

Posterolateral Portal

Indications rare

- Synovectomy

- Loose body removal

Switching Portals

Simple,Safe,Fast

Minimal Tissue Trauma

Switching Rod

Supra-patellar pouch

Patellar Articular Surface

Medial Gutter

Medial Compartment- Meniscus

Articular cartilage

Intercondylar Notch- ACL

PCL

Lateral Compartment- Meniscus

Articular Cartilage

Lateral Gutter

Diagnostic Arthroscopy

Thank You

Problems

Viewing Portal Problem

Extension deficit problem

Adhesions in Ant. Compartment

Medial Patellar Plica

Instrument Portal Problem

Shifting of tissue layers

Skin incision large

Fluid Extravasation in Subcut.tissue