Knee arthroscopic Surgery in delhi by Dr. Shekhar Srivastav
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Transcript of 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
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Arthroscopic Portal
Provides access to knee joint to LOOK and FEEL
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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
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Arthroscopic Portal Common portals
Anterolateral Portal- Viewing Portal
Anteromedial Portal- Working Portal
Other Portals
Posteromedial ,Posterolateral
Superolateral , Superomedial
Central (Gillquist) Portal
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Viewing Portal
ANTEROLATERAL PORTAL
Position of Knee
Draping
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Viewing Portal Portal site-
-level of patellar apex just lat. to patellar tendon
-hollow spot just above lat. Tibial condyl
Infiltration with LA
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Viewing Portal
Skin Incision- 700 Knee Flexion
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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
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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
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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
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Instrument Portal
Infiltrate LA
Skin Incision
-Transverse incision
-Avoid damage to veins
-Avoid damage to peripheral rim meniscus
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Instrument Portal
Suprameniscal Portal - post third med.men.
High Medial Portal -Lat.men.
-Post horn med. Men.
-PCL recnstn.
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Lateral Suprapatellar Portal
Synovectomy
Loose body removal
Patellar Tracking
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Lateral Portal
Removal Loose Body
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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
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Posteromedial Portal
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Posterolateral Portal
Indications rare
- Synovectomy
- Loose body removal
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Switching Portals
Simple,Safe,Fast
Minimal Tissue Trauma
Switching Rod
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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
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Thank You
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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