Basic Principles of Knee Arthroscopy

Medial Approach.- 6.2.4 Suprapatellar Approaches.- 6.2.5 Posterior Approaches.- 6.2.6 Problems with the Instrument Portal.- 7 Basic Principles of Arthroscopy.- 7.1 Movements of the Arthroscope.- 7.1.1 Advancing and Retracting the Scope.- 7.1.2 Sweeping the Scope.- 7.1.3 Rotating the Scope.- 7.2 Position of the Light Post.- 7.3 Movements of the Knee.- 7.3.1 Flexion and Extension.- 7.3.2 Internal and External Rotation.- 7.3.3 Medial and Lateral Opening.- 7.3.4 Anterior and Posterior Drawer.- 7.4 Direct Manual Maneuvers.- 7.5 Orientation.- 7.5.1 Basic Rules.- 7.5.2 Intraarticular Orientation.- 7.6 Principle of Triangulation.- 7.7 Rendezvous Technique.- 8 Examination Procedure - Normal and Pathologic Findings.- 8.1 Retropatellar Space.- 8.2 Suprapatellar Pouch.- 8.2.1 Suprapatellar Plica.- 8.3 Lateral Recess.- 8.3.1 Lateral Aspect of the Lateral Meniscus.- 8.3.2 Popliteus Tendon, Popliteal Hiatus.- 8.3.3 Outerbridge Ridge.- 8.4 Femoropatellar Joint.- 8.4.1 Centering and Lateralization of the Patella.- 8.4.2 Femoral Trochlea.- 8.5 Anteromedial Capsule.- 8.5.1 Mediopatellar Plica.- 8.6 Medial Compartment.- 8.6.1 Medial Meniscus.- 8.6.2 Medial Femorotibial Joint.- 8.7 Intercondylar Area.- 8.7.1 Posterior Horn of Medial Meniscus, Posteromedial Recess, Posterior Cruciate Ligament.- 8.7.2 Infrapatellar Plica.- 8.7.3 Anterior Cruciate Ligament.- 8.8 Moving the Leg to the Figure-4 Position.- 8.9 Lateral Compartment.- 8.9.1 Lateral Meniscus.- 8.9.2 Lateral Femorotibial Joint.- 8.9.3 Popliteal Hiatus.- 8.9.4 Posterolateral Recess.- 8.10 Summary.- 8.11 Completing the Examination.- 9 The Articular Cartilage - Normal and Pathologic Findings.- 9.1 Normal Findings.- 9.2 Chondromalacia.- 9.2.1 "Chondropathy".- 9.3 Degenerative Changes.- 9.4 Traumatic Cartilage Lesions.- 9.4.1 Cartilage Contusions.- 9.4.2 Cartilage Fissures.- 9.4.3 Chondral and Osteochondral Fractures.- 9.5 Osteochondritis Dissecans.- 10 The Synovium - Normal and Pathologic Findings.- 10.1 Normal Findings.- 10.1.1 Synovial Biopsy.- 10.2 Posttraumatic Synovial Changes.- 10.3 Synovial Changes in Rheumatoid Arthritis.- 10.4 Pigmented Villonodular Synovitis (PVNS).- 10.5 Gout and Chondrocalcinosis.- 10.6 Synovitis Secondary to Psoriasis.- 10.7 Postarthrotomy Changes and Reactions to Implants.- 10.8 Synovial Chondromatosis.- 11 Problems in Arthroscopy.- 11.1 Poor-Quality Monitor Image.- 11.1.1 Dark Image.- 11.1.2 Image too Bright.- 11.1.3 Unsharp Image.- 11.1.4 Foggy Image.- 11.1.5 Image Flicker or Flutter.- 11.1.6 Persistent Image Features.- 11.1.7 Image Off-Center.- 11.2 Inadequate Joint Distention.- 11.3 Yellow-Out.- 11.4 Red-Out.- 11.5 No Picture.- 11.6 Extravasation of Irrigating Fluid.- 11.7 Inadequate Visualization of the Joint Compartments.- 11.8 Visualization of the Posterior Horn of the Medial Meniscus.- 11.8.1 Applying Valgus Stress to the Slightly Flexed Knee.- 11.8.2 Applying Manual Pressure from the Front of the Joint.- 11.8.3 Optimum Placement of the Instrument Portal.- 11.8.4 Instrument Manipulations.- 11.8.5 Manipulating the Meniscus with Suction.- 11.8.6 Instrument Selection.- 12 Complications.- 12.1 Articular Cartilage Damage.- 12.2 Carrying Particles of the Incise Drape into the Joint.- 12.3 Instrument Breakage.- 12.4 Nerve Injuries.- 12.5 Vascular Injuries.- 12.6 Ligament and Bone Injuries.- 12.7 Infection.- 12.8 Compartment Syndrome.- 12.9 Hemarthrosis and Postoperative Effusion.- 12.10 Thromboembolitic Complications.- 12.11 Synovial Fistula, Synovial Hernia.- 12.12 Reflex Sympathetic Dystrophy.- 12.13 Skin Complications.- 12.14 Lost Tissue Fragments.- 12.15 Special Complications of Gas Arthroscopy.- 12.16 Arthroscopy of the "Wrong" Knee.- 12.17 Other Rare Complications.- 12.18 Late Complications.- 13 Patient Information.- 13.1 Selecting Patients for Arthroscopy.- 13.2 Preoperative Patient Conduct.- 13.3 Preoperative Interview.- 13.4 Postoperative Consultation.- 14 Documentation.- 14.1 Written Documentation.- 14.1.1 Operation Report.- 14.1.2 Documentation Sheets.- 14.2 Photographic and Video Documentation.- 14.2.1 Photographic Documentation.- 14.2.2 Video Documentation.- 14.2.3 Video Printers.- 15 Training in Arthroscopy.- 15.1 Attending an Arthroscopic Course or Workshop.- 15.2 Practice on a Knee Model.- 15.3 Visiting an Experienced Arthroscopist.- 16 Spectrum of Arthroscopic Surgery.- 16.1 Advantages and Disadvantages of Arthroscopic Surgery.- 16.2 Arthroscopic Surgical Instruments.- 16.3 Arthroscopic Surgery.- References.